Haemoperfusion: a Useful Therapy for a Severely Poisoned Patient?

Abstract

<jats:p> Although it is many years since a haemodialysis and haemoperfusion over uncoated and later coated charcoal columns have been used for the treatment of intoxicated patients, the clinical efficacy of these extracorporeal techniques in the treatment of severely poisoned patients remains a matter of debate. Some of the reasons for this controversy may be the indiscriminate use of haemoperfusion in any form of intoxication, the lack of well-controlled studies and the wrong interpretation of the high haemoperfusion clearance values sometimes obtained. Simple pharmacokinetic principles are applied to this type of treatment and some practical guidelines as to how and when haemoperfusion should be applied or presented are reviewed. The limited place of haemoperfusion in the treatment of severe poisoning, its further declining use in the future, at least in its present design, and some promising new treatments are emphasized. </jats:p>

Postmortem Analyses Unveil the Poor Efficacy of Decontamination, Anti-Inflammatory and Immunosuppressive Therapies in Paraquat Human Intoxications

“…In our opinion, unless the procedure is begun at an early stage, when PQ is concentrated in the central compartment, a poor total body PQ clearence by extracorporeal techniques will result. This can be explained by the extensive PQ tissue distribution, as it was observed in this study, and as consequence of its slow redistribution back into the circulation following termination of the extracorporeal removing procedure [24]. In accordance, a rise of PQ concentrations, for several hours following completion of CHP, may ensue, supporting the thought that even in the presence of continuous CHP, the efficacy is not clear.…”

Elimination of Paraquat

“…The clearances achieved by HP and/or HD can equal the renal clearance of paraquat, but the total amount removed remains Figure 1 Efficiency of haemoperfusion (HP) and haemodialysis (HD)/time of death of patient Table 2 Elimination of paraquat (15 g) through haemodialysis (HD) and haemoperfusion (HP) correlated with survival of patient unchanged, unless renal failure occurs. These results suggest that the successful treatment of paraquat poisoning does not depend on modification of toxicokinetics (De Broe et al, 1986). The peculiar disposi-…”

Does Hemoperfusion Increase Survival in Acute Paraquat Poisoning? A Retrospective Multicenter Study

“…Multiple secessions of HP have also been suggested as a reasonable method to remove more PQ because there is often a rebound in plasma PQ concentrations following the termination of the extracorporeal procedure [20]. Prior studies have also noted that multiple secessions of HP were associated with improved survival [21,22].…”