血液灌流治疗重症患者临床疑似有机磷和氨基甲酸酯中毒：一项随机试验

Hemoperfusion for Clinically Suspected Organophosphate and Carbamate Poisoning in Critically Ill Patients: A Randomized Trial.

作者信息

Omar Shahed, Sooka Praveer Navin, Khoza Siyabonga, Van Rooyen Martin Charles, Mashamba Lushavhana, Madi S'fisosikayise, Mathivha Lufuno Rudo, George Jaya Anna

机构信息

Critical Care, School of Clinical Medicine/University of Witwatersrand/Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

Chemical Pathology, School of Pathology/ University of Witwatersrand/ Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa.

出版信息

Blood Purif. 2023;52(2):157-165. doi: 10.1159/000525936. Epub 2022 Dec 6.

DOI:10.1159/000525936

PMID:36473449

Abstract

INTRODUCTION

Organophosphate poisoning occurs frequently, and despite treatment, increased severity and intensive care unit (ICU) admissions have been observed. We hypothesized that early hemoperfusion/hemadsorption (HA) therapy would change the clinical course of the disease.

METHODS

We performed a prospective, open, randomized controlled study at an academic ICU. Adult patients referred for an acute cholinergic toxidrome were screened. Patients meeting inclusion and exclusion criteria were randomized to standard of care (SoC) or HA therapy plus SoC, which included 2 6-h cycles of HA 12 h apart beginning within the first 24 h of ICU admission. The primary outcome was a comparison of ICU length of stay (LOS).

RESULTS

There were no significant baseline differences between the groups. The median ICU LOS was 6.5 days (IQR 4.5-10) in the HA group compared to 8 days (IQR 3.5-17) for the control group, p = 0.58. Among patients with an excess ICU LOS ≥7 days, the median ICU LOS was significantly shorter for the HA group, 10 days (IQR 8-12) compared to 17 days (IQR 14-22) for the control group, p = 0.001, resulting in a cost saving of EUR 7308 per patient. Duration (8 days vs. 13.5 days) and cumulative dosage (316 mg vs. 887 mg) of atropine among patients with excess ICU LOS were significantly lower in the HA group compared to the SoC group, respectively. A similar reduction in the duration of mechanical ventilation (HA = 6 days vs. SoC = 15 days, p = 0.001) was found. The combination of day 28 mortality and severe complications was lower in the HA group (10%, n = 2/20) compared to the SoC group (42%, 14/33) p = 0.01.

CONCLUSION

HA therapy resulted in significant cost savings driven by a reduced LOS among patients with excess ICU LOS ≥7 days. This therapy was also associated with a significant reduction in the combination of day 28 mortality and severe complications including cardiac arrest, organ dysfunction, reintubation, and tracheostomy.

摘要

引言

有机磷中毒频繁发生，尽管进行了治疗，但病情严重程度仍有增加，入住重症监护病房（ICU）的情况也有所增多。我们推测早期血液灌流/血液吸附（HA）疗法会改变该病的临床病程。

方法

我们在一家学术性ICU进行了一项前瞻性、开放性、随机对照研究。对因急性胆碱能中毒综合征转诊的成年患者进行筛查。符合纳入和排除标准的患者被随机分为标准治疗组（SoC）或HA疗法联合SoC组，HA疗法联合SoC组包括在入住ICU的头24小时内开始，间隔12小时进行2个6小时的HA治疗周期。主要结局是比较ICU住院时间（LOS）。

结果

两组之间基线无显著差异。HA组的ICU中位住院时间为6.5天（四分位间距4.5 - 10天），而对照组为8天（四分位间距3.5 - 17天），p = 0.58。在ICU住院时间过长（≥7天）的患者中，HA组的ICU中位住院时间显著更短，为10天（四分位间距8 - 12天），而对照组为17天（四分位间距14 - 22天），p = 0.001，每位患者节省成本7308欧元。在ICU住院时间过长的患者中，HA组阿托品的使用时长（8天对13.5天）和累积剂量（316毫克对887毫克）分别显著低于SoC组。机械通气时长也有类似程度的缩短（HA组 = 6天对SoC组 = 15天，p = 0.001）。HA组28天死亡率和严重并发症的综合发生率（10%，n = 2/20）低于SoC组（42%，14/33），p = 0.0,1。