Therapeutic plasma exchange in critically ill children: experience of the pediatric intensive care unit of two centers in Chile
Introduction : Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort. Methods : A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011–2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane- based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58% of children received other immunomodulatory therapy. According to ASFA, 45% of cases were I-II category, 50% to III, and 5% not classified. Response to treatment was complete in 64% (23/36) and partial in 33% (12/36). Complications occurred in 17.4% of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92%. Patients who received TPE as a single therapy (n = 26) survived 96%. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p= 0.004). Conclusions: TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.