Blood Purification in Toxicology:Reviewing the Evidence and Providing Recommendations
Background
The use of extracorporeal purification specifically for drug poisoning has existed in the clinical practice for over 70 years. Unfortunately, the evidence remains limited to reviews, opinions, commentaries, and case reports which are susceptible to biases and confounders. Randomized trials and comprehensive systematic reviews are almost inexistent. Furthermore, the toxicokinetic measurements and calculations in published reports are often imprecise, incomplete or incorrect. These factors limit the interpretation of the effect of extracorporeal treatments (ECTRs).
Despite the increasing use of ECTRs (especially hemodialysis and hemofiltration) in poisoning, clinicians remain uncertain of their precise role in poisoning, because of the following points:
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Recurrent errors are perpetuated in evaluating dialyzability of some poisons.
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The development of new antidotes and perfection of supportive care have changed the indications of ECTRs in certain poisonings.
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New ECTRs are being invented while others are hybridized or falling out of use.
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Dialyzability and clinical improvement do not always correlate.
Objectives
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To perform systematic reviews on the use of ECTRs in various poisonings.
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To provide clinical recommendations on the use of ECTRs in poisoning, including criteria for indication, cessation, and choice of ECTR.
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To publish guidelines for prospective data collection, calculations, and data reporting to assist clinicians, authors and reviewers.
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To offer tools and collaboration for multicentric research opportunities.
Further information on the background, objectives, and methodology of the EXTRIP initiative