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

Year 2022, Volume: 16 Issue: 5, 440 - 444, 20.09.2022
https://doi.org/10.12956/tchd.1136557

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.

References

  • Sharma BR, Singh VP, Bangar S, Gupta N. Septicemia: the principal killer of burn patients. Am J Infect Dis 2005; 1:132-8.
  • Devrim İ, Kara A, Düzgöl M, Karkıner A, Bayram N, Temir G, et al. Burn associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents. Burns 2017; 43: 144-8.
  • Ressner RA, Murray CK, Griffith ME, Rasnake MS, Hospenthal DR, Wolf SE. Outcomes of bacteremia in burn patients involved in combat operations overseas. J Am Coll Surg 2008; 439-44.
  • Kyles DM, Baltimore J. Adjunctive use of plasmapheresis and intravenous immunoglobulin therapy in sepsis: a case report. Am J Crit Care 2005; 14: 109-12.
  • Penack O, Becker C, Buchheidt D, Christopeit M, Kiehl M, von Lilienfeld-Toal M, et al. Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO). Ann Hematol 2014; 93: 1083-95.
  • Rimmer E, Houston BL, Kumar A, Abou-Setta AM, Friesen C, Marshall JC, et al. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: A systematic review and meta-analysis. Crit Care 2014; 18: 699.
  • Fortenberry JD, Paden ML. Extracorporeal therapies in the treatment of sepsis: experience and promise. Semin Pediatr Infect Dis 2006; 17: 72-9.
  • Szczepiorkowski ZM, Winters JL, Bondarenko N, Kim HC, Linenberger ML, Marques MB, et al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the
  • Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25: 83-177.
  • Schwartz J, Padmanabha A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the american society for apheresis: The seventh special ıssue. J Clin Apher 2016;31:149–62.
  • 1Stegmayr BG, Banga R, Berggren L, Norda R, Rydvall A, Vikerfors T. Plasma exchange as rescue therapy in multiple organ failure including acute renal failure. Crit Care Med 2003; 31:1730-6.
  • Sevketoglu E, Yildizdas D, Horoz OO, Kihtir HS, Kendirli T, Bayraktar S, et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure networks. Pediatr Crit Care Med 2014;15:354-9
  • Hadem J, Hafer C, Schneider AS, Wiesner O, Beutel G, Fuehrer T, et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single center study of 23 patients. BMC Anethesiol 2014; 14: 24.
  • Gueudry J, Roujeau JC, Binaghi M, Soubrane G, Muraine M. Risk factors for the development of ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol 2009;145:157–62.
  • Klein MB, Edwards JA, Kramer CB, Nester T, Heimbach DM, Gibran NS. The beneficial effects of plasma Exchange after severe burn injury. J Burn Care Res 2009;30:243–8.
  • Neff LP, Allman JM, Holmes JH. The use of therapeutic plasma exchange (TPE) in the setting of refractory burn shock. Burns 2010;36:372–8.
  • Mosier MJ, DeChristopher PJ, Gamelli RL. Use of therapeutic plasma exchange in the burn unit: a review of the literature. J Burn Care Res 2013;34:289-98.
  • Clark WF, Rock GA, Buskard N, Shumak KH, LeBlond P, Anderson D, et al. Therapeutic plasma exchange: an update from the Canadian Apheresis Group. Ann Intern Med 1999;131:453–62.
  • Koo AP. Therapeutic apheresis in autoimmune and rheumatic diseases. J Clin Apher 2000;15:18–27.
  • Narukawa N, Shiizaki K, Kitabata Y, Abe T, Kobata H, Akizawa T. Plasma exchange for the treatment of human Tcell lymphotropic virus type 1 associated myelopathy. Ther Apher 2001;5:491–3.
  • Yu X, Ma J, Tian J, Jiang S, Xu P, Han H, Wang L. A controlled study of double filtration plasmapheresis in the treatment of active rheumatoid arthritis. J Clin Rheumatol 2007;13:193–8.
  • Emeksiz S. Çocuk Yoğun Bakım Ünitemizdeki Terapötik Plazma Değişimi Deneyimlerimiz. Türkiye Çocuk Hast Derg 2019; 13: 447-50.
  • Aleksandrova IV, Reĭ SI, Khvatov VB, Borovkova NV, Il’inskiĭ ME, Abakumov MM. The level of dead blood leukocytes in sepsis and the significance of their elimination by extracorporeal hemocorrection techniques. Anesteziol Reanimatol 2008; 6: 57-60.
  • Nguyen TC, Han YY, Kiss JE, Hall MW, Hassett AC, Jaffe R, et al. Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia associated multiple organ failure. Crit Care Med 2008; 36: 2878-87.
  • Sevketoglu E, Yildizdas D, Horoz OO, Kihtir HS, Kendirli T, Bayraktar S, et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure networks. Pediatr Crit Care Med 2014; 15: 354-9.
  • Şenel E, Polat AD, Yastı AÇ, Karacan CD. Çocuk Yanıklarında Mortaliteyi Etkileyen Temel Parametreler ve Alınabilecek Önlemler. Türkiye Çocuk Hast Derg 2007;1:18-25.
  • Rech MA, Mosier MJ, McConkey K, Zelisko S, Netzer G, Kovacs EJ, et al. Outcomes in Burn-Injured Patients Who Develop Sepsis. J Burn Care Res 2019;40:269-73.
  • Senel E, Yasti AC, Reis E, Doganay M, Karacan CD, Kama NA. Effects on mortality of changing trends in the management of burned children in Turkey: Eight years experience. Burns 2009; 35: 372-7.
  • Demir S, Şenel E. The microorganisms isolated from patients’ cultures in a cild burn center and its impact to mortality. TJCL 2016; 7: 10-18.
  • Fortenberry JD, Nguyen T, Grunwell JR, Aneja RK, Wheeler D, Hall M, et al. Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia- Associated Multiple Organ Failure Network Prospective Experience. Crit Care Med 2019;47:e173-e181.
  • Kawai Y, Cornell TT, Cooley EG, Beckman CN, Baldridge PK, Mottes TA, et al. Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis induced multiple organ dysfunction syndrome receiving extracorporeal life support. Pediatr Crit Care Med 2015; 16: 366-74.
  • Özdemir ZC, Düzenli Kar Y, Bör Ö. Therapeutic Plasma Exchange in Children with Neutropenic Sepsis: Single Center Experience. JAREM 2018;8: 59-62.
  • Kaplan A. Complications of apheresis. Semin Dial 2012; 25: 152-8

