Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning.
Paraquat poisoning is characterized by multiorgan failure and pulmonary fibrosis with respiratory failure. Multiorgan failure with circulatory collapse is a major cause of early death within 3 days of paraquat ingestion. Recent studies suggested that continuous venovenous hemofiltration (CVVH) had a role in the treatment of multiorgan failure by promoting hemodynamic stability. We therefore evaluated the effect of prophylactic CVVH in 80 patients with paraquat poisoning (August 1996 to February 1999). The amount ingested was 2.1 +/- 1.0 mouthfuls (as 20% concentrate). All patients were treated with hemoperfusion (HP; duration, 6.4 +/- 3.0 hours) within 24 hours of ingestion and then randomly assigned to the HP-alone or HP-CVVH group. Forty-four patients underwent HP only, and 36 patients underwent CVVH (duration, 57.4 +/- 31.3 hours; ultrafiltration volume, 40.2 +/- 4.8 L/d) after HP. Although time to death after ingestion was significantly longer in the HP-CVVH than HP group (5.0 +/- 5.0 versus 2.5 +/- 2.1 days; P < 0.05), there was no difference in mortality rates between the two groups (66.7% versus 63.6%; P = 0.82). In the HP group, early circulatory collapse was a major cause of death compared with the HP-CVVH group, in which late respiratory failure was a major cause of death. In conclusion, prophylactic CVVH after HP prevented early death caused by circulatory collapse and prolonged survival time. However, it could not prevent late death caused by respiratory failure and did not provide a survival benefit in acute paraquat poisoning.
Koo
Ja-Ryong
JR
Division of Nephrology, College of Medicine, Hallym University, Chunchon, Kangwon Do, Seoul, Korea. kjr@hallym.or.kr
Kim
Jin-Cheol
JC
Yoon
Jong-Woo
JW
Kim
Gheun-Ho
GH
Jeon
Rho-Won
RW
Kim
Hyung-Jik
HJ
Chae
Dong-Wan
DW
Noh
Jung-Woo
JW
D000328:Adult; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality; D006440:Hemofiltration; D006464:Hemoperfusion; D006801:Humans; D008297:Male; D008875:Middle Aged; D010269:Paraquat / Q000506:poisoning*; D011041:Poisoning / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D017211:Treatment Failure
D010269:Paraquat