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Therapeutic plasma exchange does not reduce vasopressor requirement in severe acute liver failure: a retrospective case series.

Wiersema UF, Kim SW, Roxby D, Holt A - BMC Anesthesiol (2015)

Bottom Line: MAP was significantly higher immediately after TPE compared to baseline (p = 0.039), however when corrected for change in vasopressor requirement there was no significant change in VDI with TPE (p = 0.953).Twelve hours after TPE the MAP, vasopressor score and VDI were not significantly different from baseline (p = 0.563, p = 0.317 and p = 0.214 respectively).In this cohort of patients with severe ALF centrifugal TPE did not significantly affect vasopressor requirements.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Flinders Medical Centre, Bedford Park, South Australia Australia.

ABSTRACT

Background: In acute liver failure (ALF) therapeutic plasma exchange (TPE) improves laboratory measures of liver function. In patients with ALF requiring minimal vasoactive support TPE has also been shown to provide haemodynamic benefits including an increase in systemic blood pressure. However the haemodynamic effects of TPE in patients with severe ALF requiring moderate or high dose vasopressor therapy has not been reported. We retrospectively examined the haemodynamic effects of TPE in a cohort of patients with severe ALF requiring vasopressor therapy.

Methods: Physiological, laboratory and treatment data were collected on all patients with ALF who received TPE between January 2000 and December 2012. All patients were managed in the intensive care unit of a tertiary referral centre for ALF and liver transplantation. The primary outcome measures were changes in mean arterial pressure (MAP), vasopressor score and the ratio of vasopressor score to MAP (vasopressor dependency index (VDI)) from baseline prior to TPE through to 12 hours after completion of TPE. Secondary outcome measures were changes in other routinely collected physiological variables and laboratory results. Results are presented as median (interquartile range (IQR)). Outcome measures were evaluated using a mixed effect model.

Results: Thirty nine TPE were performed in 17 patients with ALF (13 paracetamol poisoning). All TPE were performed with a centrifugal apheresis system (duration 130 minutes (IQR 115 - 147.5), plasma volume removed 5.1% body weight (IQR 4.6 - 5.5). Baseline values for primary outcome measures were: MAP 82 mmHg (IQR 72 - 92.5), vasopressor score 8.35 (IQR 3.62 - 24.6) and VDI 0.10 (IQR 0.05 - 0.31). MAP was significantly higher immediately after TPE compared to baseline (p = 0.039), however when corrected for change in vasopressor requirement there was no significant change in VDI with TPE (p = 0.953). Twelve hours after TPE the MAP, vasopressor score and VDI were not significantly different from baseline (p = 0.563, p = 0.317 and p = 0.214 respectively).

Conclusion: In this cohort of patients with severe ALF centrifugal TPE did not significantly affect vasopressor requirements.

No MeSH data available.


Related in: MedlinePlus

Patient outcome according to liver transplant status.
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Fig1: Patient outcome according to liver transplant status.

Mentions: A total of 39 TPE treatments were performed on 17 patients with ALF during the study period; median 2 (interquartile range (IQR) 1–3) TPE treatments per patient. All TPE treatments were included for analysis. The median age was 40 years (IQR 29–45). There were 13 females (76.5%) and 4 males (23.5%). The median weight (IQR) was 60 kg (55–64.5). The median severities of illness (IQR) scores were: APACHE III 107.5 (86–124), SAPS II 55.0 (43.75-66.25). The causes of ALF were: paracetamol toxicity 13 patients, alcoholic hepatitis 2 patients, Budd Chiarri syndrome 1 patient and herbal remedy ingestion 1 patient. Five patients had intracranial pressure monitoring during at least one of their treatments with TPE. There were insufficient data to determine the effect of TPE on intracranial pressure. Patient outcome according to liver transplant status is shown in Figure 1. Six patients survived and 11 patients died.Figure 1


Therapeutic plasma exchange does not reduce vasopressor requirement in severe acute liver failure: a retrospective case series.

