Can death unrelated to secondary causes be predicted in intubated comatose tricyclic antidepressant-poisoned patients?

Sanaei‐Zadeh, Hossein; Shahmohammadi, Farhad; Zamani, Nasim; Mostafazadeh, Babak

doi:10.3109/15563650.2011.587125

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…We would like to emphasize that although this covariate is not in our prediction model, it could be an important clinical marker and therefore should be taken into account, especially with substances known to cause rhythm disturbances. [26,27] Also, the time between ingestion and presentation is not included in the prediction model. Patients that have no symptoms and the time to maximum concentration has past will not need ICU treatment.…”

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

confidence: 99%

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=120mentioning

confidence: 99%

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

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

View full text Add to dashboard Cite

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Acquired Long QT Syndrome Manifesting with Torsades de Pointes in a Patient with Panhypopituitarism due to Radiotherapy

et al. 2013

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We describe a 64-year-old male patient with panhypopituitarism who experienced polymorphic ventricular tachycardia (VT) associated with long QT intervals. The panhypopituitarism developed as a sequelae of radiation therapy administered 20 years prior to his current presentation and was recently aggravated by urinary tract infection with sepsis. In this case, polymorphic VT was resistant to conventional therapy (including magnesium infusion), and QT prolongation and T wave inversion were normalized after the administration of steroid and thyroid hormones. Thyroid hormone is generally known to be associated with torsades de pointes (TdP), but steroid or other hormones may also provoke TdP. Hormonal disorders should be considered as a cause of polymorphic VT with long QT intervals. Some arrhythmias can be life-threatening, and they can be prevented with supplementation of the insufficient hormone.

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Can death unrelated to secondary causes be predicted in intubated comatose tricyclic antidepressant-poisoned patients?

Abstract: Neither ECG parameters nor clinical characteristics of the intubated comatose patients with TCA toxicity predicts death in patients who had not died due to the secondary causes. The only prognostic indicator of death in such patients is seizure after hospital presentation.

Cited by 2 publications

References 24 publications

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

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

Acquired Long QT Syndrome Manifesting with Torsades de Pointes in a Patient with Panhypopituitarism due to Radiotherapy

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