Hemadsorption to Enhance Drug Elimination in Intoxications

In this trial the investigators assess the effectiveness of applying a hemadsorber (cytosorb®) in removing benzodiazepines or tricyclic antidepressants in intoxicated patients admitted to ICU with prolonged impaired consciousness. This is a one arm interventional investigation where a hemadsorption filter is applied in patients fulfilling inclusion criteria 8 hours after admission. Plasma titer of the neurodepressing drug will be collected sequentially both before and after start of hemadsorption to evaluate the speed of drug elimination before and after application of a hemadsorption filter. Pre- and post filter titers will be obtained to evaluate adsorbability and to evaluate time to saturation of the filter.

Inclusion Criteria: 1. older than18 years 2. Admission to ICU 3. GCS \< 8 or requiring Flumazenil 8 hours after hospital admission 4. Having an intoxication with a benzodiazepine or tricyclic antidepressant that we can measure/quantify 5. Having a risk factor for delayed drug elimination defined as either Cirrhosis CHILD B/C or chronic kidney insufficiency KDIGO 3b or worse Exclusion Criteria: 1. Pregnant patient 2. Patients in chronic dialysis before admission 3. Need for mechanical ventilation for other reasons than intoxications (e.g. pneumonia, neurotrauma) 4. Concomitant pathology requiring continued intravenous sedation 5. Known history of seizures 6. Contra-indication to heparin use 7. DNR restricting the use of mechanical ventilation or dialysis