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Extracorporeal treatment for salicylate poisoning: Systematic review and recommendations from the EXTRIP workgroup

Juurlink, David N; Gosselin, Sophie; Kielstein, Jan T; Ghannoum, Marc; Lavergne, Valery; Nolin, Thomas D.; Hoffman, Robert S.; Anseeuw, Kurt; Bhalla, Ashish; Burdmann, Emmanuel A; Roberts, Darren

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Study objective: Salicylate poisoning is a challenging clinical entity associated with substantial morbidity and mortality. The indications for extracorporeal treatments such as hemodialysis are poorly defined. We present a systematic review of the literature along with evidence- and consensus-based recommendations on the use of extracorporeal treatment in salicylate poisoning. Methods: The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup is a multidisciplinary group with...[Show more]

dc.contributor.authorJuurlink, David N
dc.contributor.authorGosselin, Sophie
dc.contributor.authorKielstein, Jan T
dc.contributor.authorGhannoum, Marc
dc.contributor.authorLavergne, Valery
dc.contributor.authorNolin, Thomas D.
dc.contributor.authorHoffman, Robert S.
dc.contributor.authorAnseeuw, Kurt
dc.contributor.authorBhalla, Ashish
dc.contributor.authorBurdmann, Emmanuel A
dc.contributor.authorRoberts, Darren
dc.date.accessioned2016-06-14T23:19:12Z
dc.identifier.issn0196-0644
dc.identifier.urihttp://hdl.handle.net/1885/102798
dc.description.abstractStudy objective: Salicylate poisoning is a challenging clinical entity associated with substantial morbidity and mortality. The indications for extracorporeal treatments such as hemodialysis are poorly defined. We present a systematic review of the literature along with evidence- and consensus-based recommendations on the use of extracorporeal treatment in salicylate poisoning. Methods: The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup is a multidisciplinary group with international representation whose aim is to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. We conducted a systematic literature review followed by data extraction and summarized findings, following a predetermined format. The entire work group voted by a 2-round modified Delphi method to reach consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote determined the final recommendations. Results: Eighty-four articles met inclusion criteria, including 1 controlled clinical trial, 3 animal studies, and 80 case reports or case series, yielding an overall very low quality of evidence for all recommendations. Clinical data on 143 patients (130 sets of which could be analyzed for patient-level entry data), including 14 fatalities, were reviewed. Toxicokinetic data on 87 patients were also included. After the second round of voting, the workgroup concluded that salicylates are dialyzable by hemodialysis and hemoperfusion (level of evidence¼B) and recommended extracorporeal treatment in patients with severe salicylate poisoning (1D), including any patient with altered mental status (1D), with acute respiratory distress syndrome requiring supplemental oxygen (1D), and for those in whom standard therapy is deemed to be failing (1D) regardless of the salicylate concentration. High salicylate concentrations warrant extracorporeal treatment regardless of signs and symptoms (>7.2 mmol/L [100 mg/dL] [1D]; and >6.5 mmol/L [90mg/dL] [2D]), with lower thresholds applied for patients with impaired kidney function (>6.5 mmol/L [90 mg/dL] [1D]; >5.8 mmol/L [80 mg/dL] [2D]). Extracorporeal treatment is also suggested for patients with severe acidemia (pH 7.20 in the absence of other indications) (2D). Intermittent hemodialysis is the preferred modality (1D), although hemoperfusion (1D) and continuous renal replacement therapies (3D) are acceptable alternatives if hemodialysis is unavailable, as is exchange transfusion in neonates (1D). Conclusion: Salicylates are readily removed by extracorporeal treatment, with intermittent hemodialysis being the preferred modality. The signs and symptoms of salicylate toxicity listed warrant extracorporeal treatment, as do high concentrations regardless of clinical status.
dc.publisherMosby Inc
dc.sourceAnnals of Emergency Medicine
dc.titleExtracorporeal treatment for salicylate poisoning: Systematic review and recommendations from the EXTRIP workgroup
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume66
dc.date.issued2015
local.identifier.absfor020100 - ASTRONOMICAL AND SPACE SCIENCES
local.identifier.ariespublicationa383154xPUB3546
local.type.statusPublished Version
local.contributor.affiliationJuurlink, David N, University of Toronto
local.contributor.affiliationGosselin, Sophie, McGill University Health Centre
local.contributor.affiliationKielstein, Jan T, Hannover Medical School
local.contributor.affiliationGhannoum, Marc, University of Montreal
local.contributor.affiliationLavergne, Valery, University of Montreal
local.contributor.affiliationNolin, Thomas D., University of Pittsburgh School of Pharmacy
local.contributor.affiliationHoffman, Robert S., New York University School of Medicine
local.contributor.affiliationAnseeuw, Kurt, Department of Emergency Medicine
local.contributor.affiliationBhalla, Ashish, Department of Internal Medicine
local.contributor.affiliationBurdmann, Emmanuel A, University of Sao Paulo
local.contributor.affiliationRoberts, Darren, College of Medicine, Biology and Environment, ANU
local.description.embargo2037-12-31
local.bibliographicCitation.issue2
local.bibliographicCitation.startpage165
local.bibliographicCitation.lastpage181
local.identifier.doi10.1016/j.annemergmed.2015.03.031
dc.date.updated2016-06-14T08:34:03Z
local.identifier.scopusID2-s2.0-84937682397
CollectionsANU Research Publications

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