Management of intoxicated patients - a descriptive outcome analysis of 4,267 ICU patients.
BMC Emerg Med
; 22(1): 38, 2022 03 12.
Article
en En
| MEDLINE
| ID: mdl-35279068
ABSTRACT
INTRODUCTION:
Intoxications are common in intensive care units (ICUs). The number of causative substances is large, mortality usually low. This retrospective cohort study aims to characterize differences of intoxicated compared to general ICU patients, point out variations according to causative agents, as well as to highlight differences between survivors and non-survivors among intoxicated individuals in a large-scale multi-center analysis.METHODS:
A total of 105,998 general ICU patients and 4,267 individuals with the admission diagnoses "overdose" and "drug toxicity" from the years 2014 and 2015 where included from the eICU Collaborative Research Database. In addition to comparing these groups with respect to baseline characteristics, intensive care measures and outcome parameters, differences between survivors and non-survivors from the intoxication group, as well as the individual groups of causative substances were investigated.RESULTS:
Intoxicated patients were younger (median 41 vs. 66 years; p<0.001), more often female (55 vs. 45%; p<0.001), and normal weighted (36% vs. 30%; p<0.001), whereas more obese individuals where observed in the other group (37 vs. 31%; p<0.001). Intoxicated individuals had a significantly lower mortality compared to general ICU patients (1% vs. 10%; aOR 0.07 95%CI 0.05-0.11; p<0.001), a finding which persisted after multivariable adjustment (aOR 0.17 95%CI 0.12-0.24; p<0.001) and persisted in all subgroups. Markers of disease severity (SOFA-score 3 (1-5) vs. 4 (2-6) pts.; p<0.001) and frequency of vasopressor use (5 vs. 15%; p<0.001) where lower, whereas rates of mechanical ventilation where higher (24 vs. 26%; p<0.001) in intoxicated individuals. There were no differences with regard to renal replacement therapy in the first three days (3 vs. 4%; p=0.26). In sensitivity analysis (interactions for age, sex, ethnicity, hospital category, maximum initial lactate, mechanical ventilation, and vasopressor use), a trend towards lower mortality in intoxicated patients persisted in all subgroups.CONCLUSION:
This large-scale retrospective analysis indicates a significantly lower mortality of intoxicated individuals compared to general ICU patients.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Cuidados Críticos
/
Unidades de Cuidados Intensivos
Tipo de estudio:
Observational_studies
Límite:
Female
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Humans
/
Male
Idioma:
En
Revista:
BMC Emerg Med
Asunto de la revista:
MEDICINA DE EMERGENCIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Austria