Plasmapheresis in the Intensive Care: The Word Goes to the Nephrologist

Abstract

Nowadays, apheresis treatments include a wide variety of extracorporeal treatments that are advisable in different pathological conditions, ranging from immunological diseases to sepsis, from liver failure to toxic pathologies. Since treatments can be scheduled and repeated at specific intervals, they are usually entrusted to the Transfusion Services. However, in the event of emergency conditions with a quoad vitam prognosis, these special treatments should be performed also in the Intensive Care Units. Nephrologists dispose of the complete know-how to directly perform apheresis in the critical area, where patients with intoxications, poisoning, acute hepatitis, and any other extremely severe clinical status need intensive support to their vital functions (pulmonary, cardiac, neurologic, etc.) An urgent plasmapheresis can be defined as an apheretic treatment that should be started as early as possible, and never more than 24–36 hours after diagnosis, in case of a life-threatening situation and no other valid alternative available. Some neurologic diseases, intoxications, and hemolysis are recognized situations for which plasmapheresis is advisable in association with the pharmacological therapy. Today, the equipment used for the extracorporeal treatments for acute renal failure can also be used for the classical plasma-exchange treatments. The substantial technological familiarity and expertise of nephrologists and nurses make apheresis treatments safe. Moreover, thanks to technological progress, new instruments are now available to treat plasma onto resins rather than replacing it. Such treatments are now applied, among others, especially in sepsis and liver failure, and should be part of the professional training of the nephrological staff working in the critical area.