Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients

Authors: Johannes Hadem, Carsten Hafer, Andrea S Schneider, Olaf Wiesner, Gernot Beutel, Thomas Fuehner, Tobias Welte, Marius M Hoeper, Jan T Kielstein

Published in: BMC Anesthesiology | Issue 1/2014

Login to get access

Abstract

Background

Several case series and small randomized controlled trials suggest that therapeutic plasma exchange (TPE) improves coagulation, hemodynamics and possibly survival in severe sepsis. However, the exact role of TPE in modern sepsis therapy remains unclear.

Methods

We performed a retrospective observational single-centre study on the use of TPE as rescue therapy in 23 consecutive patients with severe sepsis or septic shock from 2005 to 2012. Main surrogate markers of multiple organ failure (MOF) before, during and after TPE as well as survival rates are reported.

Results

At baseline, mean SOFA score was 13 (standard deviation [SD] 4) and median number of failed organ-systems was 5 (interquartile range [IQR] 4–5). TPEs were performed 3 days (IQR 2–10) after symptom onset and 1 day (IQR 0–8) after ICU admission. The median total exchange volume was 3750 ml (IQR 2500–6000), which corresponded to a mean of 1.5 times (SD 0.9) the individual plasma volume. Fresh frozen plasma was used in all but one treatments as replacement fluid. Net fluid balance decreased significantly within 12 hrs following the first TPE procedure by a median of 720 mL (p = 0.002), irrespective of outcome. Reductions of norepinephrine dose and improvement in cardiac index were observed in individual survivors, but this was not significant for the overall cohort (p = 0.574). Platelet counts decreased irrespective of outcome between days 0 and 2 (p < 0.003), and increased thereafter in many survivors. There was a non-significant trend towards younger age and higher procalcitonin levels among survivors. Nine out of 23 TPE treated patients (39%) survived until ICU discharge (among them 3 patients with baseline SOFA scores of 15, 17, and 20).

