Evaluation of patients receiving therapeutic plasmapheresis in pediatric intensive care unit

Objective: Therapeutic plasma exchange (TPE) treatment has become a widely used treatment method today. In this study, we aimed to examine the clinical and laboratory characteristics of the patients to whom we performed TPE in our pediatric intensive care unit, to investigate the effectiveness, side effects, and complications of TPE, and to evaluate the factors affecting the prognosis of the patients. Materials and Methods: All patients aged between 1 month and 18 years who underwent TPE in the Pediatric Intensive Care Unit between January 1, 2019 and June 1, 2023 were included in the study. A total of 139 patients participated in the study. Study patients were evaluated with a sociodemographic information form, a clinical evaluation form, and a mortality and morbidity evaluation form consisting of standard scales. Data were recorded retrospectively from patient files. Results: Of the patients included in the study, 65 (46,8%) were female and 74 (53,2%) were male. The median age was 10 years (min, max; 5 months - 18 years). The most common TPE indication was sepsis-associated multiple organ failure and thrombocytopenia-associated multiple organ failure (TAMOF) (39,5%). While 89,2% of the patients completed TPE without complications, complications occurred in 10,8%. The most common complication was catheter-related problems in 7 patients (5%). 50 patients (36%) who underwent TPE died. It was observed that 50 (56,2%) patients in the surviving group received IVIG treatment, and 19 (38%) patients in the deceased group received IVIG treatment (p = 0.04). It was determined that 32 (36%) patients in the surviving group and 45 (90%) patients in the other group received inotropic support (p<0.001). The median PRISM III and PELOD 2 scores of patients who died were found to be higher than those who did not (7 vs. 21; 10 vs. 20, p:0.004 and p:0.003, respectively). Mechanical ventilation treatment was seen at a higher rate in the group that died (p:0.001). In multivariate regression analysis, inotropic support was found as the most associated parameter with death. If the need for inotropic support and plasmapheresis indications were used together, exitus could be detected with 87,8% accuracy. Conclusion: It was determined that TPE was very effective in the pediatric age group, because in most of the patients critical blood values were returned to normal levels. Although TPE provides an improvement in blood values in sepsis/TAMOF and hematology patients, it cannot significantly reduce the risk of death. IVIG application rate is higher in the surviving group. Considering that sepsis and TAMOF are important risk factors in the group that died, it can be suggested that IVIG administration may reduce the risk of death. PRISM III and PELOD 2 scores are higher in the deceased group than in the surviving group. In this context, PRISM III and PELOD 2 scores seem as useful and reliable scoring systems. The absence of a relationship between complications and death indicates that there is no risk of mortality related to the TPE procedure. Especially sepsis/TAMOF and hematological TPE indications and the need for inotropic support are associated with death. Well-structured, prospective clinical studies need to be planned to further investigate the scope and limitations of TPE in child patients.