Çocuk Yanık Merkezinde Sepsis Tedavisinde Terapötik Plazma Değişimi Uygulaması

Abstract

Amaç: Çalışmamızda, bir çocuk hastanesinde yanık yoğun bakım ünitesinde septik ve Trombositopeni ile ilişkili çoklu organ yetmezliği (TAMOF) tedavisinde Terapötik plazma değişimi (TPE) kullanımını geriye dönük olarak incelemeyi amaçladık.

Gereç ve Yöntemler: 1 Ocak 2016-1 Ocak 2021 tarihleri arasında TPE uygulanan yanık çocuk hastalarının demografik, klinik ve laboratuvar verileri hastane bilgi sistemi ve tıbbi kayıtlarından elde edilerek incelendi. Hastalar takipte ölenler ve iyileşenler olarak iki gruba ayrıldı.

Bulgular: 14 yanık çocuk hastaya (Erkek:Kadın5:9) TPE yapıldı. Hastaların ortalama yaşı 6.6 yıl (1-18 yıl)’di. Hastaların ortalama TBSA’sı %47.76 (20-75)’di. En sık yanık nedeni alev yanığıydı. Hasta-ların ortalama hastanede kalış süreleri 18.4±12.6 (7-94) gündü. Grup 1’de iyileşen 4 hasta ve grup 2’de takip sırasında ölen 10 hasta vardı. Gruplar arasında yaş, cinsiyet ve TBSA açısından istatistiksel fark yoktu (p=0.590, 0.890, 0.990). Grup 2’deki hastaların MODS (p=0.030), Pelod skoru (p=0.001) ve Pelod skoruna göre beklenen ölüm oranı (p=0.003) açısından istatistiksel olarak daha yüksek olduğunu belirledik. TAMOF oluştuktan sonraki ilk 24 saat içinde TPE uygulamasının mortaliteyi anlamlı derecede azalttığı gözlendi (p=0.010).

Sonuç: Çocuk yanık yoğun bakım ünitelerindeki kritik hastalarda TPE konvansiyonel tedaviye ek bir teda-vi yöntemi olarak kullanılabilir. TAMOF oluştuktan sonraki ilk 24 saat içinde TPE uygulaması mortaliteyi azaltmaktadır.

Keywords

• çocuk
• plazma değişimi
• Yoğun bakım
• TAMOF

Therapeutic plasma exchange application in the treatment of sepsis in a pediatric burn center

Abstract

Objective: In our study, we aimed to analyze the use of Therapeutic plasma exchange (TPE) in the manage-ment of septic and Thrombocytopenia-associated multiple-organ failure (TAMOF) in the burn in-tensive care unit of a children’s hospital retrospectively.

Material and Methods: Demographic, clinical, and laboratory data of the pediatric burn patients who were applied TPE between 1 January 2016 and 1 January 2021 were obtained from the hospital information system and medical records and analyzed. The patients were divided into two groups those who died du-ring follow-up and those who recovered.

Results: TPE was performed on 14 burned children (Boy: Girl 5:9). The median age of the patients was 6,6 years (range 1-18 years). The mean TBSA of the patients was 47.76% (20-75). The most common cause of burns was flame burn. The mean hospital stay of the patients was 18.4±12.6 (7-94) days. 4 patients in group 1 recovered and 10 patients in group 2 died during follow-up. There was no statistical difference between the groups in terms of age, gender, and TBSA (p=0.590, 0.890, 0.990). We determined that patients in group 2 were statistically higher in terms of MODS (p=0.030), Pelod score (p=0.001), and expected death rate according to Pelod score (p=0.003). It was observed that the application of TPE in the first 24 hours after the occurrence of TAMOF significantly reduced mortality (p=0.010).

Conclusion: TPE should be used as an additional treatment method to conventional therapy in critically ill pati-ents in pediatric burn intensive care units. TPE application in the first 24 hours after the occurrence of TAMOF reduces mortality.

Keywords

• child
• Insentıve Care
• plasma exchange
• TAMOF

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