Çocuk Yanık Merkezinde Sepsis Tedavisinde Terapötik Plazma Değişimi Uygulaması

Year 2022, Volume: 16 Issue: 5, 440 - 444, 20.09.2022
https://doi.org/10.12956/tchd.1136557

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.

References

  • Sharma BR, Singh VP, Bangar S, Gupta N. Septicemia: the principal killer of burn patients. Am J Infect Dis 2005; 1:132-8.
  • Devrim İ, Kara A, Düzgöl M, Karkıner A, Bayram N, Temir G, et al. Burn associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents. Burns 2017; 43: 144-8.
  • Ressner RA, Murray CK, Griffith ME, Rasnake MS, Hospenthal DR, Wolf SE. Outcomes of bacteremia in burn patients involved in combat operations overseas. J Am Coll Surg 2008; 439-44.
  • Kyles DM, Baltimore J. Adjunctive use of plasmapheresis and intravenous immunoglobulin therapy in sepsis: a case report. Am J Crit Care 2005; 14: 109-12.
  • Penack O, Becker C, Buchheidt D, Christopeit M, Kiehl M, von Lilienfeld-Toal M, et al. Management of sepsis in neutropenic patients: 2014 updated guidelines from the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO). Ann Hematol 2014; 93: 1083-95.
  • Rimmer E, Houston BL, Kumar A, Abou-Setta AM, Friesen C, Marshall JC, et al. The efficacy and safety of plasma exchange in patients with sepsis and septic shock: A systematic review and meta-analysis. Crit Care 2014; 18: 699.
  • Fortenberry JD, Paden ML. Extracorporeal therapies in the treatment of sepsis: experience and promise. Semin Pediatr Infect Dis 2006; 17: 72-9.
  • Szczepiorkowski ZM, Winters JL, Bondarenko N, Kim HC, Linenberger ML, Marques MB, et al. Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the
  • Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25: 83-177.
  • Schwartz J, Padmanabha A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the american society for apheresis: The seventh special ıssue. J Clin Apher 2016;31:149–62.
  • 1Stegmayr BG, Banga R, Berggren L, Norda R, Rydvall A, Vikerfors T. Plasma exchange as rescue therapy in multiple organ failure including acute renal failure. Crit Care Med 2003; 31:1730-6.
  • Sevketoglu E, Yildizdas D, Horoz OO, Kihtir HS, Kendirli T, Bayraktar S, et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure networks. Pediatr Crit Care Med 2014;15:354-9
  • Hadem J, Hafer C, Schneider AS, Wiesner O, Beutel G, Fuehrer T, et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single center study of 23 patients. BMC Anethesiol 2014; 14: 24.
  • Gueudry J, Roujeau JC, Binaghi M, Soubrane G, Muraine M. Risk factors for the development of ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol 2009;145:157–62.
  • Klein MB, Edwards JA, Kramer CB, Nester T, Heimbach DM, Gibran NS. The beneficial effects of plasma Exchange after severe burn injury. J Burn Care Res 2009;30:243–8.
  • Neff LP, Allman JM, Holmes JH. The use of therapeutic plasma exchange (TPE) in the setting of refractory burn shock. Burns 2010;36:372–8.
  • Mosier MJ, DeChristopher PJ, Gamelli RL. Use of therapeutic plasma exchange in the burn unit: a review of the literature. J Burn Care Res 2013;34:289-98.
  • Clark WF, Rock GA, Buskard N, Shumak KH, LeBlond P, Anderson D, et al. Therapeutic plasma exchange: an update from the Canadian Apheresis Group. Ann Intern Med 1999;131:453–62.
  • Koo AP. Therapeutic apheresis in autoimmune and rheumatic diseases. J Clin Apher 2000;15:18–27.
  • Narukawa N, Shiizaki K, Kitabata Y, Abe T, Kobata H, Akizawa T. Plasma exchange for the treatment of human Tcell lymphotropic virus type 1 associated myelopathy. Ther Apher 2001;5:491–3.
  • Yu X, Ma J, Tian J, Jiang S, Xu P, Han H, Wang L. A controlled study of double filtration plasmapheresis in the treatment of active rheumatoid arthritis. J Clin Rheumatol 2007;13:193–8.
  • Emeksiz S. Çocuk Yoğun Bakım Ünitemizdeki Terapötik Plazma Değişimi Deneyimlerimiz. Türkiye Çocuk Hast Derg 2019; 13: 447-50.
  • Aleksandrova IV, Reĭ SI, Khvatov VB, Borovkova NV, Il’inskiĭ ME, Abakumov MM. The level of dead blood leukocytes in sepsis and the significance of their elimination by extracorporeal hemocorrection techniques. Anesteziol Reanimatol 2008; 6: 57-60.
  • Nguyen TC, Han YY, Kiss JE, Hall MW, Hassett AC, Jaffe R, et al. Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia associated multiple organ failure. Crit Care Med 2008; 36: 2878-87.
  • Sevketoglu E, Yildizdas D, Horoz OO, Kihtir HS, Kendirli T, Bayraktar S, et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure networks. Pediatr Crit Care Med 2014; 15: 354-9.
  • Şenel E, Polat AD, Yastı AÇ, Karacan CD. Çocuk Yanıklarında Mortaliteyi Etkileyen Temel Parametreler ve Alınabilecek Önlemler. Türkiye Çocuk Hast Derg 2007;1:18-25.
  • Rech MA, Mosier MJ, McConkey K, Zelisko S, Netzer G, Kovacs EJ, et al. Outcomes in Burn-Injured Patients Who Develop Sepsis. J Burn Care Res 2019;40:269-73.
  • Senel E, Yasti AC, Reis E, Doganay M, Karacan CD, Kama NA. Effects on mortality of changing trends in the management of burned children in Turkey: Eight years experience. Burns 2009; 35: 372-7.
  • Demir S, Şenel E. The microorganisms isolated from patients’ cultures in a cild burn center and its impact to mortality. TJCL 2016; 7: 10-18.
  • Fortenberry JD, Nguyen T, Grunwell JR, Aneja RK, Wheeler D, Hall M, et al. Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia- Associated Multiple Organ Failure Network Prospective Experience. Crit Care Med 2019;47:e173-e181.
  • Kawai Y, Cornell TT, Cooley EG, Beckman CN, Baldridge PK, Mottes TA, et al. Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis induced multiple organ dysfunction syndrome receiving extracorporeal life support. Pediatr Crit Care Med 2015; 16: 366-74.
  • Özdemir ZC, Düzenli Kar Y, Bör Ö. Therapeutic Plasma Exchange in Children with Neutropenic Sepsis: Single Center Experience. JAREM 2018;8: 59-62.
  • Kaplan A. Complications of apheresis. Semin Dial 2012; 25: 152-8
There are 33 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section ORIGINAL ARTICLES
Authors

Ahmet Ertürk 0000-0002-8156-5665

Can Öztorun 0000-0002-5408-2772

Süleyman Arif Bostancı 0000-0002-7512-3895

Gökhan Demirtaş 0000-0003-0787-2330

Serhat Emeksiz 0000-0003-1026-0386

Müjdem Nur Azılı 0000-0002-5137-7209

İkbal Ok Bozkaya 0000-0002-7666-8731

Namık Yaşar Özbek 0000-0001-6857-0681

Sabri Demir 0000-0003-4720-912X

Emrah Şenel 0000-0002-0383-4559

Publication Date September 20, 2022
Submission Date June 27, 2022
Published in Issue Year 2022 Volume: 16 Issue: 5

Cite

Vancouver Ertürk A, Öztorun C, Bostancı SA, Demirtaş G, Emeksiz S, Azılı MN, Ok Bozkaya İ, Özbek NY, Demir S, Şenel E. Therapeutic plasma exchange application in the treatment of sepsis in a pediatric burn center. Türkiye Çocuk Hast Derg. 2022;16(5):440-4.


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