Çocuk Yoğun Bakım 5 Yıllık Plazmaferez Deneyimi

Abstract

Amaç: Terapötik plazma değişimi (TPD) istenmeyen büyük molekül ağırlıklı maddelerin kandan uzaklaştırılmasını sağlayan ekstrakorpereal bir tedavi yöntemidir. Bu çalışmada çocuk yoğun bakım ünitemizde TPD uygulanan hastaların veri ve sonuçlarının araştırılması amaçlanmıştır. 2019 en güncel Amerikan Aferez Derneği (ASFA) kategori sınıflaması eşliğinde tartışmayı amaçladık.

Gereç ve Yöntemler: 1 Ocak 2014-1 Ocak 2019 tarihleri arasında Çocuk Yoğun Bakım Ünitesinde yatırılarak TPD endikasyonu koyulan hastaların demografik verileri, klinik tanı laboratuvar verileri hasta dosyası ve aferez ünitesi kayıtlarından geriye dönük incelendi. TPD işlemi hastanın yatak başında aferez ünitesi ekiplerince uygulandı.

Bulgular: Çalışmaya toplam 40 hasta alındı. 122 seans TPD uygulandı. TPD uygulanan hastaların 27 (%67.5)’si tedaviye yanıt alınarak servise devredildi. 13 (%32.5) hasta eksitus oldu. En sık TPD endikasyonu Karaciğer Yetmezliğiydi. Uygulama süresi medyanı 105.5 dakika (25-234), yatış günü medyanı 14.5 (1-90)’ti. 39 (%97.5) hastada santral yol, 1 hastada periferik yol kullanıldı. TPD sırasında 11(%27.5) hastada komplikasyon gelişirken komplikasyonlar en fazla (%45.4) kateter tıkanıklığı ve kan akımında azalmaydı.

Sonuç: Çocuk yoğun bakım ünitelerinin ülkemizde giderek yaygınlaşması, donanımının artması TPD ve hemodiyaliz gibi işlemlerin uygulanabilirliğini arttırmıştır. Çalışmamız TPD nin destek tedavide doğru endikasyonda hayat kurtarıcı olabileceğini düşündürmektedir.

Keywords

• Aferez
• Çocuk Yoğun Bakım
• Terapötik Plazma Değişimi

Plasmapheresis Experience of Pediatric Intensive Care in 5 Years

Abstract

Objective: Therapeutic plasma exchange (TPE) is an extracorporeal treatment that enables the removal of undesirable large molecular weight substances from the blood. We aimed to investigate the data and results of patients who underwent TPD in our intensive care unit for a 5-year period, with the latest American Apheresis Association(ASFA) category classification in 2019.

Material and Methods: The demographic data, clinical diagnostic laboratory data of the patients who were hospitalized in the Pediatric Intensive Care Unit between January 1, 2014 and January 1, 2019 were retrospectively analyzed from the patients’ files and apheresis unit records. TPE procedure was performed at the bedside of the patient by apheresis unit teams.

Results: A total of 40 patients were included in the study. 122 sessions of TPE were applied. Twenty-seven (67.5%) of the patients who underwent TPE were transferred to the service with a response to treatment. 13 (32.5%) patients died. The most common TPE indication was Liver Failure. The median time of administration was 105.5 minutes (25-234) and the median day of hospitalization was 14.5 (1-90). Central route was used in 39 (97.5%) patients and peripheral route was used in 1 patient. While complications developed in 11 (27.5%) patients during TPE, the most frequent complications were (45.4%) catheter occlusion and decreased blood flow.

Conclusion: The increasing of pediatric intensive care units in our country and the increase of equipment have increased the applicability of procedures such as TPE and hemodialysis. Our study suggests that TPE can be life-saving in the correct indication for supportive therapy.

Keywords

• Apheresis
• Pediatric İntensive Care
• Therapeutic plasma exchange

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