Acute and Critical Care

Original Article

Pediatrics
Prevalence of extracorporeal blood purification techniques in critically ill patients before and during the COVID-19 pandemic in Egypt: Aya Osama Mohammed, Hanaa I. Rady; Acute Crit Care. 2024;39(1):70-77. Published online February 1, 2024; DOI: https://doi.org/10.4266/acc.2023.00654

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Abstract PDF: Background
Extracorporeal blood-purification techniques are frequently needed in the pediatric intensive care unit (PICU), yet data on their clinical application are lacking. This study aims to review the indications, rate of application, clinical characteristics, complications, and outcomes of patients undergoing extracorporeal blood purification (i.e., by continuous renal replacement therapy [CRRT] or therapeutic plasma exchange [TPE]) in our PICU, including before the coronavirus disease 2019 (COVID-19) pandemic in 2019 and during the pandemic from 2020 to 2022. Methods: This study included children admitted for extracorporeal blood-purification therapy in the PICU. The indications for TPE were analyzed and compared to the American Society for Apheresis categories. Results: In 82 children, 380 TPE sessions and 37 CRRT sessions were carried out children, with 65 patients (79%) receiving TPE, 17 (20.7%) receiving CRRT, and four (4.8%) receiving both therapies. The most common indications for TPE were neurological diseases (39/82, 47.5%), followed by hematological diseases (18/82, 21.9%). CRRT was mainly performed for patients suffering from acute kidney injury. Patients with neurological diseases received the greatest number of TPE sessions (295, 77.6%). Also, the year 2022 contained the greatest number of patients receiving extracorporeal blood-purification therapy (either CRRT or TPE). Conclusions: The use of extracorporeal blood-purification techniques increased from 2019 through 2022 due to mainly autoimmune dysregulation among affected patients. TPE can be safely used in an experienced PICU. No serious adverse events were observed in the patients that received TPE, and overall survival over the 4 years was 86.5%.

Case Reports

Hematology/Pulmonary
Delayed Hemolytic Uremic Syndrome Presenting as Diffuse Alveolar Hemorrhage: Ji Young Hong, Ji Ye Jung, Young Ae Kang, Yoon Sung Bae, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2014;29(1):43-47. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.43

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Hemolytic uremic syndrome (HUS) is defined by the triad of mechanical intravascular hemolytic anemia with schistocytosis, thrombocytopenia and acute renal failure. Pulmonary involvement in HUS is known to be rare. We present the case of a 25-year-old male with diffuse alveolar hemorrhage and myocarditis followed by atypical hemolytic uremic syndrome. In this case, successful treatments included steroid pulse therapy for the fatal alveolar hemorrhage and plasma exchange for the hemolytic uremic syndrome.

Citations

Citations to this article as recorded by

Development and pilot implementation of Iranian Hemolytic Uremic Syndrome Registry
Mina Lazem, Nakysa Hooman, Abbas Sheikhtaheri
Orphanet Journal of Rare Diseases.2022;[Epub] CrossRef
Lessons learned from hemolytic uremic syndrome registries: recommendations for implementation
Mina Lazem, Abbas Sheikhtaheri, Nakysa Hooman
Orphanet Journal of Rare Diseases.2021;[Epub] CrossRef
The Prevalence and Incidence of Atypical Hemolytic Uremic Syndrome in Iran: A Systematic Review and Meta-Analysis Protocol Study
Nakysa Hooman, Mahnaz Sadeghian, Fariba Jahangiri, Soudabeh Hosseini
Journal of Comprehensive Pediatrics.2017;[Epub] CrossRef
Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos
Nefrología (English Edition).2015; 35(3): 337. CrossRef
Subcapsular liver hematoma as a complication of an atypical hemolytic uremic syndrome
Emanuel Ferreira, Nuno Oliveira, Maria Marques, Helena Pinto, Ana Santos, Armando Carreira, Mário Campos
Nefrología.2015; 35(3): 337. CrossRef

A Case of Exertional Heat Stroke with Acute Hepatic Failure Treated with Plasma Exchange: A Case Report: Young Joo Han, Jae Wook Choi, Woo Jin Chung, Dong In Suh, June Dong Park; Korean J Crit Care Med. 2012;27(2):130-133.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.130

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31 Download
1 Crossref

Abstract PDF

Heat stroke is a hyperthermia-induced systemic inflammatory response which may cause multiorgan dysfunction syndrome. We report a case of exertional heat stroke with acute hepatic failure in an 11-year-old boy. He initially presented hyperthermia and unconsciousness, which occurred after heavy exercise. His neurological state improved after terminating the hyperthermia by intensive cooling therapy. However, 24 hours after the initial recovery, his neurological state deteriorated again as acute hepatic injury progressed rapidly. We applied 4 times of total plasma exchange as an immunotherapy for systemic inflammatory response syndrome and acute hepatic failure expecting it to remove endogenous inflammatory factors and hepatotoxic cytokines. Following the plasma exchange, his mental state became normal and serial laboratory findings indicated improvement. He made a complete recovery without sequelae. We experienced successful treatment regarding exertional heat stroke with acute hepatic failure using plasma exchange.

Citations

Citations to this article as recorded by

Therapeutic plasma exchange in the treatment of exertional heat stroke and multiorgan failure
Vimal Master Sankar Raj, Amanda Alladin, Brent Pfeiffer, Chryso Katsoufis, Marissa Defreitas, Alicia Edwards-Richards, Jayanthi Chandar, Wacharee Seeherunvong, Gwenn McLaughlin, Gaston Zilleruelo, Carolyn L. Abitbol
Pediatric Nephrology.2013; 28(6): 971. CrossRef

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