Blood Purification for Paraquat Poisoning
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
This research article compares the effectiveness of oral versus intravenous proton pump inhibitors (PPIs) in preventing re-bleeding in patients with peptic ulcer bleeding after successful endoscopic therapy. 100 patients were randomly assigned to receive either oral lansoprazole or intravenous esomeprazole after endoscopic hemostasis. The re-bleeding rates within 14 days were similar between the two groups. Patients receiving oral PPI had a shorter hospital stay. While no differences in clinical outcomes were found, the study was not powered to prove equivalence between the oral and intravenous PPI treatments. Larger studies are still needed to further compare the effectiveness of oral versus intravenous PPI administration.
This systematic review and meta-analysis examined whether intermittent PPI therapy is noninferior to continuous intravenous PPI infusion for patients with high-risk bleeding ulcers after endoscopic treatment. The analysis found that intermittent PPI therapy was noninferior to continuous infusion, with an absolute risk difference of recurrent bleeding within 7 days of -0.28%, below the predefined noninferiority margin of 3%. Secondary outcomes of bleeding within 3 and 30 days also showed noninferiority of intermittent PPI therapy. Thus, intermittent PPI therapy is an acceptable alternative to continuous infusion for these high-risk patients.
This study establishes reference intervals for whole blood and plasma colloid osmotic pressure (COP) measurements in healthy cats. Whole blood COP was measured in 63 cats and found to have a mean of 24.4 mmHg with a reference interval of 18.9 to 30.4 mmHg. Plasma COP was measured in 52 cats and found to have a mean of 24.3 mmHg with a reference interval of 18.3 to 30.8 mmHg. There was no significant difference found between mean whole blood and plasma COP measurements. Total protein and albumin levels were found to be significantly correlated with whole blood and plasma COP levels.
The ProCESS trial found no significant difference in mortality between patients receiving protocol-based early goal-directed therapy (EGDT), protocol-based standard therapy, or usual care for early septic shock. While the EGDT group received fluid resuscitation more consistently, there were no differences in outcomes like mortality, organ failure, or length of stay. This prompted review by the Surviving Sepsis Campaign. They concluded that early diagnosis and treatment remain important. ProCESS did not assess patients with severe sepsis without shock. It also showed improved usual care since 2001, with mortality dropping from 46.5% to 18%, so key bundles should still be followed.
This randomized controlled trial compared the effects of 6% hydroxyethyl starch (HES) and saline for fluid resuscitation in over 7,000 critically ill patients. The primary outcome of 90-day mortality was similar between the HES and saline groups. However, the HES group had significantly higher rates of acute kidney injury, renal replacement therapy use, and pruritus. While HES achieved better intravascular volume expansion initially, it provided no clinical benefit and was associated with worse renal outcomes compared to saline for fluid resuscitation in critically ill patients.
Journal Club Group fffffffffffffffffffffff1.pptxMyThaoAiDoan
This journal club discusses a randomized controlled trial that compared a restrictive fluid strategy with early vasopressor use to a liberal fluid strategy in patients with sepsis-induced hypotension. The trial found no significant difference in mortality before discharge home by day 90 between the two strategies. Some strengths were its randomized design and excellent safety outcome reporting. Limitations included being unblinded and possibly underpowered. The results do not strongly support changing clinical practice but add to evidence that a restrictive fluid approach may be safe.
Anaemia in ICU patient. Vampirism in critical care. Unnecessary bloodletting draws. Iatrogenic anaemia. Secondary anaemia. Do not do recommendations to avoid unnecessary analytics
This research article compares the effectiveness of oral versus intravenous proton pump inhibitors (PPIs) in preventing re-bleeding in patients with peptic ulcer bleeding after successful endoscopic therapy. 100 patients were randomly assigned to receive either oral lansoprazole or intravenous esomeprazole after endoscopic hemostasis. The re-bleeding rates within 14 days were similar between the two groups. Patients receiving oral PPI had a shorter hospital stay. While no differences in clinical outcomes were found, the study was not powered to prove equivalence between the oral and intravenous PPI treatments. Larger studies are still needed to further compare the effectiveness of oral versus intravenous PPI administration.
This systematic review and meta-analysis examined whether intermittent PPI therapy is noninferior to continuous intravenous PPI infusion for patients with high-risk bleeding ulcers after endoscopic treatment. The analysis found that intermittent PPI therapy was noninferior to continuous infusion, with an absolute risk difference of recurrent bleeding within 7 days of -0.28%, below the predefined noninferiority margin of 3%. Secondary outcomes of bleeding within 3 and 30 days also showed noninferiority of intermittent PPI therapy. Thus, intermittent PPI therapy is an acceptable alternative to continuous infusion for these high-risk patients.
This study establishes reference intervals for whole blood and plasma colloid osmotic pressure (COP) measurements in healthy cats. Whole blood COP was measured in 63 cats and found to have a mean of 24.4 mmHg with a reference interval of 18.9 to 30.4 mmHg. Plasma COP was measured in 52 cats and found to have a mean of 24.3 mmHg with a reference interval of 18.3 to 30.8 mmHg. There was no significant difference found between mean whole blood and plasma COP measurements. Total protein and albumin levels were found to be significantly correlated with whole blood and plasma COP levels.
The ProCESS trial found no significant difference in mortality between patients receiving protocol-based early goal-directed therapy (EGDT), protocol-based standard therapy, or usual care for early septic shock. While the EGDT group received fluid resuscitation more consistently, there were no differences in outcomes like mortality, organ failure, or length of stay. This prompted review by the Surviving Sepsis Campaign. They concluded that early diagnosis and treatment remain important. ProCESS did not assess patients with severe sepsis without shock. It also showed improved usual care since 2001, with mortality dropping from 46.5% to 18%, so key bundles should still be followed.
This randomized controlled trial compared the effects of 6% hydroxyethyl starch (HES) and saline for fluid resuscitation in over 7,000 critically ill patients. The primary outcome of 90-day mortality was similar between the HES and saline groups. However, the HES group had significantly higher rates of acute kidney injury, renal replacement therapy use, and pruritus. While HES achieved better intravascular volume expansion initially, it provided no clinical benefit and was associated with worse renal outcomes compared to saline for fluid resuscitation in critically ill patients.
