Plasma exchange in the intensive care unit: a narrative review

doi:10.1007/s00134-022-06793-z

Review

. 2022 Oct;48(10):1382-1396.

doi: 10.1007/s00134-022-06793-z. Epub 2022 Aug 12.

Plasma exchange in the intensive care unit: a narrative review

Philippe R Bauer¹, Marlies Ostermann², Lene Russell³, Chiara Robba⁴, Sascha David⁵, Bruno L Ferreyro⁶, Joan Cid⁷, Pedro Castro⁸, Nicole P Juffermans⁹, Luca Montini¹⁰, Tasneem Pirani¹¹, Andry Van De Louw¹², Nathan Nielsen¹³, Julia Wendon¹⁴, Anne C Brignier¹⁵, Miet Schetz¹⁶, Jan T Kielstein¹⁷, Jeffrey L Winters¹⁸, Elie Azoulay¹⁹; Nine-I Investigators

Collaborators, Affiliations

Collaborators

Nine-I Investigators:
Nina Buchtele, Thomas Staudinger, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Peter Jaksch, Karin Amrein, Peter Schellongowski, Thomas Staudinger, Anne-Pascale Meert, Dominique Benoit, Fabio Silvio Taccone, Ana Paula Pierre de Moraes, William Viana, Guilliana Moralez, Thiago Lishoa, Marcio Soares, Jorge Salluh, U V Silva, Sumech Shah, Sangeeta Mehta, Laveena Munshi, Balik Martin, Karvunidis Thomas, Katerina Rusinova, Jonas Nelsen, Ann M Moeller, Anders Perner, Sylvest Meyhoff, Ramin Brandt Bukan, Lene B Nielsen, Docent Anne Kuitunen, Miia Valkonen, Antoine Rabbat, Isabelle Vinatier, Kada Klouche, Laura Platon, Martine Nyunga, Alexandre Demoule, Julien Mayaux, Akli Chermak, Caroline Lemaitre, Elise Artaud-Macari, Elie Azoulay, Virginie Lemiale, Virginie Souppart, Michael Darmon, Lara Zafrani, Sandrine Valade, Djamel Mokart, Benjamin Gaborit, Emmanuel Canet, Amélie Séguin, Sylvie Chevret, Nicolas Terzi, Carole Schwebel, Achille Kouatchet, Fabrice Bruneel, Frédéric Pène, Anne Sophie Moreau, Christophe Girault, Francois Barbier, Aisling Mc Mahon, Brian Marsh, Ignacio Martin Loeches, Gilda Cinnella, Antonella Cotoia, Massimo Antonelli, Luca Montini, Thomas Kaufmann, Dennis Bergmans, Angélique Spoelstra-de Man, Peter Pickkers, Pleun Hemelaar, Precious Pearl Landburg, Pål Klepstad, Andreas Barratt-Due, Belen Encina, Val Hebron, Gabriel Moreno, Emilio Rodriguez Luis, Llorenç Socias Crespi, Jordi Rello, Victoria Metaxa, Yadav Hemang, Philippe R Bauer, Andry van de Louw, Gaston Burghi

Affiliations

¹ Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Bauer.Philippe@mayo.edu.
² Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
³ Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
⁴ Anesthesia and Intensive Care, Policlinico San Martino, Genoa, Italy.
⁵ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
⁷ Unitat d'Afèresi i Teràpia Cel·lular, Banc de Progenitors Hematopoètics, Servei d'Hemoteràpia i Hemostàsia, ICMHO, Hospital Clinic, IDIBAPS, Barcelona, Spain.
⁸ Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁹ Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁰ Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
¹¹ Critical Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
¹² Penn State Health, Hershey, USA.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, New Mexico, USA.
¹⁴ Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
¹⁵ Apheresis Unit, Immuno-Hematology, Hôpital Saint-Louis, APHP, Paris, France.
¹⁶ Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Leuven, Belgium.
¹⁷ Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany.
¹⁸ Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
¹⁹ Médecine Intensive et Réanimation, Hôpital Saint-Louis, APHP, Paris, France.

PMID: 35960275
PMCID: PMC9372988
DOI: 10.1007/s00134-022-06793-z

Review

Plasma exchange in the intensive care unit: a narrative review

Philippe R Bauer et al. Intensive Care Med. 2022 Oct.

. 2022 Oct;48(10):1382-1396.

doi: 10.1007/s00134-022-06793-z. Epub 2022 Aug 12.

Authors

Collaborators

Nine-I Investigators:
Nina Buchtele, Thomas Staudinger, Gottfried Heinz, Gürkan Sengölge, Christian Zauner, Peter Jaksch, Karin Amrein, Peter Schellongowski, Thomas Staudinger, Anne-Pascale Meert, Dominique Benoit, Fabio Silvio Taccone, Ana Paula Pierre de Moraes, William Viana, Guilliana Moralez, Thiago Lishoa, Marcio Soares, Jorge Salluh, U V Silva, Sumech Shah, Sangeeta Mehta, Laveena Munshi, Balik Martin, Karvunidis Thomas, Katerina Rusinova, Jonas Nelsen, Ann M Moeller, Anders Perner, Sylvest Meyhoff, Ramin Brandt Bukan, Lene B Nielsen, Docent Anne Kuitunen, Miia Valkonen, Antoine Rabbat, Isabelle Vinatier, Kada Klouche, Laura Platon, Martine Nyunga, Alexandre Demoule, Julien Mayaux, Akli Chermak, Caroline Lemaitre, Elise Artaud-Macari, Elie Azoulay, Virginie Lemiale, Virginie Souppart, Michael Darmon, Lara Zafrani, Sandrine Valade, Djamel Mokart, Benjamin Gaborit, Emmanuel Canet, Amélie Séguin, Sylvie Chevret, Nicolas Terzi, Carole Schwebel, Achille Kouatchet, Fabrice Bruneel, Frédéric Pène, Anne Sophie Moreau, Christophe Girault, Francois Barbier, Aisling Mc Mahon, Brian Marsh, Ignacio Martin Loeches, Gilda Cinnella, Antonella Cotoia, Massimo Antonelli, Luca Montini, Thomas Kaufmann, Dennis Bergmans, Angélique Spoelstra-de Man, Peter Pickkers, Pleun Hemelaar, Precious Pearl Landburg, Pål Klepstad, Andreas Barratt-Due, Belen Encina, Val Hebron, Gabriel Moreno, Emilio Rodriguez Luis, Llorenç Socias Crespi, Jordi Rello, Victoria Metaxa, Yadav Hemang, Philippe R Bauer, Andry van de Louw, Gaston Burghi

Affiliations

¹ Division of Pulmonary and Critical Care, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. Bauer.Philippe@mayo.edu.
² Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
³ Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
⁴ Anesthesia and Intensive Care, Policlinico San Martino, Genoa, Italy.
⁵ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
⁷ Unitat d'Afèresi i Teràpia Cel·lular, Banc de Progenitors Hematopoètics, Servei d'Hemoteràpia i Hemostàsia, ICMHO, Hospital Clinic, IDIBAPS, Barcelona, Spain.
⁸ Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁹ Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁰ Department of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
¹¹ Critical Care Unit, King's College Hospital NHS Foundation Trust, London, UK.
¹² Penn State Health, Hershey, USA.
¹³ Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico School of Medicine, New Mexico, USA.
¹⁴ Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
¹⁵ Apheresis Unit, Immuno-Hematology, Hôpital Saint-Louis, APHP, Paris, France.
¹⁶ Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Leuven, Belgium.
¹⁷ Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany.
¹⁸ Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
¹⁹ Médecine Intensive et Réanimation, Hôpital Saint-Louis, APHP, Paris, France.

PMID: 35960275
PMCID: PMC9372988
DOI: 10.1007/s00134-022-06793-z

Abstract

In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.

Keywords: Intensive care units; Patient care team; Plasma exchange; Plasmapheresis; State-of-the-art review.

PubMed Disclaimer

Conflict of interest statement

JC received speaker fees from Fresenius Kabi and Terumo Blood and Cell Technologies. JTK received speaker fees from Fresenius Medical Care and ExThera Medical.

Figures

**Fig. 1**
Therapeutic plasma exchange: overview. *TPE* therapeutic plasma exchange, *HIV* human immunodeficiency virus

**Fig. 2**
Progressive decrease in plasma concentration of substance following four consecutive TPE treatments equaling 1.2 plasma volume each. *TPE* therapeutic plasma exchange

See this image and copyright information in PMC

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References

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1. Abe T, Matsuo H, Abe R, Abe S, Asada H, Ashida A, Baba A, Eguchi K, Eguchi Y, Endo Y, Fujimori Y, Furuichi K, Furukawa Y, Furuya M, Furuya T, Hanafusa N, Hara W, Harada-Shiba M, Hasegawa M, Hattori N, Hattori M, Hidaka S, Hidaka T, Hirayama C, Ikeda S, Imamura H, Inoue K, Ishizuka K, Ishizuka K, Ito T, Iwamoto H, Izaki S, Kagitani M, Kaneko S, Kaneko N, Kanekura T, Kitagawa K, Kusaoi M, Lin Y, Maeda T, Makino H, Makino S, Matsuda K, Matsugane T, Minematsu Y, Mineshima M, Miura K, Miyamoto K, Moriguchi T, Murata M, Naganuma M, Nakae H, Narukawa S, Nohara A, Nomura K, Ochi H, Ohkubo A, Ohtake T, Okada K, Okado T, Okuyama Y, Omokawa S, Oji S, Sakai N, Sakamoto Y, Sasaki S, Sato M, Seishima M, Shiga H, Shimohata H, Sugawara N, Sugimoto K, Suzuki Y, Suzuki M, Tajima T, Takikawa Y, Tanaka S, Taniguchi K, Tsuchida S, Tsukamoto T, Tsushima K, Ueda Y, Wada T, Yamada H, Yamada H, Yamaka T, Yamamoto K, Yokoyama Y, Yoshida N, Yoshioka T, Yamaji K. The Japanese Society for Apheresis clinical practice guideline for therapeutic apheresis. Ther Apher Dial. 2021;25:728–876. doi: 10.1111/1744-9987.13749. - DOI - PubMed
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[1] Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol. 2014;164:342–351. doi: 10.1111/bjh.12629. - DOI - PubMed

