Aspiration pneumonitis in an overdose population: Frequency, predictors, and outcomes

Isbister, Geoffrey K.; Downes, Fiona; Sibbritt, David; Dawson, Andrew; Whyte, Ian M.

doi:10.1097/01.ccm.0000104207.42729.e4

Cited by 100 publications

(90 citation statements)

References 26 publications

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“…[14] Likewise, old age has proven to be a risk factor for a bad outcome in a large German and English cohort. [15,16] Moreover, a low GCS has been frequently described as a risk factor for mortality, with evidence that only a very low GCS (< 6) predicts mortality which is consistent with our findings. [15][16][17][18][19] We were able to combine these factors into one prediction model based on a point system.…”

Section: Mechanical Venɵlaɵon N=1970 Cpr N=120supporting

confidence: 82%

The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

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Context: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. Objective: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality). Materials and methods: We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs. We aimed to include only observational admissions and therefore excluded admissions with treatment, at the start of the admission that can only be applied on the ICU (mechanical ventilation or CPR before admission). First, a generalized linear mixed-effects model with binominal link function and a random intercept per hospital was developed, based on covariates available in the first hour of ICU admission. Second, the selected covariates were used to develop a prediction model based on a practical point system. To determine the performance of the prediction model, the sensitivity, specificity, positive, and negative predictive value of several cut-off points based on the assigned number of points were assessed. Results: 9679 admissions between January 2010 until January 2015 were included for analysis. In total, 632 (6.5%) of the patients admitted to the ICU eventually turned out to actually need ICU treatment. The strongest predictors for ICU treatment were respiratory insufficiency, age >55 and a GCS <6. Alcohol and "other poisonings" (e.g., carbonmonoxide, arsenic, cyanide) as intoxication type and a systolic blood pressure !130 mmHg were indicators that ICU treatment was likely unnecessary. The prediction model had high sensitivity (93.4%) and a high negative predictive value (98.7%). Discussion and conclusion: Clinical use of the prediction model, with a high negative predictive value (98.7%), would result in 34.3% less observational admissions. ARTICLE HISTORY

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Section: Mechanical Venɵlaɵon N=1970 Cpr N=120supporting

confidence: 82%

The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

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show abstract

“…Poisoned patients are unlikely to suffer from secondary brain injury, but decreased consciousness and loss of protective airway reflexes predispose to respiratory failure and aspiration injury (6). However, the risk of aspiration is not confined to patients with a GCS of 8 or less, and the loss of airway reflexes cannot be reliably predicted using the GCS alone (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 98%

Decreased Glasgow Coma Scale Score Does Not Mandate Endotracheal Intubation in the Emergency Department

Duncan

Thakore

2009

The Journal of Emergency Medicine

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“…Seizures have been associated with hyperthermia, acidosis, anoxic brain injury, and an 8-fold increased risk of aspiration pneumonitis [1]. It is estimated that 6.1% of new onset seizures are drug related [2].…”

Section: Introductionmentioning

confidence: 99%

Evolving epidemiology of drug-induced seizures reported to a poison control center system

2007

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Introduction: We sought to determine whether or not the causes and consequences of drug-induced seizures have changed in the last decade.Methods: We conducted a retrospective review of all calls to the California Poison Control System in 2003 in which seizures occurred in association with poisoning or drug intoxication. We reviewed the poison center chart of each case to determine the drug(s) involved, the type of seizures, and the medical outcome. We compared the cause of reported seizures to that found in previous investigations.Results: 386 cases were evaluated and related to poisoning or drug intoxication. The leading causes of seizures were bupropion (89 cases, 23%), diphenhydramine (32 cases, 8.3%), tricyclic antidepressants (30 cases, 7.7%), tramadol (29 cases, 7.5%), amphetamines (27 cases, 6.9%), isoniazid (23 cases, 5.9%), and venlafaxine (23 cases, 5.9%). Since 1993, there was a statistically significant increase in antidepressant related seizures but a decrease in TCA and cocaine related seizures. In 265 patients (68.6%) only a single seizure was reported, while 3.6% (14 cases) reported status epilepticus. Two-thirds (65.5%) of the cases involved suicide attempts and 14.8% the direct result of drug abuse. There were 7 deaths. Of the 7 deaths, 4 people had significant hyperthermia. There was a statistically significant increased risk of death associated with stimulant exposure.Conclusion: While tricyclic antidepressants, antihistamines, stimulants, and isoniazid remain common causes of drug induced seizures, bupropion, tramadol, and venlafaxine have emerged as common causes of drug-induced seizures for which poison center consultation is requested.

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Aspiration pneumonitis in an overdose population: Frequency, predictors, and outcomes

Cited by 100 publications

References 26 publications

The need for ICU admission in intoxicated patients: a prediction model

The need for ICU admission in intoxicated patients: a prediction model

Decreased Glasgow Coma Scale Score Does Not Mandate Endotracheal Intubation in the Emergency Department

Evolving epidemiology of drug-induced seizures reported to a poison control center system

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