Sascha David, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland. Department of Nephrology and Hypertension, Hannover Medical School, Hannover, GermanyFollow
Lene Russell, Department of Intensive Care, Copenhagen University Hospital Gentofte, Copenhagen, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Pedro Castro, Medical Intensive Care Unit, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
Andry van de Louw, Medical Intensive Care Unit, Penn State Health Hershey Medical Center, Hershey, PA USA.
Lara Zafrani, Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France.
Tasneem Pirani, King’s College Hospital, General and Liver Intensive Care, London, UK
Nathan D. Nielsen, Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA.
Eric Mariotte, Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France.
Bruno L. Ferreyro, Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada.
Jan T. Kielstein, Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany.
Luca Montini, Department of Intensive Care Medicine and Anesthesiology, “Fondazione Policlinico Universitario Agostino Gemelli IRCCS” Università Cattolica del Sacro Cuore, Rome, Italy.
Anne C. Brignier, Apheresis Unit, Saint-Louis Hospital, AP-HP, University of Paris Cite, Paris, France.
Matthias Kochanek, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO), University of Cologne, Cologne, Germany.
Joan Cid, Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
Chiara Robba, IRCCS per Oncologia e Neuroscienze, Genoa, Italy. Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate, Universita’ di Genova, Genoa, Italy
Ignacio Martin-Loeches, Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, Dublin, D08 NHY1 Ireland. Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, D02 PN91 Ireland. Institut D’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universidad de Barcelona, Ciberes, Barcelona, Spain.
Marlies Ostermann, Department of Intensive Care, Guy’s & St Thomas’ Hospital, King’s College London, London, UK.
Nicole P. Juffermans, Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands. Laboratory of Translational Intensive Care, Erasmus MC, Rotterdam, The Netherlands.

Document Type

Article

Publication Date

5-8-2023

Abstract

Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to "TPE in the critically ill patient". These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk-benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.

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