Utilization of extracorporeal elimination methods are suggested in patients who have no clinical improvement in respiratory failure (intermediate syndrome) and cholinergic manifestations despite antidotal and supportive treatment.20 There are studies in the literature concluding that elevation in plasma cholinesterase levels and improvement in respiratory functions are achieved by TPE.20,21 Our study’s results support the effectiveness of TPE in the patients under prolonged MV support. Here, BCHE is linked to respiratory failure.