In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.

在这篇叙述性综述中，我们讨论了危重患者治疗性血浆置换 (TPE) 的相关问题。对于许多情况，最佳适应症、设备类型、频率、持续时间、置换液类型和停止 TPE 的标准是不确定的。TPE 是一种可能挽救生命但也是侵入性手术，存在不良事件和并发症的风险，需要经验丰富的团队进行密切监测。在重症监护病房（ICU），TPE的适应症可分为（1）绝对的、公认的和循证的，TPE被认为是一线治疗，（2）相对的，TPE是公认的二线治疗（单独或联合）和 (3)抢救疗法，其中 TPE 在有限或理论证据基础下使用。新的适应症不断涌现，知识差距持续存在，特别是关于在危重疾病期间使用 TPE，支持建立专门用于重症监护医学的 TPE 注册。