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. (Crit

Care Med 2006; 34:368–373)