Plasma exchange in the intensive care unit: Technical aspects and complications.
BACKGROUND
Data on plasma exchange therapy in the intensive care unit (ICU) setting are scarce. We aimed to describe the technical aspects and the adverse events associated with the procedure in critically ill patients.


METHODS
All adult patients treated by plasma exchange in the medical ICU of the Saint-Louis university hospital between January 1, 2013 and March 31, 2015 were prospectively included.


RESULTS
We report on 260 plasma exchange procedures performed in 50 patients. The centrifugation technique was used for 159 (61%) procedures and the filtration technique for the other 101 (39%) procedures. Both techniques had similar efficacy to treat hyperviscosity syndrome (n = 18). Seventy (26.9%) of the 260 plasma exchange procedures were reported with at least one adverse reaction. Centrifugation and filtration techniques had similar rates of adverse reactions (23.9 vs. 31.7%, P = .19). Hypotension was the most reported (n = 21, 8%) and correlates with a low hematocrit before therapy. Most complications were related to allergic reactions to the replacement fluids. Coagulation disorders depended on the type of replacement fluid. The post-exchange fibrinogen level was decreased by 54% [48;66] with albumin 5%, and 4% [-5;17] with plasma frozen within 24 h. Twenty-three (22.8%) of the 101 filtration procedures experienced filter clotting. Filter clotting was associated with a higher volume exchange prescribed when compared to procedures without filter clotting (4600 [4000;5000] ml vs. 3900 [3600;4800] ml, P < .01).


CONCLUSIONS
Plasma exchange is a relatively safe and generally well-tolerated procedure in the ICU setting. Most adverse events are unpredictable and related to minor allergic reactions.
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Aurélie
A
Lemaire
Therapeutic Apheresis Department, Saint Louis University Hospital, Paris, France.
Nathalie
N
Parquet
Department of Clinical Immunology, Saint Louis University Hospital, Paris, France.
Lionel
L
Galicier
Department of Clinical Immunology, Saint Louis University Hospital, Paris, France.
David
D
Boutboul
Department of Clinical Immunology, Saint Louis University Hospital, Paris, France.
Rémi
R
Bertinchamp
Department of Immuno-Hematology, Saint Louis University Hospital, Paris, France.
Marion
M
Malphettes
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Guillaume
G
Dumas
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Eric
E
Mariotte
Department of Nephrology and Kidney transplantation, Saint Louis University Hospital, Paris, France.|Paris Diderot University, Sorbonne Paris Cité, Paris, France.
Marie-Noëlle
MN
Peraldi
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Virginie
V
Souppart
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.|Paris Diderot University, Sorbonne Paris Cité, Paris, France.
Benoit
B
Schlemmer
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.|Paris Diderot University, Sorbonne Paris Cité, Paris, France.
Elie
E
Azoulay
Medical Intensive Care Department, Saint Louis University Hospital, Paris, France.
Emmanuel
http://orcid.org/0000-0002-2143-8082
E
Canet
D000328:Adult; D000368:Aged; D002498:Centrifugation; D005260:Female; D005374:Filtration; D006801:Humans; D006967:Hypersensitivity; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
complications; hyperviscosity syndrome; intensive care unit; plasma exchange; technique; thrombotic thrombocytopenic purpura