Journal Club Group fffffffffffffffffffffff1.pptxMyThaoAiDoan
This journal club discusses a randomized controlled trial that compared a restrictive fluid strategy with early vasopressor use to a liberal fluid strategy in patients with sepsis-induced hypotension. The trial found no significant difference in mortality before discharge home by day 90 between the two strategies. Some strengths were its randomized design and excellent safety outcome reporting. Limitations included being unblinded and possibly underpowered. The results do not strongly support changing clinical practice but add to evidence that a restrictive fluid approach may be safe.
Anaemia in ICU patient. Vampirism in critical care. Unnecessary bloodletting draws. Iatrogenic anaemia. Secondary anaemia. Do not do recommendations to avoid unnecessary analytics
1) The study compared outcomes of treating septic shock using either conventional sepsis bundles guided by central venous pressure or improved sepsis bundles guided by pulse-indicated continuous cardiac output (PiCCO) measurements.
2) Patients receiving improved bundles guided by PiCCO had significantly lower organ failure scores, required less vasoactive drugs and fluid resuscitation, and had shorter durations of mechanical ventilation and ICU stays.
3) The improved bundles using PiCCO to guide fluid administration and cardiac function resulted in better clearance of lactate and reduced severity of septic shock compared to conventional bundles.
This study evaluated the outcomes of hepatic resection (HR) versus percutaneous tube drainage (PD) for patients with pyogenic liver abscesses and an APACHE II score ≥15. The study found that patients who underwent HR had significantly lower mortality, failure, and double treatment rates compared to those who only underwent PD. HR patients also had significantly shorter hospital stays, shorter duration of antibiotic use, and fewer procedure-related complications. The study concludes that aggressive HR may produce better clinical outcomes than PD alone for patients with severe liver abscesses as indicated by high APACHE II scores.
Ppi for bleeding ulcers intermittent vs continuousHassan Al tomy
in last few years there is emergent data on use of intermittent PPI in bleeding ulcers compared to continous infusion
in this meta-analysis the invistigator select 13 randomized controlled trial
Intermittent PPI regimens are comparable to continuous PPIinfusion regimens in patients with bleeding ulcers and high risk endoscopic findings
Because of ease of use and lower cost and resource utilization, intermittent PPI therapy may be the regimen of choice after endoscopic therapy in such patients
Early Goal-Directed Therapy in Septic Shockshivabirdi
Early goal directed therapy (EGDT) aims to balance oxygen delivery and demand through manipulating cardiac preload, afterload and contractility using measures like lactate, base deficit and ScvO2. A study of 263 patients with severe sepsis or septic shock found that those receiving EGDT in the emergency department for at least 6 hours had significantly lower in-hospital, 28-day and 60-day mortality compared to standard therapy. EGDT also resulted in fewer organ dysfunctions, less coagulation abnormalities and cardiovascular collapse.
Fluid management in patients with trauma: Restrictive versus Liberal ApproachAnkita Patni
The document summarizes the key points from a review article on fluid management approaches for trauma patients. It discusses the pathophysiology of hemorrhagic shock and how overly aggressive fluid resuscitation can cause further harm by diluting coagulation factors and increasing bleeding. Several studies are highlighted that found a restrictive fluid approach with permissive hypotension led to better outcomes than early liberal fluid resuscitation for uncontrolled hemorrhage. The concept of damage control resuscitation is also introduced, emphasizing the need to avoid the "lethal triad" of acidosis, hypothermia, and coagulopathy in severely injured trauma patients.
This study evaluated the effects of early prone positioning on outcomes in patients with severe acute respiratory distress syndrome (ARDS). 466 patients with severe ARDS were randomly assigned to undergo at least 16 hours of prone positioning sessions or to remain in the supine position. The primary outcome was 28-day mortality. The results showed significantly lower 28-day mortality in the prone group (16.0%) compared to the supine group (32.8%). Unadjusted 90-day mortality was also significantly lower in the prone group. Complication rates were similar between the groups except cardiac arrests, which were higher in the supine group. The study concluded that in patients with severe ARDS, early application of prolonged prone positioning sessions significantly decreased
Dr. Nannika Pradhan presented on pulmonary hypertension (PH). The key points discussed include:
1. PH is defined as a mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization.
2. PH is classified clinically into 5 groups based on etiology.
3. Clinical features include dyspnea, chest pain, syncope, signs of right heart failure. Diagnosis involves echocardiogram, CT scan, ventilation-perfusion scan and right heart catheterization.
4. Treatment depends on disease severity and involves diuretics, oxygen supplementation, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostano
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
UF vs diuretics in treatment of ADHF, Cardiorenal syndrome Mohamed E. Elrggal
1. Fluid overload and congestion are major characteristics of heart failure (HF) that are important treatment targets. Diuretics have limitations like resistance and worsening renal function.
2. Ultrafiltration (UF) theoretically has advantages over diuretics for acute decompensated heart failure (ADHF) by allowing faster fluid removal without electrolyte issues.
3. However, clinical trials have had conflicting results. The UNLOAD trial found greater benefits with UF, while the CARESS-HF trial found increased renal dysfunction and adverse events with UF.
4. Further research is needed to determine optimal patient selection, monitoring of plasma refill rate during UF, and long-term outcomes comparison
This document summarizes a clinical trial comparing hydroxyethyl starch (HES) to crystalloids for fluid resuscitation in critically ill patients with sepsis. The trial found that HES increased the risk of death within 90 days compared to Ringer's acetate. Patients receiving HES also had higher rates of renal replacement therapy, fewer days alive without RRT, and fewer days alive outside the hospital. The study demonstrated that HES 130/0.42 should not be used for fluid resuscitation in critically ill septic patients due to worse clinical outcomes compared to crystalloids.
Upper GI bleeding can occur due to variceal hemorrhage or non-variceal causes. Most non-variceal bleeding stops on its own, but mortality is around 10% overall and higher for elderly patients with comorbidities. Risk of death increases with age over 60, presence of comorbid illnesses, signs of active bleeding, transfusion of over 6 units of blood, and severe coagulopathy. Early identification of bleeding source via endoscopy and appropriate medical or endoscopic therapy can help reduce mortality and rebleeding risks. Proton pump inhibitors administered via intravenous bolus and continuous infusion are effective at maintaining gastric pH above 6 and stabilizing clots to decrease rebleeding rates compared to H2 block
Eras thoracic komen dec 2020. e:a:c conferenceHelga Komen
This document discusses the implementation of an enhanced recovery after surgery (ERAS) protocol for lung surgery at Barnes-Jewish Hospital. It provides an overview of ERAS, the development of their lung surgery ERAS protocol, and the key elements of the preoperative, intraoperative, and postoperative protocol. The multidisciplinary team implemented the protocol in 2018 and continues monitoring outcomes through regular meetings and quality improvement audits to optimize recovery for patients undergoing lung surgery.
