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Detoxification hemosorption
Last reviewed: 04.07.2025

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Therapeutic hemosorption is based on the fixation of chemical compounds on non-selective carbon sorbents of natural or synthetic origin, which is determined by the forces of molecular adhesion of Van der Waals, the strength of which is due to the formation of covalent bonds between the toxicant and the sorbent. Effective sorption of target metabolites is ensured by a large total surface area of the sorbent - up to 1000 m2 / g, and the surface area of the carbon formed by pores significantly exceeds the external surface area of the carbon, and the total pore volume is up to 1 ml /g. The degree of sorption mainly depends on the capacity of the micropores of the sorbent, as well as on the polarizability and geometric characteristics of the sorbed toxic substance.
In general, the sorption capacity of activated carbon is very high: 1 g of activated charcoal can sorb 1.8 g of mercuric chloride, 1 g of sulfonamides, 0.95 g of strychnine, 0.9 g of morphine, 0.7 g of atropine, 0.7 g of barbital, 0.3-0.35 g of phenobarbital, 0.55 g of salicylic acid, 0.4 g of phenol and 0.3 g of ethanol from inorganic solutions.
The kinetics of sorption in the outer layer of the sorbent is determined by the sorbate supply and is limited by the molecular diffusion of the sorbed component in a non-stirred thin layer directly adjacent to the surface of the granules, called the Nernstian film, which is destroyed only with intensive turbulence of the biological fluid flow. The sorption rate in this case is inversely proportional to the effective radius of the granules, and the activation energy of external diffusion is relatively low and is only 4-20 kJ/mol. The rate of the process increases with turbulence of the flow, reducing the thickness of the Nernstian film, as well as with an increase in the concentration of the sorbed component.
Intra-diffusion kinetics, in turn, is determined by the concentration of the sorbent in the micropores and its diffusion gradient. The sorption rate in this case is inversely proportional to the squared radius of the sorbent granules. The activation energy of diffusion for this type of kinetics is significantly higher and is 40-120 kJ/mol. Thus, for intra-diffusion kinetics, it is desirable to use sorbents with the smallest possible granule size, which allows for a significant intensification of the process. The most stable fixation of toxic substances and the fastest kinetics are noted in micropores. In addition, due to the high adsorption potential in the micropore area, larger molecules can also be fixed.
A large number of natural (mineral, animal, plant) and synthetic sorbents have been synthesized, and the activity of plant sorbents is recognized as higher than others.
The mechanism of the therapeutic effect of hemosorption is divided into three main components: etiospecific, associated with the accelerated removal of the etiologic factor, i.e. the toxicant that caused the poisoning, pathospecific, detected during the elimination of pathogenetically significant factors ("medium molecules", circulating immune complexes, etc.), nonspecific, manifested in relation to the correction of homeostasis parameters. The main advantage of hemosorption is considered to be the intensive extraction of hydrophobic and fat-soluble toxic substances from the blood (clearance 70-150 ml/min), which allows for a short time to reduce the concentration of the toxicant in the blood from lethal or critical to the threshold and thereby minimize the spatiotemporal delay of therapeutic measures in relation to the moment of poisoning. The immediate detoxifying effect of hemosorption is supplemented by the purification of the blood from "medium molecules", the clearance of which reaches 25-30 ml/min.
Among the non-specific effects of hemosorption, its influence on hemorheological indices is most noticeable, primarily related to the disaggregation of formed elements (erythrocytes, thrombocytes). Blood viscosity and hematocrit decrease, fibrinolytic activity of blood plasma increases, which leads to the removal of fibrin destruction products from the microcirculatory bed, as a result of which the degree of development of DIC syndrome and related organ disorders significantly decreases. On the 1st-3rd day after hemosorption, the content of functionally most complete, highly stable erythrocytes in the blood increases significantly and the number of low-resistant cells decreases.
The beneficial effect of hemosorption on homeostasis parameters is accompanied by a significant acceleration of the elimination of toxic substances from the body, which is manifested by a reduction in the half-life of toxicants in the blood (barbiturates, chlorinated hydrocarbons, chlorinated hydrocarbons) by 3-10 times, in addition, the resistance of tissues to the action of toxicants in high concentrations increases significantly. High clinical and laboratory efficiency of hemosorption is noted in poisoning with psychotropic and hypnotic drugs (barbiturates, benzodiazepines, phenothiazines, leponex, etc.), chlorinated hydrocarbons, salicylates, quinine, pachycarpine hydroiodide, anti-tuberculosis drugs and many other toxicants, hemosorption is most effective in the early stages of poisoning with poisonous mushrooms (death cap, false champignons, etc.).
The clinical effect of hemosorption in the toxicogenic stage of poisoning is manifested by a reduction in the duration of toxic coma, correction of laboratory indicators of endotoxicosis, which contributes to a more favorable course or prevention of organ disorders, especially hepatorenal and neurological. As a result, the duration of inpatient treatment of patients is reduced.
Method of detoxifying hemosorption in acute poisoning
Equipment |
Hemosorption devices |
Mass transfer device |
When performing hemosorption at the prehospital stage, the amount of sorbent can be reduced to 75-100 ml with a corresponding reduction in the size of the mass exchanger. |
Highway system |
Disposable special |
Vascular access |
Catheterization of the main vein, when using the subclavian vein - followed by X-ray examination of the chest organs, arteriovenous shunt |
Preliminary preparation |
|
Hemodilution |
12-15 ml of fluid per 1 kg of the patient's body weight until the hematocrit decreases within 35-40% and the central venous pressure reaches about 60-120 mm H2O |
Auto-coating of the sorbent surface with blood |
When using natural (uncoated) carbons Perfusion through a sorbent of a special protective solution (5 ml of the patient's blood + 400 ml of 0.85% sodium chloride solution) with the addition of sodium heparin (5000 U) for 10-15 minutes |
Heparinization |
General, 350-500 U of sodium heparin per 1 kg of patient's body weight. |
Blood perfusion method |
Blood is taken from the vessel using a pump, it enters the detoxifying column, contacts with the sorbent and returns to |
Blood perfusion rate |
During the first 5-10 minutes of the operation - gradual increase in the blood perfusion rate from 50-70 ml/min to 100-150 ml/min with maintenance of the achieved blood flow rate until the end of the operation |
Blood perfusion volume |
1-1.5 BCC (6-9 l) during one hemosorption session (1 hour) |
Recommended modes |
The duration of one hemosorption session is 1 hour. |
Indications for use |
Clinical |
Contraindications |
Hypotension refractory to therapy. Gastrointestinal and cavitary bleeding. |
Premedication |
Chloropyramine (1-2 ml of 1% solution), prednisolone (30-60 mg) intravenously |