#3242 OUTCOMES OF THERAPEUTIC PLASMA EXCHANGE: A ONE-YEAR EXPERIENCE IN AN INTERNAL MEDICINE INTENSIVE CARE UNIT

Abstract

Abstract Background and Aims There is uncertainty regarding the best indication, device type, frequency, length of time, kind of replacement fluid, and criteria for ceasing therapeutic plasma exchange (TPE) for various disorders. TPE is an intrusive technique that has the potential to save lives, but it also has a risk of unfavorable outcomes and complications, necessitating close supervision by professional teams. In the intensive care unit (ICU), there are three categories of indications for TPE: (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy; (2) relative; for which TPE is a recognized second-line treatment (alone or in combination) and (3) rescue therapy; for which TPE is used with a limited or theoretical evidence base. The purpose of this study is to continue our evaluation of the outcome of nephrology care in internal medicine ICU regarding bedside membrane therapeutic plasma exchange. Method In the continuity of our previous work in the analysis of the outcome of TPE. From August 2021 to August 2022, 425 membrane plasma exchange sessions were performed on 69 patients in the internal medicine department's ICU-Cairo University Hospitals-Egypt. Results Closely similar to what we found before; the most frequent diagnosis was thrombotic microangiopathies (24 (34.8%) patients) with complete recovery seen in 18/24 patients (75%); followed by systemic vasculitis with pulmonary renal involvement (14 (20.3%) patients) with partial remission was seen in 9/14 patients (64.3%); Guillain-Barré syndrome (13 (18.8%) patients) with complete recovery was seen in 8/13 patients (61.5%); Proliferative Lupus Nephritis with crescents [10 (14.5%) patients] with partial remission in 8/10 patients (80%), and myasthenia gravis [8 (11.6%) patients] with complete recovery in 6/8 patients (75%). Hypotension occurred during 69/425 (16.2%) sessions and hypocalcemia in 8/69 (11.5%) patients during treatment. Infection of vascular access occurred in 4/69 (5.8%) patients. 6/69 (8.7%) patients died during their stay in ICU none during treatment with TPE, all of them were diagnosed to have severe sepsis as a cause of death. Conclusion According to our experience, membrane therapeutic plasma exchange is a successful and secure treatment for a variety of illnesses including thrombotic microangiopathies, systemic vasculitis, myasthenia gravis, proliferative lupus nephritis, and Guillain-Barré syndrome. The main reason for death was sepsis.