Greenberg et al-2015-anesthesia_&_analgesiasamirsharshar
This editorial discusses the ongoing controversy around the safety of hydroxyethyl starch (HES) for perioperative fluid therapy. While HES has been used clinically for over 40 years, recent large trials in sepsis patients found an association with renal failure and need for renal replacement therapy. However, the risk appears greater in more critically ill patients. Two new studies presented in the journal found mixed results - one in lower risk patients found no renal effects, while another in higher risk liver transplant patients found a dose-dependent increased risk of acute kidney injury with HES. The editorial concludes that more research is still needed to determine safety in different patient populations and clinical contexts of HES use.
Initial resuscitation of patients with upper GI bleeding is critical and includes IV access, oxygen, fluid resuscitation, and blood product transfusion if needed. Early risk stratification evaluates factors like age, comorbidities, hemodynamic stability, and endoscopic findings to determine risk of rebleeding, need for intervention, and mortality. Source of bleeding is identified through endoscopy within 24 hours when possible. For low risk patients, medical therapy with PPIs is usually sufficient, while high risk patients may require endoscopic treatment or radiologic intervention. High dose PPIs, especially IV formulations, are effective in preventing rebleeding and shortening hospital stays when given before and after endoscopy. Surgery is reserved for
Comparison of two fluid management strategies in acute lung injuryDang Thanh Tuan
A randomized clinical trial compared a conservative fluid management strategy to a liberal strategy in patients with acute lung injury. The conservative strategy aimed to decrease lung edema by restricting fluid intake and increasing urine output, while the liberal strategy allowed more fluid administration. The primary outcome was 60-day mortality, with secondary outcomes including lung function and organ failures. The conservative strategy improved lung function and shortened time on ventilation and in the ICU without increasing other organ failures, though it did not significantly impact mortality.
The emergency and intensive care management of OP poisoning Bishan Rajapakse
This talk was given at the Wollongong Hospital Intensive Care departments registrar teaching session. The surprise ending video can be found on the following web page whilst scrolling to the bottom ... http://lifeinthefastlane.com/education/international-em/ I hope you enjoy. Comments on the presentation are welcome.
Thank you
The document summarizes guidelines for managing severe sepsis and septic shock according to bundles of care elements that should be completed within specific timeframes. The bundles include a sepsis resuscitation bundle with elements that should be completed within 6 hours, and a sepsis management bundle with elements that should be completed within 24 hours. Both bundles are aimed at reducing mortality from sepsis through early intervention and treatment.
Update on the Management of Pulmonary HypertensionSarfraz Saleemi
This document provides an overview of treatment for pulmonary hypertension (PH), including:
- Currently there is no cure, but earlier treatment leads to better outcomes.
- Screening high-risk groups allows for earlier diagnosis.
- Initial treatment involves general measures, supportive therapy, and testing for vasoreactivity.
- Vasoreactive patients may be treated with calcium channel blockers, while others receive PH-specific drugs.
- Combination therapy provides greater improvements in symptoms and hemodynamics than monotherapy, though it also carries higher risk of side effects.
- Over time, treatment advances have significantly improved survival rates for PH patients.
Booklet about blood purification therapy from Jafron Biomedical Co., Ltd, Zhu...JanfronBiomedical
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
This multicenter retrospective study evaluated the efficacy of conservative treatment, hemoperfusion (HP), and HP combined with continuous veno-venous hemofiltration (HP + CVVH) for acute paraquat (PQ) poisoning. PQ blood levels decreased faster in the HP and HP + CVVH groups compared to conservative treatment alone. Additionally, PQ levels were significantly lower in the HP + CVVH group at 24 hours compared to HP alone. Organ damage, as assessed by changes in sequential organ failure assessment scores, was significantly lower in the HP and HP + CVVH groups. Survival rates at 60 days were highest in the HP + CVVH group at 46.5%.
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Similar to Blood Purification for Paraquat Poisoning
1) The study compared outcomes of treating septic shock using either conventional sepsis bundles guided by central venous pressure or improved sepsis bundles guided by pulse-indicated continuous cardiac output (PiCCO) measurements.
2) Patients receiving improved bundles guided by PiCCO had significantly lower organ failure scores, required less vasoactive drugs and fluid resuscitation, and had shorter durations of mechanical ventilation and ICU stays.
3) The improved bundles using PiCCO to guide fluid administration and cardiac function resulted in better clearance of lactate and reduced severity of septic shock compared to conventional bundles.
This study evaluated the outcomes of hepatic resection (HR) versus percutaneous tube drainage (PD) for patients with pyogenic liver abscesses and an APACHE II score ≥15. The study found that patients who underwent HR had significantly lower mortality, failure, and double treatment rates compared to those who only underwent PD. HR patients also had significantly shorter hospital stays, shorter duration of antibiotic use, and fewer procedure-related complications. The study concludes that aggressive HR may produce better clinical outcomes than PD alone for patients with severe liver abscesses as indicated by high APACHE II scores.
Ppi for bleeding ulcers intermittent vs continuousHassan Al tomy
in last few years there is emergent data on use of intermittent PPI in bleeding ulcers compared to continous infusion
in this meta-analysis the invistigator select 13 randomized controlled trial
Intermittent PPI regimens are comparable to continuous PPIinfusion regimens in patients with bleeding ulcers and high risk endoscopic findings
Because of ease of use and lower cost and resource utilization, intermittent PPI therapy may be the regimen of choice after endoscopic therapy in such patients
Early Goal-Directed Therapy in Septic Shockshivabirdi
Early goal directed therapy (EGDT) aims to balance oxygen delivery and demand through manipulating cardiac preload, afterload and contractility using measures like lactate, base deficit and ScvO2. A study of 263 patients with severe sepsis or septic shock found that those receiving EGDT in the emergency department for at least 6 hours had significantly lower in-hospital, 28-day and 60-day mortality compared to standard therapy. EGDT also resulted in fewer organ dysfunctions, less coagulation abnormalities and cardiovascular collapse.
