Affiliations: University Hospital of Freiburg, Department of
Pediatrics, Mathildenstrasse 1, D-79106 Freiburg, Germany | Universitätsklinik für Kinder und Jugendliche,
Anichstrasse 35, A- 6020 Innsbruck, Austria
Note: [] Correspondence: Marcus Krueger, MD, University Hospital of
Freiburg, Department of Pediatrics, Mathildenstrasse 1, D-79106 Freiburg,
Germany. Tel.: +49 761 270 4300; Fax: +49 761 270 4481; E-mail:
krueger@kikli.ukl.uni-freiburg.de
Abstract: Despite advances in the management of severe sepsis, the mortality
rate of septic shock in children and adults remains high. Meningococcal disease
is the leading cause of sepsis affecting previously healthy children and young
adults. In a septic infection, the production and release of mediators of
inflammation may lead to severe organ damage. The use of plasma exchange is
intended to reduce the level of inflammatory mediators as an adjunctive therapy
accompanying the standard medical care. We retrospectively studied six patients
(median age 6.5 years, range 0.8–16 years) suffering from primary septic
shock (4/6 with a proven meningococcal disease) who were treated with a single
plasma exchange. The inclusion criteria for plasma exchange were clinical
impression of a septic shock showing typical skin lesions and a refractory
hypotension after volume therapy. The plasma exchange was conducted once
between 3 and 8 hours after admission for a period of 1–3.3 hours. The
Pediatric Risk of Mortality (PRISM-I) score ranged from 10 to 36. The mortality
rate was 33%, but all of the four patients suffering from meningococcal sepsis
survived. Neither circulatory conditions nor oxygenation showed relevant
improvement during plasma exchange or in the two hours afterwards. All patients
with proven meningococcal sepsis survived, but based on the limited number of
patients in this study further conclusions can not be drawn. From the clinical
and pathophysiological studies available so far, there is insufficient evidence
to justify the use of plasma exchange as standard treatment in primary septic
shock in children.
