Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Centrifugal Therapeutic Plasma Exchange in Pediatric Patients

2021 ◽  
Author(s):  
Rekha Hans ◽  
Karalanglin Tiewsoh ◽  
Divjot Singh Lamba ◽  
Lesa Dawman ◽  
Satya Prakash ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Pediatric Patients ◽  
Therapeutic Plasma Exchange

scholarly journals Preservation of vascular access.

1993 ◽  
Vol 4 (4) ◽  
pp. 997-1003
Author(s):  
J L Porile ◽  
M Richter
Keyword(s):  
Vascular Access ◽  
Venous Pressure ◽  
Graft Loss ◽  
Laboratory Evaluation ◽  
Dialysis Access ◽  
New Techniques ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems

Preservation of vascular access is critical in the long-term successful management of hemodialysis patients. Dialysis access abnormalities are the most common cause of hospitalization in this patient group, and access problems can increase the morbidity and cost involved in the care of these patients. Native fistulas are preferable to synthetic grafts because of longer survival and a lower complication rate. Venous outflow stenosis is the most common site of obstruction in a failing graft. The pathophysiology of access failure is poorly understood, but it seems to be related to intimal hyperplasia in the native vessel downstream from the anastomosis. The stimulation of local growth factors by needle puncture may also play a role. An assessment of access adequacy includes careful physical examination, laboratory evaluation, and ultimately, angiography. Measurements of recirculation and venous pressure are commonly used to screen for access dysfunction, and their appropriate use will lower the incidence of graft loss in dialysis units. Treatment is usually either angioplasty or surgery, with some centers having success with thrombolytic therapy. New techniques such as atherectomy and stent placement may prove to be beneficial, but this requires further study.

Vascular Access for Therapeutic Plasma Exchange

1994 ◽  
Vol 18 (4) ◽  
pp. 305-308 ◽  
Author(s):  
Judy E. Grishaber ◽  
Eric D. Whitman
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Therapeutic Plasma Exchange

Therapeutic Plasma Exchange in Pediatric Patients with Nephrologic Diseases: Results from a Single Center

2017 ◽  
Vol 26 (2) ◽  
Author(s):  
Yaşar Kandur ◽  
Yeşim Özdemir ◽  
Bahar Büyükkaragöz ◽  
Şeniz Göral ◽  
İdil Yenicesu ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Pediatric Patients ◽  
Therapeutic Plasma Exchange ◽  
Single Center

Complications of therapeutic plasma exchange in patients with neurological disorders

2020 ◽  
Author(s):  
Mahdieh Afzali ◽  
Shahram Oveisgharan ◽  
Sahebeh Rajabkhah ◽  
Siamak Abdi
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Therapeutic Plasma Exchange ◽  
Health Providers ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Neurologic Disorders ◽  
Demyelinating Disorders

Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital. Methods: This retrospective cross-sectional study evaluated patients with various neurologic disorders receiving TPE in neurology department of Shariati Hospital, Tehran, Iran. Major and minor complications related to TPE were recorded. Results: Clinical information records of 417 TPE sessions (88 patients) were available. Mean age of patients was 40.0 ± 15.8 years. Underlying diseases included central demyelinating disorders, myasthenia gravis (MG), chronic neuropathy, Guillain-Barre syndrome (GBS), and autoimmune encephalopathy in 34.1%, 33.0%, 17.0%, 14.8%, and 1.1% of patients, respectively. Major complications occurred in 15.9% of patients and 37.5% of patients accounted for minor complications. Among major adverse effects, thrombosis, infection, and lifethreatening complications were seen more commonly in patients with central vascular access (P = 0.005, P = 0.003, and P = 0.010, respectively). Conclusion: TPE complications were seen more commonly in patients with central vascular access. Therefore, use of peripheral vascular access and vigilant patient monitoring by trained health providers can reduce its complications.

scholarly journals Long-term renal function under plasma exchange in atypical hemolytic uremic syndrome

2011 ◽  
Vol 26 (10) ◽  
pp. 1915-1916 ◽  
Author(s):  
Jean-Claude Davin ◽  
Jaap Groothoff ◽  
Valentina Gracchi ◽  
Antonia Bouts
Keyword(s):  
Renal Function ◽  
Hemolytic Uremic Syndrome ◽  
Plasma Exchange ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Uremic Syndrome

scholarly journals Pediatric Long-Term Endotracheal Intubation and Role for Tracheostomy: Patient and Provider Factors

2018 ◽  
Vol 08 (02) ◽  
pp. 078-082 ◽  
Author(s):  
Kassi Ackerman ◽  
Taylor Saley ◽  
Nasir Mushtaq ◽  
Timothy Carroll
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
Intubation Time ◽  
Increased Risk ◽  
Illness Category ◽  
The Impact ◽  
Provider Surveys

AbstractTracheostomy provides an alternative to long-term intubation in patients with respiratory failure, but there is little guidance for its use in pediatric patients. Our study used provider surveys of pediatric intensive care physicians managing patients intubated longer than 14 days to evaluate accuracy of physician estimates for total intubation time and the impact of medical history and illness category on determining tracheostomy placement. Providers' ability to estimate length of intubation was found to be highly inaccurate. With delayed tracheostomy conferring increased risk and mortality, better recommendations regarding indication and timing of pediatric tracheostomy placement are needed.

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