Fluid management in patients with trauma: Restrictive versus Liberal ApproachAnkita Patni
The document summarizes the key points from a review article on fluid management approaches for trauma patients. It discusses the pathophysiology of hemorrhagic shock and how overly aggressive fluid resuscitation can cause further harm by diluting coagulation factors and increasing bleeding. Several studies are highlighted that found a restrictive fluid approach with permissive hypotension led to better outcomes than early liberal fluid resuscitation for uncontrolled hemorrhage. The concept of damage control resuscitation is also introduced, emphasizing the need to avoid the "lethal triad" of acidosis, hypothermia, and coagulopathy in severely injured trauma patients.
This study evaluated the effects of early prone positioning on outcomes in patients with severe acute respiratory distress syndrome (ARDS). 466 patients with severe ARDS were randomly assigned to undergo at least 16 hours of prone positioning sessions or to remain in the supine position. The primary outcome was 28-day mortality. The results showed significantly lower 28-day mortality in the prone group (16.0%) compared to the supine group (32.8%). Unadjusted 90-day mortality was also significantly lower in the prone group. Complication rates were similar between the groups except cardiac arrests, which were higher in the supine group. The study concluded that in patients with severe ARDS, early application of prolonged prone positioning sessions significantly decreased
Dr. Nannika Pradhan presented on pulmonary hypertension (PH). The key points discussed include:
1. PH is defined as a mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization.
2. PH is classified clinically into 5 groups based on etiology.
3. Clinical features include dyspnea, chest pain, syncope, signs of right heart failure. Diagnosis involves echocardiogram, CT scan, ventilation-perfusion scan and right heart catheterization.
4. Treatment depends on disease severity and involves diuretics, oxygen supplementation, calcium channel blockers, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, prostano
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
UF vs diuretics in treatment of ADHF, Cardiorenal syndrome Mohamed E. Elrggal
1. Fluid overload and congestion are major characteristics of heart failure (HF) that are important treatment targets. Diuretics have limitations like resistance and worsening renal function.
2. Ultrafiltration (UF) theoretically has advantages over diuretics for acute decompensated heart failure (ADHF) by allowing faster fluid removal without electrolyte issues.
3. However, clinical trials have had conflicting results. The UNLOAD trial found greater benefits with UF, while the CARESS-HF trial found increased renal dysfunction and adverse events with UF.
4. Further research is needed to determine optimal patient selection, monitoring of plasma refill rate during UF, and long-term outcomes comparison
This document summarizes a clinical trial comparing hydroxyethyl starch (HES) to crystalloids for fluid resuscitation in critically ill patients with sepsis. The trial found that HES increased the risk of death within 90 days compared to Ringer's acetate. Patients receiving HES also had higher rates of renal replacement therapy, fewer days alive without RRT, and fewer days alive outside the hospital. The study demonstrated that HES 130/0.42 should not be used for fluid resuscitation in critically ill septic patients due to worse clinical outcomes compared to crystalloids.
Upper GI bleeding can occur due to variceal hemorrhage or non-variceal causes. Most non-variceal bleeding stops on its own, but mortality is around 10% overall and higher for elderly patients with comorbidities. Risk of death increases with age over 60, presence of comorbid illnesses, signs of active bleeding, transfusion of over 6 units of blood, and severe coagulopathy. Early identification of bleeding source via endoscopy and appropriate medical or endoscopic therapy can help reduce mortality and rebleeding risks. Proton pump inhibitors administered via intravenous bolus and continuous infusion are effective at maintaining gastric pH above 6 and stabilizing clots to decrease rebleeding rates compared to H2 block
Eras thoracic komen dec 2020. e:a:c conferenceHelga Komen
This document discusses the implementation of an enhanced recovery after surgery (ERAS) protocol for lung surgery at Barnes-Jewish Hospital. It provides an overview of ERAS, the development of their lung surgery ERAS protocol, and the key elements of the preoperative, intraoperative, and postoperative protocol. The multidisciplinary team implemented the protocol in 2018 and continues monitoring outcomes through regular meetings and quality improvement audits to optimize recovery for patients undergoing lung surgery.
Greenberg et al-2015-anesthesia_&_analgesiasamirsharshar
This editorial discusses the ongoing controversy around the safety of hydroxyethyl starch (HES) for perioperative fluid therapy. While HES has been used clinically for over 40 years, recent large trials in sepsis patients found an association with renal failure and need for renal replacement therapy. However, the risk appears greater in more critically ill patients. Two new studies presented in the journal found mixed results - one in lower risk patients found no renal effects, while another in higher risk liver transplant patients found a dose-dependent increased risk of acute kidney injury with HES. The editorial concludes that more research is still needed to determine safety in different patient populations and clinical contexts of HES use.
Initial resuscitation of patients with upper GI bleeding is critical and includes IV access, oxygen, fluid resuscitation, and blood product transfusion if needed. Early risk stratification evaluates factors like age, comorbidities, hemodynamic stability, and endoscopic findings to determine risk of rebleeding, need for intervention, and mortality. Source of bleeding is identified through endoscopy within 24 hours when possible. For low risk patients, medical therapy with PPIs is usually sufficient, while high risk patients may require endoscopic treatment or radiologic intervention. High dose PPIs, especially IV formulations, are effective in preventing rebleeding and shortening hospital stays when given before and after endoscopy. Surgery is reserved for
Comparison of two fluid management strategies in acute lung injuryDang Thanh Tuan
A randomized clinical trial compared a conservative fluid management strategy to a liberal strategy in patients with acute lung injury. The conservative strategy aimed to decrease lung edema by restricting fluid intake and increasing urine output, while the liberal strategy allowed more fluid administration. The primary outcome was 60-day mortality, with secondary outcomes including lung function and organ failures. The conservative strategy improved lung function and shortened time on ventilation and in the ICU without increasing other organ failures, though it did not significantly impact mortality.
The emergency and intensive care management of OP poisoning Bishan Rajapakse
This talk was given at the Wollongong Hospital Intensive Care departments registrar teaching session. The surprise ending video can be found on the following web page whilst scrolling to the bottom ... http://lifeinthefastlane.com/education/international-em/ I hope you enjoy. Comments on the presentation are welcome.
