Therapeutic plasma exchange (TPE); A Management Strategy for Critically ill Covid-19 patients

Abstract

Objective: To determine the effectiveness of therapeutic plasma exchange (TPE) in management of critically ill Covid-19 patients Materials and Methods: In this study non-randomized controlled trial, a total of 47 patients were included after thorough screening of the admitted patients in Covid ITC CMH, Multan from July-2020 to May-2021.Single administration of TPE was done to determine the results. The parameters assessed in this study included the efficacy of TPE in terms of improvement of critical end points such as Norepinephrine dose to maintain MAP of more than 65mmHg, 6-hour balance of fluid, MAP, CRP (C reactive protein), WBC count (white blood cell), platelets, INR (international normalized ratio), IL-6. Results: The variations before and after TPE in clinical and biochemical parameters shown in table. II. In clinical parameters and in gas exchange parameters no significant difference was found. Inflammatory biomarkers, before and after TPE, the parameters had not significant different, (p>0.005). The differences before and after TPE between acid base balance, cytokines and vasoactive substances were also statistically insignificant, (p>0.005). Conclusion: Even though there is evidence of slight improvement in clinical endpoints of Covid-19 patients with TPE, overall efficacy of TPE is still a question that needs an answer as no significant improvement could be seen in outcome values after TPE. Keywords: Therapeutic Plasma Exchange (TPE), Hemodynamics, Acute Respiratory Distress Syndrome (ARDS).