One-lung circumvention, an interventional strategy for pulmonary salvage in acute paraquat poisoning: An evidence-based review

Paraquat is highly toxic to humans. Peak plasma levels are reached within 1 hour after intentional
ingestion of this poison, followed by a rapid decline because of its distribution to the extravascular
compartment and renal elimination. It induces generation of free oxygen radicals and consumption of
intracellular nicotinamide adenine dinucleotide phosphate in a cyclic single-electron reduction/oxidation
reaction; consequently, cell death occurs because of lipid peroxidation of the cell membrane.
Paraquat selectively accumulates in the lungs, resulting in pulmonary fibrosis, which can eventually lead
to respiratory failure in many survivors of the acute phase. It is believed that charcoal hemoperfusion is
the best modality for extracorporeal elimination in the acute phase. Afterward, anti-inflammatory and
immunosuppressive treatment and even lung radiotherapy have been proposed to alleviate inflammation.
Unfortunately, these protocols are unsuccessful in a majority of patients. Because the first hours are
critical for treatment and the lungs are the target organs, pulmonary salvage is the aim of the toxicologist.
Deep insertion of an endotracheal tube as the first treatment effort can produce alveolar collapse,
as well as an arteriovenous pulmonary shunt in one lung. Decreased paraquat uptake, at least in one
lung, leads to a reduced inflammatory process in the treated lung after the acute phase of toxicity.
Furthermore, preserving a functioning lung is sufficient for life.
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