Plasmapheresis as adjunct treatment of severe sepsis in pediatric patients

Ramaz Kutubidze, George Adamashvili, Avtandil Kutubidze, Tamar Robakidze, Helen Shvangiradze

Department of Pediatric Surgery, Tbilisi State Medical University, Georgia

Aim: Investigation of therapeutic efficacy of plasmapheresis as an adjunct treatment of sepsis in surgical pediatric patients. Objective: Determination of relative risk of mortality in patients who received plasamapheresis with standard treatment of sepsis, in comparison to patients who received standard treatment alone. Design: prospective, randomized controlled clinical trial. Setting: Intensive Care Unite at Pediatric Clinic of Tbilisi State Medical University. Patients: 0-14 years old surgical pediatric patients with severe sepsis, septic shock and MODS. Interventions: 257 patients were stratified in 4 age groups and then randomized to receive either standard sepsis treatment or an add-on treatment with plasmapheresis. Measurments: Primary endpoint was intrahospital survival. Mortality rates were detected in plasmapheresis and control groups and relative risk of mortality associated with plasmapheresis were calculated. Differences were considered statistically significant at P values less than 0,05. Results: All cause mortality rate was 23,2% (29/125) in consolidated plasmapheresis group and 46,97% (62/132) in control group. This represents relative risk of fatal outcome in plasmapheresis group of 0,49 and absolute risk reduction 23,77%. Relative risk of mortality associated with plasmapheresis was the lowest in 1-12 months age group patients (Risk Ratio – 0,32). Conclusions: Plasmapheresis may be an important add-on to conventional treatment of severe sepsis in surgical pediatric patients.

Keywords:  plasmapheresis, plasma exchange, sepsis, severe sepsis. shock, MODS, pediatrics, treatment, survival, surgery, PICU