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Poisoning in an intensive care unit: 8 years experience

Poisoning in an intensive care unit: 8 years experience. Dr Grace SM Lam Department of Intensive Care Toxicology Meeting 7 August 2009. introduction. Poisoning A significant cause of morbidity & mortality worldwide, and a common cause of ICU admission.

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Poisoning in an intensive care unit: 8 years experience

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  1. Poisoning in an intensive care unit:8 years experience Dr Grace SM Lam Department of Intensive Care Toxicology Meeting 7 August 2009

  2. introduction • Poisoning • A significant cause of morbidity & mortality worldwide, and a common cause of ICU admission. • A heterogeneous subject that poses a challenge for clinicians. • Knowledge of local poisoning pattern • Guide focus of poisoning prevention; • Guide clinical research & professional training; • Improve management of patients with poisoning.

  3. Aims of study • To describe: • Pattern of poisoning • Clinical characteristics • Outcomes Of patients admitted to the ICU for poisoning

  4. methods • The study included patients: • Admitted to PYNEH ICU • From 1 January 2000 – 31 May 2008 • For poisoning, defined as exposure to: • An agent capable of producing a deleterious response in an individual; or • A drug at a dosage exceeding that normally used for human in the prophylaxis, diagnosis or therapy of disease • Significant head injury after intoxication & fire victims were excluded

  5. results • 14 excluded: • 10 chronic alcoholics /drug addicts with significant HI • 4 fire victims with CO poisoning

  6. Demographic & clinical characteristics

  7. Pattern of poisoning • Miscellaneous • Theophylline • Bricanyl durule • Anti-epileptic agents • Hypoglycemic agents • Artane • Allopurinol • Warfarin • Commercial slimming agent • Thinner

  8. Mortality • 8 (3%) did not survive to hospital discharge • 5 (1.9%) died in ICU

  9. Complications

  10. Duration of mechanical ventilation • 67.9% intubated and mechanically ventilated • 65.3% with GCS ≤8 on presentation • Median = 1 day • Independent predictors of a duration of mechanical ventilation > 1 day:

  11. ICU Length of stay • Median = 1 day • Independent predictors of an ICU LOS >1 day:

  12. Acute HOSPITAL length of stay • Median = 3 days • Independent predictors of an acute hospital LOS >3 days:

  13. result CO poisoning: • HBO performed in 2 (5%) patients • No factor was identified as independent predictors of neurological or cardiac complications • Including initial COHb level

  14. result TCA poisoning • No factor was identified as independent predictors of neurological or cardiac complications

  15. limitations • Retrospective study • Missing data e.g. time of intoxication • ICU admission was not standardized • Heterogeneous study population & uncommon adverse outcomes limited the validity of statistical analyses • Long-term outcome was not systematically studied • Single-center study

  16. conclusions • The 4 commonest poisons encountered in our ICU from 2000 to 2008 were BDZ, alcohol, TCA, and CO • Mortality was comparable to international data • Timely management with emphasis on prevention of aspiration pneumonia may reduce adverse outcomes • It is hoped that outcomes of these patients can be further improved in the future through: • Collaboration with local advisory bodies (HKPIC) • Raising clinicians’ awareness • Continued efforts on clinical trials

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