<abstract xmlns="http://www.w3.org/1999/xhtml"><bold>Background</bold>.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics &amp; outcome.<bold>Methods.</bold> We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume.<bold>Results.</bold> In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p &lt; 0.002) and norepinephrine dose which significantly reduced post TPE (p &lt; 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p &lt; 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p &lt; 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p &lt; 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p &lt; 0.01). C-reactive protein significantly improved after TPE (P &lt; 0.01).<bold>Conclusion.</bold> Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.</abstract>

Background.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics & outcome.Methods. We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume.Results. In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p < 0.002) and norepinephrine dose which significantly reduced post TPE (p < 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p < 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p < 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p < 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p < 0.01). C-reactive protein significantly improved after TPE (P < 0.01).Conclusion. Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.

Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients

Department of Internal Medicine, Faculty of Medicine

Department of Cardiology, Faculty of Medicine

Department of Critical Care, Faculty of Medicine

Romanian Journal of Internal Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Background.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of...

Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients

Published Online: Jun 02, 2020

Page range: 75 - 80

Received: Sep 28, 2019

DOI: https://doi.org/10.2478/rjim-2019-0026

Keywords
septic shock, plasma exchange, hemodynamics, norepinephrine, critical care

© 2020 Rabab Mahmoud Ahmed et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients

Published Online: Jun 02, 2020

Page range: 75 - 80

Received: Sep 28, 2019

DOI: https://doi.org/10.2478/rjim-2019-0026

Keywordsseptic shock, plasma exchange, hemodynamics, norepinephrine, critical care

© 2020 Rabab Mahmoud Ahmed et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
septic shock, plasma exchange, hemodynamics, norepinephrine, critical care