Outcomes of previously healthy pediatric patients with fulminant sepsis‐induced multisystem organ failure receiving therapeutic plasma exchange

Abstract

Fulminant sepsis-induced multisystem organ failure (MSOF) in pediatric patients carries substantial morbidity and mortality. Therapeutic plasma exchange (TPE) has been reported to be beneficial in sepsis-induced MSOF. We evaluated the outcomes of previously healthy children with fulminant sepsis-induced MSOF receiving TPE. Previously healthy pediatric ICU patients who underwent TPE for MSOF due to fulminant bacterial sepsis were retrospectively reviewed. Eleven patients (three females and eight males) with age ranging 8 months to 14 years were identified (eight meningococcemia and three other infections). All patients received daily TPE with fresh frozen plasma (FFP) as replacement fluid. Organ failure index (OFI-maximum score = 6) was assessed daily for 7 days. A median of 4 TPE (1-14) were performed. Improvements in organ function and platelet count occurred in most patients with 2-4 TPE treatments. All 10 patients who were alive had reduced OFI to 2 by day 7 of initial TPE and were all fully recovered (survival rate = 10/11, 91%). The only death occurred in a patient who died the same day after his first TPE treatment, which was initiated 24 h after development of MSOF. The 10 survivors underwent early initiation of TPE (median 5.3 h) after the onset of MSOF. > TPE may contribute to a better outcome in previously healthy pediatric patients with fulminant sepsis-induced MSOF, especially if instituted early in the course of multiorgan failure.