Toxicology in the Critical Care Unit

Alapat, Philip; Zimmerman, Janice L.

doi:10.1378/chest.07-1840

Cited by 37 publications

(18 citation statements)

References 81 publications

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“…This is concordant with the 3% of empoisoned patients requiring critical care in the United States7. Although these life-threatening cases are limited, they require an early and appropriate management5627, which motivated the development and validation of our model. Predictors include early diagnosis, which is commonly revealed by specific clinical syndromes (“toxidromes”) suggesting particular substances.…”

Section: Discussionsupporting

confidence: 69%

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Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

Nguyen

Boudemaghe

Leguelinel-Blache

et al. 2017

Sci Rep

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Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1st, 2009 and December 31st, 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort. We developed a multivariate logistic model including patient’s age, sex, entrance mode and diagnosis as predictors of a composite primary outcome of in-hospital death or ICU admission. A total of 2,747 (4.2%) patients died or were admitted to ICU. The risk of death or ICU admission was mainly associated with the consumption of opioids, followed by cocaine and other narcotics. Particularly, methadone poisoning was associated with a substantial risk (OR: 35.70, 95% CI [26.94–47.32], P < 0.001). In the validation cohort, our model achieved good predictive properties in terms of calibration and discrimination (c-statistic: 0.847). This allows an accurate identification of life-threatening admissions in drug users to support an early and appropriate management.

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Section: Discussionsupporting

confidence: 69%

“…Life-threatening hospital admissions need an early and appropriate management, and sometimes require supportive care567. In drug-overdosed patients, the immediate need for ICU monitoring can be assessed with tools such as the Glasgow coma score8.…”

mentioning

confidence: 99%

Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

Nguyen

Boudemaghe

Leguelinel-Blache

et al. 2017

Sci Rep

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“…More specifically, there now is very strong evidence in the scientific literature to support the need for a series of time-dependent actions for various critical care management pathways such as trauma [1][2][3], toxicology [4], acute myocardial infarction [5,6 ,7] stroke [8][9][10], sepsis [11], and cardiac arrest [12][13][14]. Although the establishment of a coordinated continuum of care extending across the prehospital, ED, operating room, ICU, and rehabilitation phases of care has taken root in many venues for trauma care, the execution of these pathways for the majority of other critical conditions occurs in a highly variable fashion and, in some circumstances, this traditional compartmentalized approach has led to adverse patient outcomes and increased mortality rates.…”

mentioning

confidence: 99%

The critical care cascade: a systems approach

Ghosh

Pepe

2009

Current Opinion in Critical Care

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This article discusses the basis and rationale for the 'critical care cascade' concept, which contends that the optimal management of critically ill patients should be a continuum of care through the healthcare system. In the critical care cascade, each patient is enrolled on a 'pathway' of management based on their working diagnosis and each and every healthcare provider engaged along that continuum acts as part of a interconnected coordinated team that ensures a specific endpoint for these patients in a bundled manner that seamlessly extends from the prehospital and ED phases to the ICU and rehabilitation services.

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“…Les principales sources bibliographiques nouvelles depuis la parution de l'article de 2003 [9][10][11] sont peu nombreuses [4,[12][13][14][15].…”

Section: Matériel Et Méthodesunclassified

Recommandations pour la prescription, la réalisation et l’interprétation des examens de biologie médicale dans le cadre des intoxications graves

Bartoli

Berny²,

Capolaghi

et al. 2013

Immuno-analyse & Biologie Spécialisée

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Résumé -Un groupe de travail pluridisciplinaire « Toxicologie et biologie clinique » constitué de membres appartenant à la Société française de toxicologie analytique (SFTA), à la Société française de biologie clinique (SFBC), à la Société de toxicologie clinique (STC), à la Société de réanimation de langue française (SRLF), à la Société française de médecine d'urgence (SFMU), et au Collège national de biochime (CNBH), propose une réactualisation des recommandations de pratique professionnelle à l'attention des biologistes non spécialistes en toxicologie et plus largement de tous les professionnels de santé impliqués dans la prise en charge des patients gravement intoxiqués. Parmi les documents de synthèse élaborés dans la publication initiale, seul le tableau des principales intoxications graves a été réactualisé, les autres annexes demeurant toujours d'actualité. Ce tableau traite des intoxications liées à cinquante-cinq différents xénobiotiques. Il en rappelle les principaux symptômes, les paramètres biologiques marqueurs utiles de toxicité, les méthodes d'identification ou de dosage disponibles en urgence ainsi que leur pertinence et le délai recommandé de réa-lisation. Un consensus sur la place des examens biologiques et toxicologiques dans la prise en charge des intoxications a été recherché. Un nouveau tableau réactualise la liste des principaux antidotes utilisés. Un paragraphe sur l'intérêt et la place du criblage toxicologique a été rajouté.

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Toxicology in the Critical Care Unit

Abstract: The online version of this article, along with updated information

Cited by 37 publications

References 81 publications

Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

The critical care cascade: a systems approach

Recommandations pour la prescription, la réalisation et l’interprétation des examens de biologie médicale dans le cadre des intoxications graves

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