RESUMO
INTRODUCTION: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort. METHODS: A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011-2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane-based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58 % of children received other immunomodulatory therapy. According to ASFA, 45 % of cases were I-II category, 50 % to III, and 5% not classified. Response to treatment was complete in 64 % (23/36) and partial in 33 % (12/36). Complications occurred in 17.4 % of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92 %. Patients who received TPE as a single therapy (n = 26) survived 96 %. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p = 0.004). CONCLUSIONS: TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.
Assuntos
Cuidados Críticos/métodos , Unidades de Terapia Intensiva Pediátrica , Troca Plasmática/métodos , Doenças Autoimunes/complicações , Doenças Autoimunes/terapia , Remoção de Componentes Sanguíneos , Centrifugação , Criança , Pré-Escolar , Chile , Estado Terminal , Feminino , Humanos , Nefropatias/complicações , Nefropatias/terapia , Masculino , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/terapia , Plasmaferese , Estudos Retrospectivos , Doenças Reumáticas/complicações , Doenças Reumáticas/terapiaRESUMO
Necrotizing fasciitis (NF) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. Extremities, trunk and pelvis are the most common body sites affected. Periorbital celullitis with necrotizing fasciitis of the eyelid is rare. We report the case of a three years oíd child with bilateral NF of the eyelids and toxic shock syndrome secondary to Streptococcus pyogenes infection occurring after a minor skin trauma. Early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.
Assuntos
Doenças Palpebrais/terapia , Fasciite Necrosante/terapia , Choque Séptico/terapia , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Antibacterianos/uso terapêutico , Pré-Escolar , Terapia Combinada , Desbridamento , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/microbiologia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Resultado do TratamentoRESUMO
Necrotizing fasciitis (NF) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. Extremities, trunk and pelvis are the most common body sites affected. Periorbital celullitis with necrotizing fasciitis of the eyelid is rare. We report the case of a three years old child with bilateral NF of the eyelids and toxic shock syndrome secondary to Streptococcus pyogenes infection ocurring after a minor skin trauma. Early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.
La fascitis necrosante (FN) es una infección grave de los tejidos subcutáneos, localizada más frecuentemente en extremidades, tronco y pelvis. El compromiso de la cara y la región palpebral es inusual. Reportamos el curso clínico de un niño de tres años, previamente sano, que presentó una FN palpebral bilateral asociado a shock tóxico por Streptococcus pyogenes, secundaria a un trauma localizado. El paciente requirió tratamiento en cuidado intensivo con resucitación enérgica, antimicrobianos, inmunoglobulina intravenosa y desbridamiento quirúrgico precoz, lo que permitió su evolución favorable.