Authors: (including presenting author): :
Lau K Y (1), Yeung M W (1), Lo WPJ (1)
Affiliation: :
Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Keyword 3: :
multi-organ failure
Introduction: :
Critically ill patients with multi organ dysfunction frequently require extracorporeal purification to stabilize patient’s condition and support failing organs. To support both hepatic and renal function of the patient, Therapeutic Plasma Exchange (TPE) and Continuous Renal Replacement Therapy (CRRT) provide complementary removal of protein bound and small molecule toxins while maintaining fluid, electrolyte, and acid–base homeostasis. When delivered concurrently through a single vascular access, combined therapy may streamline complex care, minimize catheter manipulation, and reduce the risk of catheter associated bloodstream infection. For hemodynamically unstable patients who cannot tolerate interruptions in either therapy, concurrent CRRT–TPE offers a potential rescue strategy to maintain stability during critical deterioration.
Objectives: :
To evaluate the feasibility, safety, and clinical effectiveness of concurrent CRRT–TPE in critically ill patients with multi organ failure presenting with hepatorenal syndrome.
Methodology: :
A retrospective cohort review was conducted on six critically ill patients admitted in 2025 who received concurrent CRRT–TPE. Both therapeutic circuits were run in parallel via the same vascular access. Clinical parameters—including hemodynamic status, biochemical markers, coagulation profile, and occurrence of complications—were closely monitored. In addition, staff perceptions of competency, troubleshooting ability, and readiness to manage the complex setup were assessed using a 5 point Likert questionnaire.
Result & Outcome: :
Concurrent CRRT–TPE achieved significant biochemical improvements, including reductions in ammonia (40%), alanine aminotransferase (ALT) (39%), creatinine (39%), and lactate (24%), alongside correction of metabolic acidosis. Hemodynamic instability (4cases, 67%), bleeding (1 case,17%), and hemolysis (2cases,33%) were present prior to treatment and were attributed to underlying disease rather than the extracorporeal modalities. Despite severely deranged coagulation profiles, only one episode of circuit clotting (16.7%) occurred, necessitating temporary suspension of CRRT while TPE continued to completion. Staff self evaluation revealed limited confidence in managing the combined setup, with mean scores indicating low familiarity (2.83), moderate operational readiness (3.0), and moderate troubleshooting capability (3.17). Highlighted the need for structured training to reduce the stress associated with advanced technology and skill requirements. Concurrent CRRT–TPE appears feasible, safe, and clinically beneficial for patients with multi organ failure. Early initiation, appropriate patient selection, and enhanced staff training may further optimize outcomes and support its role as a rescue therapy before bridging to definitive treatment.