Conclusions

Our data suggest that some patients with severe sepsis and septic shock may experience hemodynamic stabilisation by early TPE therapy.
Appendix
Available only for authorised users
Literature
1.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ, Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group: Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001, 344: 699-709. 10.1056/NEJM200103083441001.CrossRefPubMed
2.
Annane D, Aegerter P, Jars-Guincestre MC, Guidet B: Current epidemiology of septic shock: the CUB-Rea network. Am J Respir Crit Care Med. 2003, 168: 165-72. 10.1164/rccm.2201087.CrossRefPubMed
3.
4.
Klempner MS, Talbot EA, Lee SI, Zaki S, Ferraro MJ: A 24-year-old woman with abdominal pain and shock. N Engl J Med. 2010, 363: 766-77. 10.1056/NEJMcpc1003887.CrossRefPubMed
5.
Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R: Severe sepsis in cirrhosis. Hepatology. 2009, 20: 2022-2033.CrossRef
6.
Weineisen M, Sjöbring U, Fällman M, Andersson T: Streptococcal M5 protein prevents neutrophil phagocytosis by interfering with CD11b/CD18 receptor-mediated association an signalling. J Immunol. 2004, 172: 3798-807.CrossRefPubMed
7.
Bryant AE: Biology and pathogenesis of thrombosis and procoagulant activity in invasive infections caused by group A streptococci and Clostridium perfringens. Clin Microbiol Rev. 2003, 16: 451-62. 10.1128/CMR.16.3.451-462.2003.CrossRefPubMedPubMedCentral
8.
Carcillo JA, Kellum JA: Is there a role for plasmapheresis/plasma exchange therapy in septic shock, MODS, and thrombocytopenia-associated multiple organ failure? We still do not know – but perhaps we are closer. Intensive Care Med. 2002, 28: 1373-1375. 10.1007/s00134-002-1428-x.CrossRefPubMed
9.
Martin K, Borgel D, Lerolle N, Feys HB, Trinquart L, Vanhoorelbeke K, Deckmyn H, Legendre P, Diehl JL, Baruch D: Decreased ADAMTS-13 (a disintegrin-like and metalloprotease with thrombospondin type 1 repeats) is associated with a poor prognosis in sepsis-induced organ failure. Crit Care Med. 2007, 35: 2375-82. 10.1097/01.CCM.0000284508.05247.B3.CrossRefPubMed
10.
Busund R, Koukline V, Utrobin U, Nedashkovsky E: Plasmapheresis in severe sepsis and septic shock: a prospective, randomized, controlled trial. Intensive Care Med. 2002, 28: 1434-9. 10.1007/s00134-002-1410-7.CrossRefPubMed
11.
Reeves JH, Butt WW, Shann F, Layton JE, Stewart A, Waring PM, Presneill JJ: Continuous plasma filtration in sepsis syndrome. Plasmafiltration in sepsis study group. Crit Care Med. 1999, 27: 2096-104. 10.1097/00003246-199910000-00003.CrossRefPubMed
12.
Scharfman WB, Tillotson JR, Taft GE, Wright E: Plasmapheresis for meningococcemia with disseminated intravascular coagulation. N Engl J Med. 1979, 300: 1277-1278.PubMed
13.
Barzilay E, Kessler D, Berlot G, Gullo A, Geber D, Ben Zeev I: Use of extracorporeal supportive techniques as additional treatment for septic-induced multiple organ failure patients. Crit Care Med. 1989, 17: 634-637. 10.1097/00003246-198907000-00007.CrossRefPubMed
14.
Van Deuren M, Santman FW, van Dalen R, Sauerwein RW, Span LFR, van der Meer JWM: Plasma and whole blood exchange in meningococcal sepsis. Clin Infect Dis. 1992, 15: 424-430. 10.1093/clind/15.3.424.CrossRefPubMed
15.
Gardlund B, Sjolin J, Nilsson A, Roll M, Wickerts CJ, Wilkström B, Wretlind B: Plasmapheresis in the treatment of primary septic shock in humans. Scand J Infect Dis. 1993, 25: 757-61. 10.3109/00365549309008575.CrossRefPubMed
16.
Stegmayr BG: Plasma exchange in patients with septic shock including acute renal failure. Blood Purif. 1996, 14: 102-8. 10.1159/000170251.CrossRefPubMed
17.
Berlot G, Gullo A, Fasiolo S, Serra L, Silvestri L, Worz M: Hemodynamic effects of plasma exchange in septic patients: preliminary report. Blood Purif. 1997, 15: 45-53. 10.1159/000170316.CrossRefPubMed
18.
Simmonds M: Necrotising fasciitis and group A streptococcus toxic shock-like syndrome in pregnancy: treatment with plasmapheresis and immunoglobulin. Int J Obstet Anesth. 1999, 8: 125-30. 10.1016/S0959-289X(99)80009-0.CrossRefPubMed
19.
Hjorth V, Stenlund G: Plasmapheresis as part of the treatment for septic shock. Scand J Infect Dis. 2000, 32: 511-4. 10.1080/003655400458794.CrossRefPubMed
20.
Schmidt J, Mann S, Mohr VD, Lampert R, Firla U, Zirngibl H: Plasmapheresis combined with continuous venovenous hemofiltration in surgical patients with sepsis. Intensive Care Med. 2000, 26: 532-7. 10.1007/s001340051200.CrossRefPubMed
21.
Hoeper MM, Abou-Rebyeh F, Athman C, Schwarz A: Plasmapheresis in streptococcal toxic shock syndrome. Crit Care Med. 2001, 29: 2399-10.1097/00003246-200112000-00033.CrossRefPubMed
22.
Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A: A pilot study of coupled plasma filtration with adsorption in septic shock. Crit Care Med. 2002, 30: 1250-1255. 10.1097/00003246-200206000-00015.CrossRefPubMed
23.
Ataman K, Jehmlich M, Kock S, Neumann S, Leischik M, Filipovic Z, Hopf HB: Short-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock. Intensive Care Med. 2002, 28: 1164-1167. 10.1007/s00134-002-1375-6.CrossRefPubMed
24.
Stegmayr BG, Banga R, Gerggren 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. 10.1097/01.CCM.0000064742.00981.14.CrossRefPubMed
25.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Crit Care Med. 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af.CrossRefPubMed
26.