Thank you
The document summarizes guidelines for managing severe sepsis and septic shock according to bundles of care elements that should be completed within specific timeframes. The bundles include a sepsis resuscitation bundle with elements that should be completed within 6 hours, and a sepsis management bundle with elements that should be completed within 24 hours. Both bundles are aimed at reducing mortality from sepsis through early intervention and treatment.
Update on the Management of Pulmonary HypertensionSarfraz Saleemi
This document provides an overview of treatment for pulmonary hypertension (PH), including:
- Currently there is no cure, but earlier treatment leads to better outcomes.
- Screening high-risk groups allows for earlier diagnosis.
- Initial treatment involves general measures, supportive therapy, and testing for vasoreactivity.
- Vasoreactive patients may be treated with calcium channel blockers, while others receive PH-specific drugs.
- Combination therapy provides greater improvements in symptoms and hemodynamics than monotherapy, though it also carries higher risk of side effects.
- Over time, treatment advances have significantly improved survival rates for PH patients.
Similar to Blood Purification for Paraquat Poisoning (20)
Booklet about blood purification therapy from Jafron Biomedical Co., Ltd, Zhu...JanfronBiomedical
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
This multicenter retrospective study evaluated the efficacy of conservative treatment, hemoperfusion (HP), and HP combined with continuous veno-venous hemofiltration (HP + CVVH) for acute paraquat (PQ) poisoning. PQ blood levels decreased faster in the HP and HP + CVVH groups compared to conservative treatment alone. Additionally, PQ levels were significantly lower in the HP + CVVH group at 24 hours compared to HP alone. Organ damage, as assessed by changes in sequential organ failure assessment scores, was significantly lower in the HP and HP + CVVH groups. Survival rates at 60 days were highest in the HP + CVVH group at 46.5%.
Hemperfusion - The Key to Paraquat Poisoning Treatment INDIA
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poison or toxicant that is easily combined with plasma protein.
Successful Treatment of Paraquat Poisoning
Hemperfusion - The Key to Successful Treatment of Paraquat Poisoning
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
Hemperfusion - The Key to Paraquat Poisoning Treatment INDIA
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
Hemperfusion - The Key to Acute Poisoning
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning. Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
Jafron provides solutions for poisoning Paraquat Poisoning Treatment iNDIA HA230 removes poisons and excessive drugs It is applicable for drug overdose, biotoxin, pesticides, etc For Opinion or consultation @ +86 (756) 3689708
Jafron HA230 efficiently absorbs toxin in blood and relieves the symptoms of acute poisoning.
Clinical Practices prove an ideal efficacy of jafron HA230 in drug poisoning and intoxication caused by fat soluble poision or toxicant that is easily combined with plasma protein.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
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Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
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tion. PQ binds weakly to plasma proteins and is not re-
absorbed in the renal tubules. The kidney is the organ
with the highest concentration of PQ and the main or-
gan responsible for PQ excretion. The clearance rate of
PQ is associated with the kidney function. The lethal
concentration in the lung tissues can be reached within
6 h in case of severe PQ poisoning. PQ levels in muscles
are also relatively high. Lung and muscle become a res-
ervoir of PQ, releasing it into the blood as the kidneys
clear it [8].
Blood purification of PQ poisoning is controversial
[8]. Hemoperfusion (HP) can be used to treat PQ poison-
ing at the early stage [8–10], but HP is more suitable for
poisons with a large molecular mass, that are lipid soluble,
and with a high protein binding rate [11], which is not the
case for PQ. On the other hand, continuous veno-venous
hemofiltration (CVVH) is more efficient for clearing wa-
ter soluble, small molecular poisons with a low protein
binding rate [11], but there is lack of data for the use of
CVVH in PQ poisoning.
Therefore, the aim of this retrospective study was to
examine the efficacy of conservative treatment, HP, and
HP + CVVH for the early treatment of PQ poisoning.
Materials and Methods
Patients
This was a retrospective study of consecutive patients with
acute PQ poisoning treated at the Beijing Chaoyang Hospital, The
Second Affiliated Hospital of Hebei Medical University, Cangzhou
People’s Hospital of Hebei Province, and Shangdong Province-
Owned Hospital between January 2013 and June 2014.
Inclusion criteria were as follows: (1) PQ poisoning by oral in-
take; (2) aged >14; (3) admission within 24 h of PQ poisoning; and
(4) urine concentration of PQ was 5–200 μg/ml by the semi-quan-
titative sodium bisulfite method. Exclusion criteria were as fol-
lows: (1) combined with the other poisonings; (2) hypersensitivity
to heparin; (3) history of heparin-induced thrombocytopenia; (4)
significant bleeding tendency; (5) history of severe diseases of the
heart, lung, liver, kidney, or hematological system; (6) pregnant or
lactating; (7) multiple organ failure; or (8) refusal of active therapy,
for example, due to economic reasons.
This study was approved by the Ethics Committees of each par-
ticipating hospital. The need for individual consent was waived off
by the committees because of the retrospective nature of the study.
Grouping
The patients were classified according to the treatment they
received: conservative treatment (conservative treatment group),
conservative treatment + HP (HP group), or conservative treat-
ment + HP + CVVH (HP + CVVH group). The selection of the
treatment was made by the attending physician after discussion
with the patients and their families after considering the condition
of the patients and their financial status.
Treatments
For conservative treatment, patients received an emetic (so-
dium bicarbonate solution or activated carbon suspension of 200
ml injected into the stomach); gastric lavage (15% bleaching clay
suspension or 15% activated carbon suspension); catharsis (15%
bleaching clay suspension or 15% activated carbon suspension,
300 ml with 20% mannitol, 250 ml); promotion of PQ excretion
by fluid infusion and diuresis. Organ function supportive thera-
py included oxygen supply, mechanical ventilation, expanding
blood volume, and administration of vasoactive drugs to main-
tain appropriate tissue perfusion and cell metabolism when nec-
essary.
