Application of hybrid blood purification treatment for severe acute arsine poisoning

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Abstract

Objective:

Severe acute arsine poisoning (SAAP) complicated by multiple organ dysfunction syndrome is a critical clinical illness. The limited efficacy of conventional drug therapy prompted us to investigate the application of hybrid blood purification treatment (HBPT) to improve the prognosis in critically ill patients. The present manuscript describes a series of cases treated with HBPT.

Methods:

Eleven SAAP subjects were enrolled. The study did not include a control group, because of ethical issues. On the basis of conventional therapy, HBPT (plasma exchange [PE] + continuous venovenous hemofiltration [CVVH]) was used to treat SAAP. PE was performed once a day for 5 days, and CVVH was performed after each session of PE for 7 days or more; HBPT treatment duration amounted to an average of 10 days (range 7-18 days). Arsenic was detected in blood and discarded liquid. Clinical indicators, laboratory parameters, and prognostic indicators were assessed.

Results:

HBPT was smoothly implemented without obvious adverse reaction. It can continuously remove arsenic and terminate hemolysis in a time-dependent manner. HBPT also significantly improved the poor clinical manifestations and laboratory indicators of SAAP, leading to a low mortality. Ten patients were discharged because of improved conditions, and only 1 patient died.

Conclusions:

The early application of HBPT can improve the prognosis of SAAP. The advantage of HBPT is that it can integrate the characteristics of different blood purification technologies to maximize treatment efficacy.

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