Wiersema UF, Kim SW, Roxby D, Holt A - BMC Anesthesiol (2015)

Patient outcome according to liver transplant status.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359494&req=5

Fig1: Patient outcome according to liver transplant status.
Mentions: A total of 39 TPE treatments were performed on 17 patients with ALF during the study period; median 2 (interquartile range (IQR) 1–3) TPE treatments per patient. All TPE treatments were included for analysis. The median age was 40 years (IQR 29–45). There were 13 females (76.5%) and 4 males (23.5%). The median weight (IQR) was 60 kg (55–64.5). The median severities of illness (IQR) scores were: APACHE III 107.5 (86–124), SAPS II 55.0 (43.75-66.25). The causes of ALF were: paracetamol toxicity 13 patients, alcoholic hepatitis 2 patients, Budd Chiarri syndrome 1 patient and herbal remedy ingestion 1 patient. Five patients had intracranial pressure monitoring during at least one of their treatments with TPE. There were insufficient data to determine the effect of TPE on intracranial pressure. Patient outcome according to liver transplant status is shown in Figure 1. Six patients survived and 11 patients died.Figure 1

Bottom Line: MAP was significantly higher immediately after TPE compared to baseline (p = 0.039), however when corrected for change in vasopressor requirement there was no significant change in VDI with TPE (p = 0.953).Twelve hours after TPE the MAP, vasopressor score and VDI were not significantly different from baseline (p = 0.563, p = 0.317 and p = 0.214 respectively).In this cohort of patients with severe ALF centrifugal TPE did not significantly affect vasopressor requirements.

View Article: PubMed Central - PubMed

Affiliation: Department of Critical Care Medicine, Flinders Medical Centre, Bedford Park, South Australia Australia.

ABSTRACT

Background: In acute liver failure (ALF) therapeutic plasma exchange (TPE) improves laboratory measures of liver function. In patients with ALF requiring minimal vasoactive support TPE has also been shown to provide haemodynamic benefits including an increase in systemic blood pressure. However the haemodynamic effects of TPE in patients with severe ALF requiring moderate or high dose vasopressor therapy has not been reported. We retrospectively examined the haemodynamic effects of TPE in a cohort of patients with severe ALF requiring vasopressor therapy.

Methods: Physiological, laboratory and treatment data were collected on all patients with ALF who received TPE between January 2000 and December 2012. All patients were managed in the intensive care unit of a tertiary referral centre for ALF and liver transplantation. The primary outcome measures were changes in mean arterial pressure (MAP), vasopressor score and the ratio of vasopressor score to MAP (vasopressor dependency index (VDI)) from baseline prior to TPE through to 12 hours after completion of TPE. Secondary outcome measures were changes in other routinely collected physiological variables and laboratory results. Results are presented as median (interquartile range (IQR)). Outcome measures were evaluated using a mixed effect model.

Results: Thirty nine TPE were performed in 17 patients with ALF (13 paracetamol poisoning). All TPE were performed with a centrifugal apheresis system (duration 130 minutes (IQR 115 - 147.5), plasma volume removed 5.1% body weight (IQR 4.6 - 5.5). Baseline values for primary outcome measures were: MAP 82 mmHg (IQR 72 - 92.5), vasopressor score 8.35 (IQR 3.62 - 24.6) and VDI 0.10 (IQR 0.05 - 0.31). MAP was significantly higher immediately after TPE compared to baseline (p = 0.039), however when corrected for change in vasopressor requirement there was no significant change in VDI with TPE (p = 0.953). Twelve hours after TPE the MAP, vasopressor score and VDI were not significantly different from baseline (p = 0.563, p = 0.317 and p = 0.214 respectively).

Conclusion: In this cohort of patients with severe ALF centrifugal TPE did not significantly affect vasopressor requirements.

No MeSH data available.


Related in: MedlinePlus