For the HP group, conservative treatment was administered as
mentioned above; central venous access was achieved by indwell-
ing a double lumen catheter within 1 or 2 h after admission. The
HP treatment was carried out with the HA330 neutral resin perfu-
sionapparatus(JafronBiomedicalCo.,Ltd.,Zhuhai,China).Blood
flow was set at 150–200 ml/min, and each session lasted 3–4 h. The
first treatment was conducted on the day of admission, the second
treatment 6–8 h later, and subsequent treatments once on days 2
and 3. Heparin was intravenously injected before HP using a load-
ing dose of 0.5 mg/kg and continuous intravenous injection using
a maintenance dose of 10–20 mg/h. Heparin was stopped 30 min
before HP completion.
For the HP + CVVH group, conservative treatment was admin-
istered as mentioned above; HP lasting 3–4 h was performed on
the day of admission, with CVVH immediately conducted for 72 h.
Before HP and CVVH, vascular access was obtained using an 11.5F
double-lumen catheter (Teleflex, Arrow, USA). The extracorpo-
real circulation line and filter (AV600S, Fresenius, Germany) were
washed with 100 mg heparin dissolved in 2,000 ml normal saline
before CVVH. Postdilution CVVH was performed at a blood flow
rate of 150–200 ml/min; ultrafiltration rate was 25–30 ml/kg/h for
each new circuit. Circuits were disconnected at high prefilter (>280
mm Hg) or transmembrane (>280 mm Hg) pressure. After discon-
nection, a new circuit was immediately initiated until CVVH was
completed. A 1.4 m2 polysulfone membrane filter (AV600S, Fre-
senius, Germany) and CRRT device (Multifiltrate, Fresenius,
Germany) were used. Replacement fluids were heated to 39 ° C; a
combination buffer containing 113 mmol/l Na+, 3.0 mmol/l K+,
0.797 mmol/l Mg2+, 118 mmol/l Cl–, 1.5 mmol/l Ca2+, 10.6 mmol/l
anhydrous dextrose, and bicarbonate-buffered fluids were used
post-filtration, adjusted by plasma bicarbonate levels and pH ac-
cording to blood gas data. Heparin was intravenously injected at a
loading dose of 25–30 IU/kg, and continuous intravenous injec-
tion occurred at a maintenance dose of 5–10 IU/kg/h until CVVH
was completed.
Data Collection
Baseline patient data were collected including age, gender, dose
of PQ, blood levels of PQ at admission, serum levels of superoxide
dismutase (SOD), white blood cell counts, platelets counts, blood
glucose level, serum levels of creatinine (Cr), alanine aminotrans-
ferase, and amylase. The score of acute physiology and chronic
health status (APACHE-II) was assessed as well. The serum levels
of PQ were monitored and the score of sequential organ failure as-
sessment (SOFA) was calculated at 24, 48, and 72 h after admission
[8, 12]. ΔSOFA was defined as the differences between the SOFA
scores at 24 and 72 h. The patients were followed up for 60 days.
Mortality was recorded.
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Serum Levels of PQ
Total blood samples were obtained with heparin anti-coagula-
tion, stored at –80 ° C, and sent on ice for detection within 72 h.
Quantitative and qualitative analysis of PQ in blood was per-
formed according to previously published methods [13].
Statistical Analysis
Continuous data were tested for normality using the Kol-
mogorov–Smirnov test. Normally distributed continuous data are
presented as mean ± SD and were analyzed using analysis of vari-
ance (ANOVA) with the Student–Newman–Keuls post hoc test or
repeated measures ANOVA with Bonferroni post hoc test, as ap-
propriate.
Non-normally distributed continuous data are presented as me-
dian (range) and were analyzed using the Kruskal–Wallis test. Cat-
egorical data are presented as frequencies and were analyzed using
the chi-square test. The risk factors for death and prognosis were
assessed by univariate and multivariate non-conditional logistic re-
gression. The survival curves were made by the Kaplan–Meier
method and compared using the log-rank test. Statistical analysis
was performed using SPSS 18.0 (IBM, Armonk, N.Y., USA). Two-
sided p values <0.05 were considered statistically significant.
Results
Characteristics of the Patients
Seventy-five (41.0%), 65 (35.5%), and 43 (23.5%) pa-
tients were in the conservative treatment, HP, and HP +
CVVH groups, respectively. There were no differences
among the 3 groups in terms of gender distribution, age,
time to admission (time elapsed from PQ poisoning to
hospital admission), dose of PQ, blood levels of PQ at ad-
mission, serum levels of SOD, APACHE-II score, white
blood cell counts, and SOFA score at admission (all p >
0.05; table 1).
Blood Levels of PQ
There were no significant differences among the 3
groups at admission (p > 0.05; table 2). Blood levels of PQ
were significantly lower in the HP and HP + CVVH groups
at 24, 48, and 72 h after admission in comparison with the
conservative treatment group (p < 0.05); in addition, PQ
blood levels were significantly lower in the HP + CVVH
group compared with the HP group at 24 h (p < 0.05). The
bloodlevelsofPQweredecreasedinall3groupsafter3days
of treatment, though the blood levels of PQ were lower in
the HP and HP + CVVH groups 72 h after admission com-
pared with the conservative treatment group (p < 0.05).
SOFA Scores
SOFA scores at admission and at 24, 48, and 72 h after
admission are presented in table 3. There were no signif-
icant differences among the 3 groups regarding SOFA
scores at 24 h (p > 0.05). ΔSOFA values in the HP and
Table 1. Baseline characteristics of the patients with acute PQ poisoning according to subsequent treatments
Parameters Conservative
treatment (n = 75)
HP treatment
(n = 65)
HP + CVVH
treatment (n = 43)
p value
Gender, n (%)
Man 35 (46.7) 36 (55.4) 25 (58.1) 0.409
Woman 40 (53.3) 29 (44.6) 18 (44.6)
Age, years 36 (18–56) 36 (16–52) 38 (18–60) 0.782
Time to admission, h 12.2 (0.5–22.0) 7.5 (0.5–20.5) 7.8 (0.5–19.0) 0.106
Dose, ml 96 (5,250) 87 (2,200) 66 (5,200) 0.176
PQ blood levels at admission, μg/ml 21.6 (0.3–100.2) 23.0 (0.6–124.5) 20.8 (0.9–200.6) 0.071
WBC, ×109/l 14.2±6.8 16.1±9.9 15.3±5.9 0.073
SOD, U/g 177.1±51.7 200.0±77.9 177.3±23.6 0.106
APACHE-II score 3 (0–8) 3 (0–11) 3 (0–9) 0.208
SOFA score at 24 h after admission
Respiratory score 1.5 (0–3) 1.7 (0–4) 0.9 (0–3) 0.732
Coagulation score 0.1 (0–1) 0.5 (0–2) 0.6 (0–3) 0.021
Liver function score 0.4 (0–3) 0.5 (0–3) 0.7 (0–3) 0.414
Blood circulation score 0.9 (0–3) 1.0 (0–3) 0.9 (0–3) 0.732
CNS function score 0.1 (0–2) 0.1 (0–2) 0.1 (0–2) 0.526
Kidney function score 0.4 (0–3) 0.5 (0–3) 0.2 (0–3) 0.927
Total score 3.0 (0–9) 2.9 (0–7) 3.1 (0–10) 0.212
WBC = White blood cells. Data are presented as median (minimum–maximum) or as mean ± SD.
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HP + CVVH groups were significantly lower than in the
conservative treatment group (p < 0.05), but there were
no significant differences between the HP and HP +
CVVH groups (p > 0.05).
Survival
The 3-day survival rates were 86.0 and 65.1% for the
HP and HP + CVVH groups, and were significantly high-
er than those of the conservative treatment group (56.0%)
(p < 0.05). The 7-day survival rates were 56.9 and 65.1%
for the HP and HP + CVVH groups, and were signifi-
cantly higher than those of the conservative treatment
group (41.3%) (p < 0.05). The 60-day survival rates were
43.1 and 46.5% for the HP and HP + CVVH groups, and
were significantly higher than those of the conservative
treatment group (21.3%, p < 0.05). However, there were
no significant differences between the HP and HP +
CVVH groups at any time point (p > 0.05).
The 60-day survival curve is shown in figure 1. Median
survival times were 3, 15, and 40 days for the conservative
treatment, HP, and HP + CVVH groups, suggesting that
blood purification could significantly improve survival.
Median survival was significantly longer in the HP (p =
0.003) and HP + CVVH (p = 0.001) groups compared
with the conservative treatment group, but without dif-
ference between the HP and HP + CVVH groups (p =
0.535).
Analysis of Risk Factors for Death
Tables 4 and 5 present univariate and multivariate
analyses of factors associated with 60-day mortality, re-
spectively. Factors significantly associated with mortality
in univariate analyses (table 4) were included in the mul-
tivariate model. Results showed that age (OR 1.128, 95%
CI 1.030–1.235), PQ dose (OR 1.076, 95% CI 1.020–
1.136), PQ serum levels at admission (OR 1.539, 95% CI
1.142–2.073), and SOFA score at admission (OR 8.073,
95% CI 1.515–43.006) were independently associated
with mortality, while HP (OR 0.316, 95% CI 0.119–0.838)
and HP + CVVH (OR 0.297, 95% CI 0.111–0.795) were
protective factors (table 5).
Discussion
This study showed that conservative, HP, and HP +
CVVH treatments all decreased PQ serum levels and im-
proved SOFA scores. HP and HP + CVVH treatment
Table 2. Blood levels of PQ comparison at baseline and during treatment
Group n Baseline 24 h 48 h 72 h p value
Conservative 75 21.56±11.17 16.71±8.35a 10.33±6.67a, b 6.02±3.29a–c <0.001
HP 65 22.95±10.41 7.84±3.63*, a 4.54±2.58*, a, b 2.50±1.34a–c <0.001
HP + CVVH 43 20.82±9.26 4.95±2.81*, #, a
3.91±1.89*, a, b 2.11±1.67a–c
<0.001
p value – 0.553 <0.001 <0.001 <0.001
All data are presented as mean ± SD, μg/ml.
* p < 0.05 vs. conservative treatment; # p < 0.05 vs. HP; a p < 0.05 vs. before baseline; b p < 0.05 vs. 24 h; c p <
0.05 vs. 48 h.
Table 3. SOFA score during treatment
Conservative
treatment (n = 75)
HP treatment
(n = 65)
HP + CVVH
(n = 43)
p value
24 h 3.03±2.06 2.97±1.82 3.06±2.04 0.763
48 h 4.07±2.72 4.54±3.22 4.81±3.70 0.759
72 h 5.76±3.29 4.43±3.1* 4.93±3.57* <0.001
ΔSOFA 3.34±1.69 1.72±1.05* 2.11±1.28* <0.001
All data are presented as mean ± SD, score.
* p < 0.05 vs. conservative treatment.
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were better than the conservative therapy; HP and HP +
CVVH groups were similar in most parameters studies.
However, PQ blood levels were significantly lower in the
HP + CVVH group compared with the HP group at 24 h.
Multivariate analysis indicated that age, PQ dose, PQ se-
rum levels at admission, and SOFA score at admission
were independently associated with mortality, while HP
and HP + CVVH were protective factors. These results
suggest that early HP or HP + CVVH after PQ poisoning
could decrease PQ blood levels, alleviate organ damage,
and improve survival.
PQ undergoes almost no biological transformation in
vivo and 90% is excreted through the kidneys. PQ uptake
by alveolar epithelial cells is an energy-dependent active
process, and the peak concentration in lungs can be
reached within 15 h, up to concentrations as high as 10–
90 times the serum levels [8, 12]. Therefore, lung and
muscle tissues are regarded as reservoirs for PQ, which is
released into the blood once the plateau is reached. Acute
respiratory distress syndrome was reported to occur in
patients with acute PQ poisoning, and the mortality rate
can be as high as 50–80% [6]. Hemodialysis (HD), HP,
and CVVH are commonly used blood purification meth-
ods for PQ poisoning. It is widely accepted that HP is
more effective than HD for PQ poisoning; indeed, the
clearance rate of HP is about 5–7 times that of HD [1],
and HP is still effective when blood levels of PQ are low-
ered to <0.2 mg/l [14].
However, PQ is a small water soluble molecule with a
low protein binding rate, and secondary distribution can
be observed. Theoretically, clearance effectiveness of
CVVH is superior to that of HP. Therefore, in this study,
results indicated that the blood levels of PQ were signifi-
cantly decreased within the first 3 days after admission,
Table 4. Univariate analysis of factors involved in mortality after
acute PQ poisoning
Parameters OR 95% CI p value
lower upper
Gender 1.347 0.741 2.446 0.328
Age 1.055 1.032 1.079 <0.001
Time to admission 0.955 0.921 0.990 0.012
Dose 1.031 1.020 1.043 <0.001
Times of blood perfusion 0.879 0.691 1.119 0.295
CVVH times 0.823 0.441 1.536 0.541
PQ blood levels at admission 1.240 1.135 1.354 <0.001
SOD 0.994 0.986 1.001 0.099
Blood purification (control) 0.006
HP 0.358 0.171 0.750 0.006
HP + CVVH 0.312 0.138 0.705 0.005
SOFA score at 1st day 2.015 1.545 2.629 <0.001
WBC 0.908 0.864 0.953 <0.001
Platelets 0.999 0.995 1.003 0.509
Neutrophils 1.008 0.982 1.035 0.536
Blood glucose 0.817 0.737 0.905 <0.001
Blood Cr 0.999 0.995 1.003 0.776
ALT 0.994 0.985 1.003 0.176
Hemodlastase 1.000 0.998 1.002 0.889
WBC = White blood cells; ALT = alanine aminotransferase.
Table 5. Multivariate analysis of factors involved in mortality after
acute PQ poisoning
Parameters OR 95% CI p value
lower upper
Age 1.128 1.030 1.235 0.009
Time to admission 0.923 0.772 1.104 0.380
Dose 1.076 1.020 1.136 0.007
PQ blood levels at admission 1.539 1.142 2.073 0.005
Blood purification (control) 0.025
HP 0.316 0.119 0.838 0.021
HP + CVVH 0.297 0.111 0.795 0.016
SOFA score at 1st day 8.073 1.515 43.006 0.014
WBC 1.076 0.889 1.304 0.451
Blood glucose 1.023 0.783 1.337 0.868
WBC = White blood cells.
0
0.2
0.4
0.6
0.8
1.0
Survival
(%)
0 10 20 30 40 50 60
Time (days)
HP + CVVH
HP
Conservative
Fig. 1. Sixty-day survival according to treatment after acute PQ
poisoning.
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and that the blood levels of PQ were significantly lower in
the blood purification groups (HP and HP + CVVH)
compared to the conservative treatment group at 24, 48,
and 72 h after admission, suggesting that blood purifica-
tion could rapidly reduce the blood levels of PQ, which is
supported by Pond et al. [12]. Multivariate analysis
showed that HP and HP + CVVH treatments were associ-
ated with lower mortality.
Nevertheless, no matter the blood purification method
(HP, CVVH, or HD), the sooner the blood is purified, the
better the outcome. It was reported that though HD and
HP could decrease the severity of PQ poisoning and pro-
long survival, mortality was not decreased [8, 15]. This
might be ascribed to the fact that lethal amounts of PQ
had started entering into the alveolar epithelial cells and
major organs, with blood purification not able to alter the
toxicokinetics of PQ in these conditions [8, 12]. The sec-
ondary distribution of PQ from lung and muscle tissues
to blood circulation could be observed once the blood
levels started to decrease; therefore, the timing and dura-
tion of blood purification may be very important [16, 17].
Generally, blood purification is recommended to be per-
formed as soon as 4–12 h after PQ poisoning, and the
earlier the better [16, 17]. Since it takes time for PQ to
diffuse from tissues to blood, it might be necessary to con-
tinue blood purification [1].
HP was conducted only once on the day of admission
in the HP + CVVH group, and then CVVH was immedi-
ately performed for 72 h, while HP was carried out once
a day within the first 3 days of admission in the HP group.
Finally, this study indicated that the PQ clearance rate
was equivalent between HP and HP + CVVH, except for
the first 24 h, where a faster rate was obtained in the HP +
CVVH group; in addition, no significant differences in
60-day survival were observed. Compared to HP, HP +
CVVH has some merits [17]: (1) PQ is removed continu-
ously to maintain hemodynamics; (2) CVVH corrects the
imbalances in water, electrolytes, and acid-base equilib-
rium; and (3) CVVH continuously removes metabolites
such as urea and Cr. Since HP cannot correct water, elec-
trolyte, and acid-base equilibrium imbalances, HP +
CVVH should be prioritized for treating PQ poisoning.
However, randomized control studies are needed to eval-
uate the effects of CVVH alone on PQ poisoning.
Limitations
Thisstudydoeshavesomelimitations.First,thesample
size was relatively small. Second, this was a retrospective
study with all the inherent biases and limitations. Third,
given the limitation of financial resources of some pa-
tients, a bias could have been introduced leading to more
wealthy and healthy patients to undergo HP + CVVH.
Fourth, urine concentrations of PQ in the study popula-
tion were 5–200 μg/ml; therefore, the study results could
not be extrapolated for urine concentrations of PQ >200
μg/ml observed in severe PQ poisoning. Fifth, time to ad-
mission was higher in the conservative treatment group
compared with values obtained for the HP and HP +
CVVH groups, although the differences were not statisti-
cally significant; whether this has contributed to our re-
sults merits further assessment. Finally, the toxicokinetics
of PQ is still poorly understood, limiting the application
of treatments. Additional studies are still necessary to de-
termine the best course of action for acute PQ poisoning.
Conclusion
HP or HP + CVVH could rapidly decrease the blood
levels of PQ at the early stage, alleviate organ injuries, and
improve survival. The therapeutic effect was mostly
equivalent between HP and HP + CVVH treatment re-
garding to the acute PQ poisoning, especially after the
first day of treatment. Age, dose, blood levels of PQ at
admission, and SOFA score at 24 h after admission were
independent risk factors for mortality, while HP and
HP + CVVH were independent protective factors.
Acknowledgments
The authors acknowledge the dedicated help of Professor W.
Li, director of Surgical ICU, Chaoyang Hospital, Beijing, China,
for his guidance and efforts on the study design, implementation,
and manuscript preparation; the funding support from Dr. F. Hao,
director of Occupational Diseases and Poisoning Medicine; and
the considerable assistance of Mr. H. Wang, lecture in Shangdong
Province-owned hospital during the 2-year information collection
for the study.
Funding
The study was funded by the special research project funding
(No. 201202006-06) for public welfare from Division of Science
and Education, National Health and Family Planning Commis-
sion of the People’s Republic of China and National Science and
Technology major projects and significant new drug creation
(2014ZX09J15104002)
Disclosure Statement
The authors declare that they have no conflict of interests.
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