Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients

Abstract

Objective: To determine whether haemoperfusion (HP) with continuous venovenous haemofiltration (CVVH) improves the survival of patients with acute paraquat poisoning, compared with those treated using HP alone. Methods: Medical records of patients with acute paraquat poisoning were analysed. Patients were randomised to undergo HP or HP þ CVVH within 24 h of paraquat ingestion. Mortality rate, survival duration and cause of death were recorded. Results: There were no significant differences in mortality rate between the HP group (n ¼ 458) and the HP þ CVVH group (n ¼ 226) (57.4% and 58.4%, respectively). The mean survival duration was significantly longer in the HP þ CVVH group than the HP group (8.6 AE 3.1 and 5.1 AE 2.3 days, respectively). Early circulatory collapse was a major cause of death in the HP group. The major cause of death in the HP þ CVVH group was late respiratory failure. Conclusion: Combined therapy with HP and CVVH can prevent early death and prolong survival duration following acute paraquat poisoning, providing the opportunity for further treatment.

Immunosuppressive drugs to reduce the mortality rate in patients with moderate to severe paraquat poisoning: A Meta-analysis

“…In some other observational studies, the study by Jie Gao et al states that prolonged MP therapy after pulse treatment can reduce the mortality of moderate-to-severe PQ poisoning patients (Gao et al, 2017). Early hemoperfusion may improve the survival chances of PQ poisoning patients, as was confirmed in three studies (Gao et al, 2015;Hsu et al, 2012;Wang et al, 2017). A multivariate logistic regression analysis showed that the addition of vitamin C to the treatment was significantly associated with increased survival of the patients in the study by Moon and Chun (2011).…”

The Role of Early Haemoperfusion/Haemodialysis With Steroids, Cyclophosphamide, N Acetyl Cysteine and Everolimus in Acute Paraquat Poisoning: Is There Still Hope?

“…The survival advantage of early haemoperfusion following paraquat exposure has been addressed in various studies. [5], [6] 8 patients received Haemoperfusion while 14 patients received early Haemodialysis for toxin removal.2 patients died before extracorporeal therapy could be initiated. Pulse steroids and cyclophosphamide are generally given to reduce the inflammation process in the lung following paraquat ingestion.…”

Continuous venovenous hemofiltration in the management of paraquat poisoning

“…[13–17] Compared to HP, continuous venovenous hemofiltration (CVVH), the most commonly used type of continuous renal replacement therapy, possesses diffusive, convective, and adsorptive functions. [18,19] Theoretically, these features of CVVH cannot only help remove the toxin from the blood, but can also help clear the large number of inflammatory mediators and inflammatory factors produced upon PQ poisoning. However, although CVVH has already been applied for the treatment of PQ poisoning in clinical practice, its efficacy remains controversial.…”

“…However, although CVVH has already been applied for the treatment of PQ poisoning in clinical practice, its efficacy remains controversial. [9,18–21] Therefore, in the present study, we conducted a meta-analysis of reported randomized controlled trials (RCTs) to further clarify the efficacy of CVVH in the treatment of PQ poisoning.…”