Safety and efficacy of plasma exchange therapy for Kawasaki disease in children in intensive care unit: case series

Abstract Background We have reviewed four cases of Kawasaki disease treated with plasma exchange with 5% albumin in electrolyte-balanced solution, according to the recommended guidelines for Kawasaki disease in the intensive care unit, as their responses to intravenous immunoglobulin therapy were poor. Case presentation The four cases were aged between 5 months and 3 years and weighted between 6.4 and 15.6 kg. The plasma levels of C-reactive protein were significantly decreased after plasma exchange (p < 0.05). The dilatations of the coronary artery were found in two cases, but both of them were ameliorated until 1 month after the onset and the other cases recovered without any complications. However, we recognized that one case showed marked decreases in coagulation factors, especially in fibrinogen after each plasma exchange even with a transfusion of fresh frozen plasma. Conclusions Plasma exchange with 5% albumin was effective for refractory Kawasaki disease. However, as there was a possibility of coagulation disorder, attention should be given to changes in coagulation factors like fibrinogen, especially in small patients who need frequent plasma exchange

Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery

Abstract Background It has been reported that prolonged intensive care unit (ICU) stay after cardiac surgery is associated with poor patient outcome. In addition, prolonged stay can block the efficient use of ICU beds with an increase in expenditure of health-care costs. The aim of the present study was to retrospectively determine which pre- and intra-operative factors could significantly affect ICU-free survival days (IFSD) which has been suggested to reflect postoperative patients’ outcome, as well as variables significantly associated with the main predictors of IFSD. Findings We reviewed anesthesia charts and medical records of 145 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) in our hospital from January 2014 to October 2015, and 72 patients’ records were finally used for the analysis. IFSD was a median of 25 days (95% CI 24–26). The multiple regression analysis indicated that preoperative estimated glomerular filtration rate, differences between preoperative mean arterial pressure and mean CPB pressure, and blood lactate level at 2 h after CPB (CPB-2 h) were independently associated with IFSD (β regression coefficients 0.086, −0.083, and −3.601, respectively). Conclusion In addition to preoperative renal function and differences between preoperative MAP and CPB pressure, the lactate level at CPB-2 h could be a major predictor of postoperative outcome in patients undergoing cardiac surgery