Adsorptive Capacities of Hemoperfusion Devices in Clinical Use

Abstract

Five different hemoperfusion devices have been used in the treatment of patients intoxicated with barbiturates. The changes in drug clearance values which occurred during hemoperfusion varied according to the device used. Even after very long periods of hemoperfusion, however, drug clearance values never fell to zero. Using data collected from comparable cases, it has been shown that the rate of uptake of chug from the blood is independent of the amount of adsorbent in the columns, those containing 100 gm charcoal having the same efficiency as the conventional 300 gm. The prime factor which determines the rate of drug uptake h a s been shown to be the arterial plasma drug concentrations. Other factors, such as the deposition of cellular debris and proteins a s hemoperfusion progresses, are also thought to influence the efficiency of drug removal. hemoperfusion, drug intoxication, charcoal, resin From the Poisons Unit, GuyS Hospital, London, SEl, England. ~~ ~~ The authors gratefully acknowledge the help of Mr. E. Esser and Mr. R Scott of the Pol.ions Unrt and Mr. Steven Lang of Smith and Nephew Re search Limited in the preparation of this work. This paper was presented, in part, at the "Hemoperfusion, Dialysate and Diafiltrate Purili'cation" Symposium, September 11-13, 1978, Tutring, Federal Republic of Germany.

Coated Carbon Hemoperfusion Provides Limited Clearance of Protein‐bound Solutes

“…However, the clearance rates declined with time, and the decline could not be attributed to a fall in the plasma concentration of the solutes. The finding that clearance falls with time is consistent with results of early clinical studies of coated carbon hemoperfusion (14,15). It was originally suggested that clearance falls because the carbon in the cartridge becomes saturated with solutes.…”

Hemoperfusion for the Treatment of Poisoning: Technology, Determinants of Poison Clearance, and Application in Clinical Practice

“…The larger the mass of adsorbent on the column, the more extensive is the poison clearance. This has been shown in vitro and in vivo for both resins and charcoal , although not confirmed in human studies . The reason for negative results in humans is not clear.…”

“…Saturation of a HP column occurs after 2–6 hours of continuous use and results in a progressive decrease in clearance of the poison. Saturation results from the deposition of cellular debris and plasma proteins on the HP column; accumulation of adsorbed poison has a smaller contribution given the relatively massive surface area of most resin and charcoal cartridges . In some studies, saturation of charcoal cartridges occurred more quickly compared to resins , although this is not a consistent finding .…”