title: Systemic lithium reabsorption from lithium-chloride-coated heat and moisture exchangers.
abstract: OBJECTIVE
  To evaluate possible reabsorption and systemic effects of lithium released by lithium-chloride-coated heat and moisture exchangers (HMEs) during prolonged mechanical ventilation.
  
  
  METHODS
  Prospective study, including all patients mechanically ventilated for 5-30 days.
  
  
  METHODS
  A 7 bed general-traumatological ICU in a University Hospital.
  
  
  METHODS
  27 consecutive ICU patients, admitted following trauma, neurosurgery and respiratory insufficiency, mechanically ventilated for at least 5 days, with a lithium coated hygroscopic HME in the circuit.
  
  
  RESULTS
  Serum lithium levels were measured daily, with a standard laboratory spectrophotometric method, from admission to discharge from the ICU, and showed a reabsorption of lithium in all the patients; in the adults, levels were 5 to 15 times lower than therapeutic range, while in a child therapeutic and even toxic levels were reached.
  
  
  CONCLUSIONS
  LiCl coat enhances HMEs' performance greatly, but reabsorption and systemic action must be considered. In adults, serum lithium levels were lower than the therapeutic range, but lithium is effective at low concentrations and it has a narrow therapeutic range; moreover, toxicity can be observed within this range too. In children, the risk of toxicity is much greater. When lithium coated HMEs are used, the risk/benefit ratio between good performance and systemic reabsorption must be evaluated carefully.
authors.affiliation: Istituto di Anestesia e Rianimazione, Nuovo Policlinico, Siena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Rosi
authors.forename: A
authors.initials: A
authors.lastname: Buscalferri
authors.forename: M R
authors.initials: MR
authors.lastname: Monfregola
authors.forename: S
authors.initials: S
authors.lastname: Criscuolo
authors.forename: P
authors.initials: P
authors.lastname: Dal Pra
authors.forename: A
authors.initials: A
authors.lastname: Stanca
mesh_terms: D000042:Absorption; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018692:Antimanic Agents / Q000097:blood* / Q000506:poisoning; D002648:Child; D016903:Drug Monitoring; D005260:Female; D006358:Hot Temperature; D006801:Humans; D016651:Lithium Carbonate / Q000097:blood* / Q000506:poisoning; D018021:Lithium Chloride / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D018692:Antimanic Agents; D016651:Lithium Carbonate; D018021:Lithium Chloride