Extracorporeal Removal Techniques for the Poisoned Patient: A Review for the Intensivist

血液灌流 医学 体外 肾脏替代疗法 重症监护医学 异型生物质的 重症医师 血液滤过 血液透析 重症监护 外科 生物化学 化学
作者
Baruch S. Fertel,Lewis S. Nelson,David S. Goldfarb
出处
期刊:Journal of Intensive Care Medicine [SAGE]
卷期号:25 (3): 139-148 被引量:55
标识
DOI:10.1177/0885066609359592
摘要

The kidney is able to rapidly eliminate many water-soluble xenobiotics (exogenous chemicals). However, in the face of extraordinary serum concentrations of these xenobiotics or renal dysfunction, alternative elimination techniques often become necessary. Extracorporeal removal (ECR) techniques are used to increase the clearance of xenobiotics. These techniques include hemodialysis (HD), charcoal hemoperfusion (HP), and modalities grouped under the heading of continuous renal replacement therapy (CRRT): continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF). Extracorporeal removal is limited to patients with significant or potentially significant clinical poisoning because the resources required to perform ECR are great. Therefore, most patients who are treated with these techniques are being cared for in intensive care units (ICUs). Our goal in this review is to discuss the properties that make xenobiotics amenable to removal by ECR and the advantages and disadvantages of the individual techniques. We discuss xenobiotics that constitute clear indications for ECR, including the toxic alcohols, salicylates, and lithium. We review the use of CRRT, a modality for which clear indications for treatment of poisonings are currently lacking.
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