Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors

Hua, Angela; Haight, Stephen; Hoffman, Robert S.; Manini, Alex F.

doi:10.1016/j.jemermed.2016.07.114

Cited by 18 publications

(13 citation statements)

References 17 publications

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“…Blood gases data in the current study revealed that acidosis and respiratory failure were significantly associated with mortality, Hua et al, (2017) found the same result and reported that mortality was associated with lower mean pH and higher mean PaCO2.…”

Section: Discussionsupporting

confidence: 83%

Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

Mohammed

Gawesh

2019

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Background: Emergency physicians are often challenged with a comatose patient; 30% of patients with coma of unknown origin are due to intoxication. Comatose patients are at high risk for morbidity and mortality. Objective: The present study assessed poisoning-induced coma regarding demographic and intoxication data, causative agents, clinical data, management modalities and outcome. In addition to evaluation of the role of creatine phosphokinase (CPK) level on admission and other variables as predictive factors for the outcome in toxic coma. Subjects and Methods: This study was conducted prospectively on one hundred comatose intoxicated patients, admitted to Poison Control Center Ain Shams University Hospitals (PCCASU). Results: The majority of patients (64%) were in the age group 18-40 year, and there was male predominance (56%). Organophosphorus, carbamazepine and tramadol were the most common toxic agents inducing coma. Death rate was 12% and mortality is much higher in patients with older age, elevated admission creatine phosphokinase, longer duration of hospital stay and higher grade of Reed's classification of coma. Conclusion: Organophosphorus followed by carbamazepine and tramadol were the most common toxic agents inducing coma. Older age, elevated admission creatine phosphokinase, longer duration of hospitalization and higher grade of Reed's classification of coma can predict the mortality. In addition, respiratory acidosis and the need of intubation and mechanical ventilation indicated poorer outcome, while administration of antidotes was correlated with better outcome.

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Section: Discussionsupporting

confidence: 83%

Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

Mohammed

Gawesh

2019

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…The proportional incidence of intubation is low (2.3% of all alcohol-intoxications presenting to our ED). This is lower than the intubation rate of 3.5% for drug intoxication found in the United States [18]. In addition to this, only about a fifth of patients with a GCS < 9 -that would mandate invasive airway protection in non-intoxicated trauma patients -were intubated in our study.…”

Section: Proportional Incidence Of Intubation In Alcohol Intoxicationmentioning

confidence: 56%

Intubation in acute alcohol intoxications at the emergency department

Sauter

Rönz

Hirschi

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Guidelines recommend endotracheal intubation in trauma patients with a Glasgow coma scale (GCS) < 9 because of the loss of airway reflexes and consequential risk of airway obstruction. However, in patients with acute alcohol intoxication guidelines are not clear. Thus, we aimed to determine the proportional incidence of intubation in alcohol intoxication and compare the clinical characteristics of intubated and non-intubated patients, as well as reasons for intubation in all patients and in the subgroup of patients with reduced GCS (< 9) but without traumatic brain injury. Methods: We performed a retrospective analysis of all consultations to an urban ED in Switzerland that presented with an acute alcohol intoxication between 1st June 2012 and 31th Mai 2017. Patient and emergency consultations' characteristics, related injuries, intubation and reason for intubations were extracted. As a subgroup analysis, we analysed the patients with a GCS < 9 without a traumatic brain injury.Results: Of 3003 consultations included from 01.06.2012 to 31.05.2017, 68 were intubated, leading to a proportional incidence of 2.3% intubations in alcohol-intoxication. Intubated patients had a lower blood alcohol concentration (1.3 g/kg [IQR 1.0-2.2] vs. 1.6 g/kg [IQR1.1-2.2], p = 0.034) and less often suffered from chronic alcohol abuse (1183 [39.4%] patients vs. 14 [20.6%], p = 0.001) than non-intubated patients. Patients with trauma were intubated more often (33 patients [48.5%] vs. 742 [25.3%], p < 0.001). In subgroup analysis, 110/145 patients (74.3%) were not intubated; again, more intubated patients had a history of trauma (9 patients [25.7%] vs. 10 [9.1%], p = 0.011).Conclusions: Intubation in alcohol-intoxicated patients is rare and, among intoxicated patients with GCS < 9, more than two thirds were not intubated in our study -without severe complications. Trauma in general, independent of the history of a traumatic brain injury, and a missing history of chronic alcohol abuse are associated with intubation, but not with blood alcohol concentration. Special caution is required for intoxicated patients with trauma or other additional intoxications or diseases.

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“…Drug overdose is the leading cause of injury-related fatality in the United States (US) after a motor vehicle accident [1]. In 2018, 70% of US drug overdose deaths involved opioid use [2].…”

Section: Introductionmentioning

confidence: 99%

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States

Oladunjoye

Olubiyi

et al. 2020

Cureus

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Introduction Opioid overdose is increasingly becoming common and so is the need for invasive mechanical ventilation (IMV) for opioid overdose admissions in hospitalized patients. Respiratory failure requiring invasive mechanical ventilation is the most common reason for the admission of opioid-associated overdose patients. The aim of our study was to assess the demographic and clinical characteristics associated with the increased need for IMV in hospitalized opioid overdose patients. Methods We analyzed all adult admissions (18 years and above) using the National Inpatient Sample (NIS) database for five years from January 1, 2010-December 31, 2014 to identify opioid overdose patients requiring invasive mechanical ventilation. We compared the demographic and clinical characteristics of opioid overdose patients requiring and not requiring mechanical ventilator support and performed univariate and multivariate analyses to determine the odds ratio (OR) of association. Results A total of 2,528,751 opioid overdose patients were identified among which 6.4% required IMV during hospitalization. The prevalence of opioid overdose and the need for IMV increased by 31% and 38%, respectively, over the study period. Multivariate logistic regression (OR (95% CI), p<0.001) determined the following to be associated with increased odds of mechanical ventilator use: (OR 1.12 (1.06-1.19)) among patients aged 25-39 years vs (1.36 (1.28-1.44)) for the age group 40-64 years when compared to 18-24 years; hospital locations in the south US region (OR 1.62 (1.49-1.75)) when compared to the northeast US region; the presence of aspiration pneumonia (OR 14.30 (13.63-15.0)), rhabdomyolysis (3.22 (3.04-3.42)), septic shock (9.15 (8.41-9.97)), and anoxic brain injury (15.5 (13.70-17.50)). Other factors associated with decreased odds of IMV include hepatitis C virus infection (OR 0.75 (0.72-0.79)) and black race (OR 0.68 (0.63-0.74)]. Opioid overdose patients requiring IMV had a higher length of stay by 8.

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Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors

Cited by 18 publications

References 17 publications

Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

Acute Poisoning Induced Coma: Characteristics and Predictive Role of Early Creatine Phosphokinase on Its Outcome

Intubation in acute alcohol intoxications at the emergency department

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States

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