Mehmet ALAKAYA, Sadık KAYA, Ali Ertuğ ARSLANKÖYLÜ, Özlem TEZOL, Asuman Nur KARHAN, Eyüp Naci TİFTİK

Çocuk Yoğun Bakım 5 Yıllık Plazmaferez Deneyimi

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.

Anahtar Kelimeler:

Aferez, Çocuk Yoğun Bakım, Terapötik Plazma Değişimi

Plasmapheresis Experience of Pediatric Intensive Care in 5 Years

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,

PDF

___

1- Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E 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 Eighth Special Issue. J Clin Apher. 2019;34:171–354
2- Larsen FS, Schmidt LE, Bernsmeier C, Rasmussen A, Isoniemi H, Patel VC et al. High-volume plasma exchange in patients with acute liver failure: An open randomised controlled trial. J Hepatol. 2016;64:69-78
3- Ye X, Wang F, Ding Y, Ma D, Lv B. Plasma exchange improves outcome of sepsis-associated liver failure: A case report. Medicine (Baltimore). 2019;98(18):e15307
4- Colic E, Dieperink H, Titlestad K, Tepel M. Management of an acute outbreak of diarrhoea-associated haemolytic uraemic syndrome with early plasma exchange in adults from southern Denmark: an observational study. Lancet. 2011;378:1089-93
5- Fujinaga S, Ohtomo Y, Umino D, Mochizuki H, Murakami H, Shimizu T et al. Plasma exchange combined with immunosuppressive treatment in a child with rapidly progressive IgA nephropathy. Pediatr Nephrol. 2007;22:899-902
6- Kashgary A, Sontrop J, Li L, Al-Jaishi AA, Habibullah ZN, Alsolaimani R et al. The role of plasma exchange in treating post-transplant focal segmental glomerulosclerosis: a systematic review and meta-analysis of 77 case-reports and case-series. BMC Nephrology. 2016;17:104
7- Haque A, Sher G, Hoda M, Moiz B. Feasibility of pediatric apheresis in intensive care settings. Ther Apher Dial. 2014;18:497-501
8- Long EJ, Shann F, Pearson G, Buckley D, Butt W. A randomised controlled trial of plasma filtration in severe paediatric sepsis. Crit Care Resusc. 2013;15:198-204
9- Ibrahim RB, Balogun RA. Medications and therapeutic apheresis procedures: are we doing our best? J Clin Apher. 2013;28:73-77
10- Bosnak M, Erdogan S, Aktekin EH, Bay A. Therapeutic plasma exchange in primary hemophagocytic lymphohistiocytosis: Reports of two cases and a review of the literatüre. Transfus Apher Sci. 2016 ;55:353-56
11- Kara A, Turgut S, Cagli A, Sahin F, Oran E, Tunc B. Complications of therapeutic apheresis in children. Transfus Apher Sci 2013;48:375-76