Navigating Therapeutic Plasma Exchange in Critically Ill Children: A Retrospective Review of Indications, Timing, Outcomes, and Complications in a Developing Nation <scp>PICU</scp>

To retrospectively review the indications, timing, outcomes, and complications of membrane-based therapeutic plasma exchange (mTPE) in critically ill children at a single-center pediatric intensive care unit (PICU). Retrospective observational study. A tertiary-care PICU at All-India Institute of Medical Sciences (AIIMS), Raipur. A total of 106 patients aged 1 month to 18 years who underwent mTPE between January 2022 and December 2024. Patients had a median age of 144 months (IQR: 13-216). Renal and hepatic diseases were the most common indications. Overall, 61.3% of patients recovered and were discharged. Complications (inclusive of minor and line-related events) were observed in 35.8% of patients. Logistic regression analysis identified fluid-refractory shock at admission (p < 0.001), elevated Pediatric Risk of Mortality (PRISM-3) scores (p = 0.007), and concurrent continuous renal replacement therapy (CRRT) (p = 0.016) as statistically significant predictors of mortality. In the subgroup of patients with liver disease, time to mTPE initiation was an independent, significant predictor of mortality (p = 0.013). Membrane-based therapeutic plasma exchange is a safe and feasible adjunct therapy in critically ill children. While mTPE is most effective for conditions classified as American Society for Apheresis (ASFA) category I, its outcomes are highly variable and are significantly influenced by the underlying condition and the timing of the intervention, particularly for acute liver failure.