[2] Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol. 2014;164:342–351. doi: 10.1111/bjh.12629. - DOI - PubMed

[3] Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher. 2019;34:171–354. doi: 10.1002/jca.21705. - DOI - PubMed

[4] Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher. 2019;34:171–354. doi: 10.1002/jca.21705. - DOI - PubMed

[5] Abe T, Matsuo H, Abe R, Abe S, Asada H, Ashida A, Baba A, Eguchi K, Eguchi Y, Endo Y, Fujimori Y, Furuichi K, Furukawa Y, Furuya M, Furuya T, Hanafusa N, Hara W, Harada-Shiba M, Hasegawa M, Hattori N, Hattori M, Hidaka S, Hidaka T, Hirayama C, Ikeda S, Imamura H, Inoue K, Ishizuka K, Ishizuka K, Ito T, Iwamoto H, Izaki S, Kagitani M, Kaneko S, Kaneko N, Kanekura T, Kitagawa K, Kusaoi M, Lin Y, Maeda T, Makino H, Makino S, Matsuda K, Matsugane T, Minematsu Y, Mineshima M, Miura K, Miyamoto K, Moriguchi T, Murata M, Naganuma M, Nakae H, Narukawa S, Nohara A, Nomura K, Ochi H, Ohkubo A, Ohtake T, Okada K, Okado T, Okuyama Y, Omokawa S, Oji S, Sakai N, Sakamoto Y, Sasaki S, Sato M, Seishima M, Shiga H, Shimohata H, Sugawara N, Sugimoto K, Suzuki Y, Suzuki M, Tajima T, Takikawa Y, Tanaka S, Taniguchi K, Tsuchida S, Tsukamoto T, Tsushima K, Ueda Y, Wada T, Yamada H, Yamada H, Yamaka T, Yamamoto K, Yokoyama Y, Yoshida N, Yoshioka T, Yamaji K. The Japanese Society for Apheresis clinical practice guideline for therapeutic apheresis. Ther Apher Dial. 2021;25:728–876. doi: 10.1111/1744-9987.13749. - DOI - PubMed

[6] Abe T, Matsuo H, Abe R, Abe S, Asada H, Ashida A, Baba A, Eguchi K, Eguchi Y, Endo Y, Fujimori Y, Furuichi K, Furukawa Y, Furuya M, Furuya T, Hanafusa N, Hara W, Harada-Shiba M, Hasegawa M, Hattori N, Hattori M, Hidaka S, Hidaka T, Hirayama C, Ikeda S, Imamura H, Inoue K, Ishizuka K, Ishizuka K, Ito T, Iwamoto H, Izaki S, Kagitani M, Kaneko S, Kaneko N, Kanekura T, Kitagawa K, Kusaoi M, Lin Y, Maeda T, Makino H, Makino S, Matsuda K, Matsugane T, Minematsu Y, Mineshima M, Miura K, Miyamoto K, Moriguchi T, Murata M, Naganuma M, Nakae H, Narukawa S, Nohara A, Nomura K, Ochi H, Ohkubo A, Ohtake T, Okada K, Okado T, Okuyama Y, Omokawa S, Oji S, Sakai N, Sakamoto Y, Sasaki S, Sato M, Seishima M, Shiga H, Shimohata H, Sugawara N, Sugimoto K, Suzuki Y, Suzuki M, Tajima T, Takikawa Y, Tanaka S, Taniguchi K, Tsuchida S, Tsukamoto T, Tsushima K, Ueda Y, Wada T, Yamada H, Yamada H, Yamaka T, Yamamoto K, Yokoyama Y, Yoshida N, Yoshioka T, Yamaji K. The Japanese Society for Apheresis clinical practice guideline for therapeutic apheresis. Ther Apher Dial. 2021;25:728–876. doi: 10.1111/1744-9987.13749. - DOI - PubMed

[7] Pham HP, Schwartz J. Therapeutic plasma exchange in Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med. 2019;48:338–346. doi: 10.1016/j.lpm.2019.03.016. - DOI - PubMed

[8] Pham HP, Schwartz J. Therapeutic plasma exchange in Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med. 2019;48:338–346. doi: 10.1016/j.lpm.2019.03.016. - DOI - PubMed

[9] Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017;2:CD001798. doi: 10.1002/14651858.CD001798.pub3. - DOI - PMC - PubMed

[10] Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017;2:CD001798. doi: 10.1002/14651858.CD001798.pub3. - DOI - PMC - PubMed

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Plasma exchange in the intensive care unit: a narrative review

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Affiliations

Plasma exchange in the intensive care unit: a narrative review

Authors

Collaborators

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Abstract

Conflict of interest statement

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Cited by

References

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