Bellomo R, Honoré PM, Matson J, Ronco C, Winchester J: Extracorporeal blood treatment (EBT) methods in SIRS/Sepsis. Int J Artif Organs. 2005, 28: 450-458.PubMed
27.
Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH, Apheresis Applications Committee of the American Society for Apheresis: Guidelines on the use of therapeutic apheresis in clinical practice – evidence-based approach from the Apheresis Applications Committee of the American Society of Apheresis. J Clin Apher. 2010, 25: 83-177. 10.1002/jca.20240.CrossRefPubMed
28.
Reinhart K, Brunkhorst FM, Bone HG, Bardutzky J, Dempfle CE, Forst H, Gastmeier P, Gerlach H, Gründling M, John S, Kern W, Kreymann G, Krüger W, Kujath P, Marggraf G, Martin J, Mayer K, Meier-Hellmann A, Oppert M, Putensen C, Quintel M, Ragaller M, Rossaint R, Seifert H, Spies C, Stüber F, Weiler N, Weimann A, Werdan K, Welte T, et al: Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V.) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin). Ger Med Sci. 2010, 28: Doc14-
29.
Faulhaber-Walter R, Hafer C, Jahr N, Vahlbruch J, Hoy L, Haller H, Fliser D, Kielstein JT: The Hannover Dialysis Outcome study: comparison of standard versus intensified extended dialysis for treatment of patients with acute kidney injury in the intensive care unit. Nephrol Dial Transplant. 2009, 24: 2179-86. 10.1093/ndt/gfp035.CrossRefPubMed
30.
Kaplan AA: A simple and accurate method for prescribing plasma exchange [abstract]. ASAIO Trans. 1990, 36: M597-PubMed
31.
Vincent JL, Moreno R, Takala J, Willatts S, de Medonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996, 22: 707-710. 10.1007/BF01709751.CrossRefPubMed
32.
Vincent JL: We should abandon randomized controlled trials in the intensive care unit. Crit Care Med. 2010, 38 (Suppl): S534-S538.CrossRefPubMed
33.
Kaplan A: Complications of apheresis. Semin Dial. 2012, 25: 152-158. 10.1111/j.1525-139X.2011.01026.x.CrossRefPubMed
34.
Madore F: Plasmapheresis – technical aspects and indications. Crit Care Clin. 2002, 18: 375-92. 10.1016/S0749-0704(01)00010-0.CrossRefPubMed
35.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall J-R, Payen D, on behalf of the Sepsis Occurrence in Acutely Ill Patients Investigators: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3A.CrossRefPubMed
36.
Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C: Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomised trial. Lancet. 2007, 370: 676-84. 10.1016/S0140-6736(07)61344-0.CrossRefPubMed
37.
Jones AE, Trzeciak S, Kline JA: The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med. 2009, 37: 1649-1654. 10.1097/CCM.0b013e31819def97.CrossRefPubMedPubMedCentral
38.
Flaum MA, Cuneo RA, Appelbaum FR, Deisseroth AB, Engel WK, Gralnick HR: The hemostatic imbalance of plasma-exchange transfusion. Blood. 1979, 54: 694-702.PubMed
39.
Stegmayr B, Abdel-Rahman EM, Balogun RA: Septic shock with multiorgan failure: from conventional apheresis to adsorption therapies. Semin Dial. 2012, 25: 171-175. 10.1111/j.1525-139X.2011.01029.x.CrossRefPubMed
40.
Fülöp T, Pathak MB, Schmidt DW, Lengvárszky Z, Juncos JP, Lebrun CJ, Brar H, Juncos LA: Volume-related weight gain and subsequent mortality in acute renal failure patients treated with continuous renal replacement therapy. ASAIO J. 2010, 56: 333-7.PubMedPubMedCentral
41.
Teixeira C, Garzotto F, Piccinni P, Brienza N, Iannuzzi M, Gramaticopolo S, Forfori F, Pelaia P, Rocco M, Ronco C, Anello CB, Bove T, Carlini M, Michetti V, Cruz DN, or the NEFROlogia e Cura INTensiva (NEFROINT) investigators: Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care. 2013, 17: R14-10.1186/cc12484.CrossRefPubMedPubMedCentral
42.
David S, Mukherjee A, Ghosh CC, Yano M, Khankin EV, Wenger JB, Karumanchi SA, Shapiro NI, Parikh SM: Angiopoietin-2 may contribute to multiple organ dysfunction and death in sepsis. Crit Care Med. 2012, 40: 3034-41. 10.1097/CCM.0b013e31825fdc31.CrossRefPubMedPubMedCentral
43.
Lovric S, Lukasz A, Hafer C, Kielstein JT, Haubitz M, Haller H, Kümpers P: Removal of elevated circulating angiopoietipn-2 by plasma exchange – a pilot study in critically ill patients with thrombotic microangiopathy and anti-glomerular basement membrane disease. Thromb Haemost. 2010, 104: 1038-43. 10.1160/TH10-02-0138.CrossRefPubMed
44.
Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E: Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med. 1989, 321: 1-7. 10.1056/NEJM198907063210101.CrossRefPubMed
Metadata
Title
Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational single-centre study of 23 patients
Authors
Johannes Hadem
Carsten Hafer
Andrea S Schneider
Olaf Wiesner
Gernot Beutel
Thomas Fuehner
Tobias Welte
Marius M Hoeper
Jan T Kielstein
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-24

Other articles of this Issue 1/2014

BMC Anesthesiology 1/2014 Go to the issue

Research article

The accuracy of locating the cricothyroid membrane by palpation – an intergender study

Research article

Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients

Research article

Measurement of endotracheal tube secretions volume by micro computed tomography (MicroCT) scan: an experimental and clinical study

Research article

Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?

Database

Hemodynamic impact of isobaric levobupivacaine versus hyperbaric bupivacaine for subarachnoid anesthesia in patients aged 65 and older undergoing hip surgery

Research article

Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial