Hackl Gerald, Schreiber Nikolaus
Allgemeine Intensivstation, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 27, 8036, Graz, Österreich.
Med Klin Intensivmed Notfmed. 2024 Sep;119(6):511-520. doi: 10.1007/s00063-024-01156-6. Epub 2024 Jul 10.
In rare cases, intoxicated patients may require an extracorporeal procedure for enhanced toxin elimination. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup provides consensus- and evidence-based recommendations regarding the use of extracorporeal procedures in the management of critically ill, poisoned patients, with ongoing updates. Extracorporeal clearance is highest for low molecular weight substances with low volume of distribution, low plasma protein binding, and high water-solubility. To maximize the effect of extracorporeal clearance, blood and dialysate flow rates should be as high as possible, and the membrane with the largest surface area should be utilized. Intermittent hemodialysis is the most commonly employed extracorporeal procedure due to its highest effectiveness, while hemodynamically compromised patients can benefit from a continuous procedure.
在极少数情况下，中毒患者可能需要进行体外治疗以加强毒素清除。中毒体外治疗（EXTRIP）工作组提供了关于在重症中毒患者管理中使用体外治疗的基于共识和证据的建议，并不断更新。对于分布容积低、血浆蛋白结合率低且水溶性高的低分子量物质，体外清除率最高。为了使体外清除效果最大化，血液和透析液流速应尽可能高，并应使用表面积最大的膜。间歇性血液透析因其效果最佳而成为最常用的体外治疗方法，而血流动力学不稳定的患者可从连续性治疗中获益。
