engleski

Acutely Intoxicated Patients Treated in the Medical ICU - a Single-center 15-year Follow-up

Objective: To analyze patients treated in the medical intensive care unit (ICU) for acute poisoning by drugs or chemicals - their demographic characteristics, intent of substance intake, main toxic agents, clinical presentation and outcome. Design and Method: A prospective, observational, single-center clinical study, conducted in the Medical ICU of the University Hospital Center Sisters of Charity, Zagreb, Croatia, during years 2001, 2010 and 2015. All acutely intoxicated patients from the Emergency Department (ED) who required ICU treatment were consecutively enrolled in the study. Treatment was performed according to the evidence-based medicine guidelines. The study comprised only patient data and laboratory test results collection. Results: During the study period a total of 160 acutely intoxicated patients were treated in the ICU - 67 in 2001 (20.2% of all acutely intoxicated patients presented to the ED; 7.2% of all patients treated in the ICU in 2001), 49 in 2010 (7.9%; 5.8%) and 44 patients in 2015 (6.8%; 5.6%). There was no difference in sex distribution (50.7% of women in 2001, 46.9% in 2010 and 54.5% in 2015; P2001vs2010=0.53, P2010vs2015=0.29, P2001vs2015=0.53), but the rise in patients' age was recorded during the study [median age 34 (18-89) years (yr.) in 2001, 42 (20-81) yr. in 2010, 49 (20-95) yr. in 2015; P2001vs2010=0.005, P2010vs2015=0.18, P2001vs2015<0.001]. The majority of the patients took the drug or chemical in suicide attempt (62.7% in 2001, 42.9% in 2010, 65.9% in 2015). The main toxic agent were benzodiazepines in all the studied years and ethanol was the most frequently used coagent [figure1]. 52.5% of patients in 2001, 38.8% in 2010 and 54.5% in 2015 were admitted to the ICU in coma (Glasgow Coma Score <8) [figure2]. 9.0%, 12.2% and 36.4%, respectively, were mechanically ventilated (P2001vs2010=0.41, P2010vs2015<0.001, P2001vs2015<0.001) [figure2]. Death in ICU due to acute poisoning occurred in 3.0% of patients in 2001, 10.2% in 2010 and 11.4% in 2015; median age of these patients was 46.5 (29-64), 70 (53-81) and 83 (51-95) yr., respectively. Substances that caused fatal outcomes are presented in [figure1]. Conclusion: Management of acutely intoxicated patients in the ED improved during the study - only high risk patients require treatment in the ICU. Intoxications by heroin almost disappeared, while the distribution of intoxications by other substances among the ICU patients did not change significantly during 15-year period.

intoxication; poisoning; ICU

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