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Background .Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics &amp; outcome. Methods.  We conducted a prospective, before-after case series study on 16 septic shock patients requiring high doses of vasopressors admitted in two ICUs from Cairo, Egypt. All of our patients received TPE within 4 hours of ICU admission. The fresh frozen plasma exchange volume = 1.5 × plasma volume. Results.  In the 16 patients included in the study, mean arterial pressure was significantly improved after the initial TPE (p &lt; 0.002) and norepinephrine dose which significantly reduced post TPE (p &lt; 0.001). In addition, norepinephrine dose to mean arterial pressure significantly improved (p &lt; 0.001). There was reduction of a net 6 hours fluid balances following the first TPE were observed in all the patients (p &lt; 0.03) by a mean of 757 ml. Systemic vascular resistance index was markedly improved post-TPE along with statistically improved cardiac index (p &lt; 0.01). Stroke volume variance was also significantly decreased after the TPE sessions (p &lt; 0.01). C-reactive protein significantly improved after TPE (P &lt; 0.01). Conclusion.  Early initiation of TPE in severe septic shock patients might improve hemodynamic measures.

Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients