医学
败血症
感染性休克
相对风险
置信区间
荟萃分析
内科学
随机对照试验
新鲜冰冻血浆
重症监护医学
血小板
作者
Olive P E Lee,Nalaayeni Kanesan,Esther Huimin Leow,Rehena Sultana,Yek K Chor,Chin Seng Gan,Jan Hau Lee
标识
DOI:10.1177/08850666231170775
摘要
To summarize the role of therapeutic plasma exchange (TPE) in critically ill adults and children with severe sepsis.A systematic search was performed using the following databases: Medline, EMBASE, CINAHL, and Cochrane from January 1990 till December 2022. Comparative studies of TPE in severe sepsis were selected. Adult and pediatric data were analyzed separately.Eight randomized control trials and 6 observational studies (n = 50,142 patients) were included. Centrifugal TPE was the most common modality (209/280, 74.6% adults and 952/1026, 92.7% children). Every TPE study utilized different volume exchanges. Most TPE sessions (1173/1306, 89.8%) employed fresh frozen plasma (FFP) as replacement fluid and heparin as anticoagulant. Adults with severe sepsis supported with TPE using FFP had lower mortality (risk ratio, RR: 0.64 [95% confidence interval, CI: 0.49, 0.84]) compared to those who did not. In contrast, TPE was associated with increased mortality in septic children without thrombocytopenia-associated multiorgan failure (RR: 2.23, 95% CI: 1.93, 2.57). There was no difference in outcomes in patients supported with centrifugal and membrane TPE. In both populations, patients supported on TPE as a continuous regime had poorer outcome.Current evidence indicates that TPE is a potential adjunct therapy in adults with severe sepsis but not in children.
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