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Plasma exchange as rescue therapy in multiple organ failure including acute renal failure*

Stegmayr, Bernd G. MD, PhD; Banga, Ravjet; Berggren, Lars; Norda, Rut; Rydvall, Anders; Vikerfors, Tomas

doi: 10.1097/01.CCM.0000064742.00981.14
CLINICAL INVESTIGATIONS
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Objective To describe the outcome of using a rescue therapy including plasma exchange given to patients with a progressive acute disseminated intravascular coagulation and multiple organ dysfunction syndrome.

Study Design Retrospective study.

Setting University and county hospital.

Patients Included were 76 consecutive patients (41 men and 35 women) treated with plasma exchange as rescue therapy besides optimal conventional therapy during a progressive course of disseminated intravascular coagulation and multiple organ dysfunction syndrome, including acute renal failure. Of the 76 patients, 66% needed dialysis. The distribution was hemodialysis in 76%, continuous arteriovenous hemofiltration in 36%, continuous venovenous hemodialysis in 12%, and peritoneal dialysis in 24%. The median organ-failure score was 5 (range, 1–6). Seventy-two percent required mechanical ventilation; septic shock was present in 88%. The median septic shock score was 4 (range, 2–4). Nine patients had another reason than sepsis for the multiple organ dysfunction syndrome.

Intervention Plasma exchange (centrifugation technique) was performed until disseminated intravascular coagulation was reversed (median, two times; range, 1–14). Besides antibiotics and fluid administration, most patients received heparin or low molecular weight heparin (77%), steroids (87%), and inotropes (88%). More than one vasoactive drug was used in 57% of the patients.

Measurements and Main Results Eighty-two percent of the patients survived and could leave the hospital. The previously observed survival rates by others for this category of patients would be <20%, and thus, the outcome in this study is significantly better.

Conclusion Plasma exchange using plasma as replacement may, in addition to conventional intensive care, help to reverse severe progressive disseminated intravascular coagulation and multiple organ dysfunction syndrome and improve survival.

From the Division of Nephrology, Department of Internal Medicine (BGS, RB), Division of Intensive Care Medicine (LB, AR), Transfusion Center and Apheresis Unit (RN), Department of Infectious Diseases (TV), County Hospital Örebro (LB, RN, TV), and University Hospital (BGS, RB, AR), Umeå, Sweden.

Address requests for reprints to: Bernd G. Stegmayr, MD, PhD, Department of Internal Medicine, Medicinkliniken, University Hospital, SE-901 85 Umeå, Sweden. E-mail: bernd.stegmayr@medicin.umu.se

Plasma exchange using plasma as replacement may, in addition to conventional intensive care, help to reverse severe progressive disseminated intravascular coagulation and multiple organ dysfunction syndrome and improve survival.

*See also p. 1875.

© 2003 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins