Experience of a therapeutic plasma exchange program in a pediatric intensive care unit: A single-center retrospective observational study from Canada

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Abstract
Background: Pediatric intensive care units (PICUs) may not have timely access to therapeutic plasma exchange (TPE) for critically ill patients. The purpose of this study was to evaluate the common indications for TPE in a smaller tertiary PICU-developed TPE program and to evaluate the associated predictors of mortality. We hypothesized that a PICU-developed TPE program could provide timely access for a wide breadth of pathologies and can be delivered safely. Subjects and Methods: This was a retrospective case-comparison within-cohort study in a PICU from Canada. Data from pediatric patients between October 2015 and January 2022 was examined. The study included all patients < 18 years admitted to the PICU and requiring TPE. Multiorgan dysfunction syndrome (MODS) was defined to agree with the International Pediatric Sepsis Consensus Conference. Proportions, medians, and interquartile ranges (IQR) were calculated where appropriate. Results: Twenty-five patients with a median age of 14 years underwent 118 acute TPE runs. The most common diagnosis (24%) was MODS. The median time from PICU admission to initiation of TPE was 38 h (IQR: 5–113.5) hours. The median PICU length of stay was 10 (IQR: 5.5–26) days. Twenty percent (n = 5) of patients who received TPE acutely in the PICU required chronic TPE. There were no adverse events. Conclusions: TPE may be delivered quickly and safely from a small PICU for many indications, with MODS being the most common.

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