PDF(Pubmed)
Abstract：
UNASSIGNED: Pediatric acute liver failure (PALF) is a life-threatening condition. Extracorporeal support has been applied for toxic metabolite clearance and serves as a bridging therapy to liver transplantation (LT) or to the regeneration of the liver, but evidence for treatment approaches is still lacking in the pediatric population. We aim to report our experience on therapeutic plasma exchange with high-volume continuous renal replacement therapy (TPE + HV-CRRT) as a promising supportive treatment for PALF.
UNASSIGNED: A total of eight PALF cases aged 9 months to 14 years, weighing 10-50 kg., who were admitted to PICU King Chulalongkorn Memorial Hospital, Thailand and treated with TPE + HV-CRRT from January 2016 to September 2019 were reviewed. Patient demographic data, indications, technical aspects, and clinical outcomes were recorded.
UNASSIGNED: All patients who underwent TPE + HV-CRRT showed clinical improvement regarding serum bilirubin levels and coagulation studies after the therapy. Complications from the therapy were hemodynamic instability, symptomatic fluid overload, and bleeding from catheter sites. Among these, 6 (75%) patients survived with 4 (50%) successful LTs and 2 (25%) spontaneous recovery. Two children (25%) died while on the transplantation list.
UNASSIGNED: TPE + HV-CRRT can be used safely as a bridging therapy in children with PALF. As opposed to the adult population, higher volume of TPE or higher blood flow rate in pediatric patients might associate with hemodynamic instability during the procedure.
UNASSIGNED: Trepatchayakorn S, Chaijitraruch N, Chongsrisawat V, Chanakul A, Kongkiattikul L, Samransamruajkit R. Therapeutic Plasma Exchange with Continuous Renal Replacement Therapy for Pediatric Acute Liver Failure: A Case Series from Thailand. Indian J Crit Care Med 2021;25(7):812-816.
UNASSIGNED: A total of eight PALF cases aged 9 months to 14 years, weighing 10-50 kg., who were admitted to PICU King Chulalongkorn Memorial Hospital, Thailand and treated with TPE + HV-CRRT from January 2016 to September 2019 were reviewed. Patient demographic data, indications, technical aspects, and clinical outcomes were recorded.
UNASSIGNED: All patients who underwent TPE + HV-CRRT showed clinical improvement regarding serum bilirubin levels and coagulation studies after the therapy. Complications from the therapy were hemodynamic instability, symptomatic fluid overload, and bleeding from catheter sites. Among these, 6 (75%) patients survived with 4 (50%) successful LTs and 2 (25%) spontaneous recovery. Two children (25%) died while on the transplantation list.
UNASSIGNED: TPE + HV-CRRT can be used safely as a bridging therapy in children with PALF. As opposed to the adult population, higher volume of TPE or higher blood flow rate in pediatric patients might associate with hemodynamic instability during the procedure.
UNASSIGNED: Trepatchayakorn S, Chaijitraruch N, Chongsrisawat V, Chanakul A, Kongkiattikul L, Samransamruajkit R. Therapeutic Plasma Exchange with Continuous Renal Replacement Therapy for Pediatric Acute Liver Failure: A Case Series from Thailand. Indian J Crit Care Med 2021;25(7):812-816.
摘要：
■小儿急性肝衰竭（PALF）是一种危及生命的疾病。体外支持已应用于有毒代谢物清除，并作为肝移植（LT）或肝脏再生的桥接疗法，但是儿科人群仍然缺乏治疗方法的证据。我们的目标是报告我们在治疗性血浆置换和高容量连续性肾脏替代疗法（TPEHV-CRRT）作为PALF的有希望的支持治疗方法的经验。
■共有8例9个月至14岁的PALF病例，重10-50公斤。,他们被送进了PICU朱拉隆功国王纪念医院，对2016年1月至2019年9月接受TPE+HV-CRRT治疗的泰国进行了回顾。患者人口统计数据，适应症,技术方面,并记录临床结局.
■所有接受TPE+HV-CRRT治疗的患者在治疗后血清胆红素水平和凝血研究方面均表现出临床改善。治疗的并发症是血流动力学不稳定，有症状的液体超负荷，还有导管部位的出血.其中,6例（75％）患者存活，4例（50％）成功的LTs和2例（25％）自发恢复。两名儿童（25％）在移植名单上死亡。
■TPE+HV-CRRT可安全用作PALF患儿的桥接治疗。与成年人相反，在儿科患者中,较高的TPE量或较高的血流速度可能与手术过程中的血流动力学不稳定有关.
■TrepatchayakornS,ChaijitraruchN,ChongsrisawatV,ChanakulA,KongkiattikulL,SamransamruajkitR.连续性肾脏替代治疗小儿急性肝衰竭的治疗性血浆置换：来自泰国的病例系列。印度JCritCareMed2021；25（7）：812-816。
■共有8例9个月至14岁的PALF病例，重10-50公斤。,他们被送进了PICU朱拉隆功国王纪念医院，对2016年1月至2019年9月接受TPE+HV-CRRT治疗的泰国进行了回顾。患者人口统计数据，适应症,技术方面,并记录临床结局.
■所有接受TPE+HV-CRRT治疗的患者在治疗后血清胆红素水平和凝血研究方面均表现出临床改善。治疗的并发症是血流动力学不稳定，有症状的液体超负荷，还有导管部位的出血.其中,6例（75％）患者存活，4例（50％）成功的LTs和2例（25％）自发恢复。两名儿童（25％）在移植名单上死亡。
■TPE+HV-CRRT可安全用作PALF患儿的桥接治疗。与成年人相反，在儿科患者中,较高的TPE量或较高的血流速度可能与手术过程中的血流动力学不稳定有关.
■TrepatchayakornS,ChaijitraruchN,ChongsrisawatV,ChanakulA,KongkiattikulL,SamransamruajkitR.连续性肾脏替代治疗小儿急性肝衰竭的治疗性血浆置换：来自泰国的病例系列。印度JCritCareMed2021；25（7）：812-816。
