Ja-Liang Lin1, Dan-Tzu Lin-Tan, Kuan-Hsing Chen, Wen-Hung Huang. 1. Division of Clinical Toxicology and Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung University, School of Medicine, Taipei, Taiwan, ROC. jllin99@hotmail.com
Abstract
OBJECTIVE: Paraquat is widely used in the world, and all treatments for paraquat poisoning have been unsuccessful. Many patients have died of paraquat poisoning in developing countries. A novel anti-inflammation method was developed to treat severe paraquat-poisoned patients with >50% to <90% predictive mortality: initial pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 2 days), followed by dexamethasone 20 mg/day until Pao2 was >11.5 kPa (80 mm Hg) and repeated pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 1 day), which was repeated if Pao2 was <8.64 kPa (60 mm Hg). DESIGN: Randomized controlled trial. SETTING:Academic medical center in Taiwan. PATIENTS: Twenty-three paraquat-poisoned patients with >50% and <90% predictive mortality assessed by plasma paraquat levels were prospectively and randomly assigned to the control and study groups at a proportion of 1:2. INTERVENTIONS: The control group received conventional therapy and the study group received the novel repeated pulse treatment with long-term steroid therapy. MEASUREMENTS AND MAIN RESULTS: We measured patient mortality during the study period. There was not a different distribution of basal variables between the two study groups. The mortality rate (85.7%, six of seven) of the control group was higher than that of the study group (31.3%, five of 16; p = .0272). CONCLUSIONS: The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquat poisoning.
RCT Entities:
OBJECTIVE:Paraquat is widely used in the world, and all treatments for paraquatpoisoning have been unsuccessful. Many patients have died of paraquatpoisoning in developing countries. A novel anti-inflammation method was developed to treat severe paraquat-poisoned patients with >50% to <90% predictive mortality: initial pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 2 days), followed by dexamethasone 20 mg/day until Pao2 was >11.5 kPa (80 mm Hg) and repeated pulse therapy with methylprednisolone (1 g/day for 3 days) and cyclophosphamide (15 mg/kg/day for 1 day), which was repeated if Pao2 was <8.64 kPa (60 mm Hg). DESIGN: Randomized controlled trial. SETTING: Academic medical center in Taiwan. PATIENTS: Twenty-three paraquat-poisoned patients with >50% and <90% predictive mortality assessed by plasma paraquat levels were prospectively and randomly assigned to the control and study groups at a proportion of 1:2. INTERVENTIONS: The control group received conventional therapy and the study group received the novel repeated pulse treatment with long-term steroid therapy. MEASUREMENTS AND MAIN RESULTS: We measured patient mortality during the study period. There was not a different distribution of basal variables between the two study groups. The mortality rate (85.7%, six of seven) of the control group was higher than that of the study group (31.3%, five of 16; p = .0272). CONCLUSIONS: The novel anti-inflammatory therapy reduces the mortality rate for patients with severe paraquatpoisoning.