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

Rabab Mahmoud Ahmed; Amin R. Soliman; Ahmad Yousry; Khaled Marzouk; Farouk Faris

doi:10.2478/rjim-2019-0026

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

Romanian Journal of Internal Medicine

Volume 58 (2020): Issue 2 (June 2020)

By: Rabab Mahmoud Ahmed, Amin R. Soliman, Ahmad Yousry, Khaled Marzouk and Farouk Faris

Open Access

|Jun 2020

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.

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Articles in this issue

DOI: https://doi.org/10.2478/rjim-2019-0026 | Journal eISSN: 2501-062X | Journal ISSN: 1220-4749

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Language: English

Page range: 75 - 80

Submitted on: Sep 28, 2019

Published on: Jun 2, 2020

Published by: N.G. Lupu Internal Medicine Foundation

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Related subjects:

Internal medicine, other,

Cardiology,

Gastroenterology,

Rheumatology

© 2020 Rabab Mahmoud Ahmed, Amin R. Soliman, Ahmad Yousry, Khaled Marzouk, Farouk Faris, published by N.G. Lupu Internal Medicine Foundation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 58 (2020): Issue 2 (June 2020)