A Study of Toxification Types in Intubated Poisoned Patients in the ICUs of Taft Shahid Beheshti and Yazd Shahvali Hospitals (2015–2019)

Articles in Press

Document Type : Original Article

Authors

1 Department of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran

2 Department of Forensic Medicine & Clinical Toxicology, Yazd Branch, Islamic Azad University, Yazd, Iran

3 Department of Internal medicine, Fasa University of Medical Sciences, Fasa, Iran

4 Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

5 Department of Internal medicine, Faculty of medicine, Shahid Sadougi University of Medical Sciences and Health Service, Yazd, Iran

6 General Practitioner, Social security organization of Yazd, Iran

Abstract

Background: Although poisoning is one of the most common reasons for visits to emergency departments, the types of toxification among intubated poisoned patients in ICUs have not been well documented.
 
Objectives: This study aimed to identify the toxification types among intubated poisoned patients in an intensive care unit (ICU).
 
Methods: This retrospective cross-sectional study was conducted on poisoned patients with chemical compounds, hospitalized in ICU, and underwent endotracheal intubation. Toxicological and clinical factors, as well as outcomes, were collected and analyzed. Analysis was performed using the Chi-square test and Fisher's exact test. The p-value < 0.05 was considered significant.
 
Results: In this study, 307 patients with the diagnosis of poisoning were evaluated. The most common toxic agents were methadone (46.8%), opium (5.9%), organophosphorus compounds (5.9%), methanol (4.2%), and other chemical substances (2.4%). A single compound poisoned most patients (70%). Furthermore, 167 patients (54.4%) experienced accidental poisoning or drug abuse, while the remaining cases (45.6%) were due to suicidal intentions. Significant differences were observed between these two groups (suicidal and accidental poisoning groups) regarding age, gender, types of toxification, and grouping and duration of ICU hospitalization (P < 0.05). Significant differences were found in patient outcomes based on toxification types, toxification type grouping, or ICU hospitalization duration (P < 0.05).
 
Conclusion: Our results indicate that opioids, especially methadone, were the most frequent cause of poisoning in our study. Pesticide poisoning occurred significantly more often in patients with suicidal intent. Additionally, patient outcomes were significantly influenced by age, gender, type, grouping of toxic agents, and duration of ICU hospitalization.
 

Keywords

Acknowledgements: This study was financially supported by Yazd Islamic Azad University of Medical Sciences, Yazd, center Iran. We gratefully acknowledge the dedicated efforts of the investigators, the coordinators, and the volunteers who participated in this study.

 

Availability of data and materials: The dataset analyzed during the current study is available upon reasonable request from the corresponding author.

 

Conflicts of interests: The authors have indicated that they have no conflicts of interest regarding the content of this article.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: The study received ethics approval from the Ethics Committee of Yazd Islamic Azad University of Medical Sciences (IR.IAU.YAZD.REC.1399.002).The study was conducted in accordance with the principles of the Declaration of Helsinki.

 

Financial disclosure: None.

 

Author contributions: Conceptualization, Investigation and Project administration by Ghonghe OmidShafiee,Hamid Owliaey, Sareh Rafat Moghadam, Methodology and writing the original draft by Shadi Talebi, Hamidreza Ghasemirad,Marjan Shariatpanahi. Writing and Ediiting by Forouzan Farez,Faezeh Niknam, Mehrnoush Giahi Yazdi.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Mégarbane, B., Oberlin, M., Alvarez, JC. et al. Management of pharmaceutical and recreational drug poisoning. Ann. Intensive Care 10, 157 (2020).
https://doi.org/10.1186/s13613-020-00762-9
PMid:33226502 PMCid:PMC7683636
 
2. Ahmadi A, Pakravan N, Ghazizadeh Z. Pattern of acute food, drug, and chemical poisoning in Sari City, Northern Iran. Hum Exp Toxicol. 2010;29:731-8.
https://doi.org/10.1177/0960327110361501
PMid:20144960  
 
3. Ala A, Vahdati SS, Moosavi L, Sadeghi H. Studying the Relationship Between Age, Gender and Other Demographic Factors with the Type of Agent Used for Self-Poisoning at a Poisoning Referral Center in North West Iran/Kuzey Bati Iran' da Bir Zehirlenme Referans Merkezinde Kendini Zehirlemek için Kullanilan Ajan Tipi ile Yas, Cinsiyet ve Diger Demografik Faktörlerin Iliskisinin Arastirilmasi. Journal of Academic Emergency Medicine. 2011;10:2.
https://doi.org/10.5152/jaem.2011.022  
 
4. Karbakhsh M, Zandi NS. Pattern of poisoning in the elderly: An experience from Tehran. Clin Toxicol (Phila) 2008;46:211-7.
https://doi.org/10.1080/15563650701638982
PMid:17906992  
 
5. Kassiri H, Feiz-Haddad M-H, Ghasemi F, Rezaei M, Ghanavati F. An epidemiologic and demographic survey of poisoning in Southwest of Iran. Middle East J Sci Res. 2012;12:990-6.  
 
6. Masoumi G, Ganjei Z, Teymoori E, Sabzghabaee AM, Yaraghi A, Akbari M, et al. Evaluating the Prevalence of Intentional and Unintentional Poisoning in Vulnerable Patients Admitted to a Referral Hospital. Journal of Isfahan Medical School. 2013;31:1452-60. Persian.  
 
7. Sawalha AF, Sweileh WM, Tufaha MT, Al-Jabi DY. Analysis of the pattern of acute poisoning in patients admitted to a governmental hospital in Palestine. Basic Clin Pharmacol Toxicol. 2010;107:914-8.
https://doi.org/10.1111/j.1742-7843.2010.00601.x
PMid:20533924  
 
8. Shadnia S, Esmaily H, Sasanian G, Pajoumand A, Hassanian-Moghaddam H, Abdollahi M. Pattern of acute poisoning in Tehran-Iran in 2003. Hum Exp Toxicol. 2007;26:753-6.
https://doi.org/10.1177/0960327107083017
PMid:17984147  
 
9. Konradsen F, van der Hoek W, Cole DC, Hutchinson G, Daisley H, Singh S, et al. Reducing acute poisoning in developing countries--options for restricting the availability of pesticides. Toxicology. 2003;192:249-61.
https://doi.org/10.1016/S0300-483X(03)00339-1
PMid:14580791  
 
10. Mehrpour O, Zamani N, Brent J, Abdollahi M. A tale of two systems: Poisoning management in Iran and the United States. Daru. 2013;21:42.
https://doi.org/10.1186/2008-2231-21-42
PMid:23718923 PMCid:PMC3669081  
 
11. Bagheri P, Sepand M. A meta-analytical study of intentional and accidental non-food poisoning incidences in Iran (1991-2013) Koomesh. 2015;16:443-53. Persian.  
 
12. Kheir Abadi G. Intentional and unintentional poisonings and the relationship with some individual characteristics. Scientific Journal of Kordestan University of Medical Sciences. 2001;6:26-29. Persian.  
 
13. Spinello IM, Dellinger RP. Management of poisoning and overdose in the intensive care unit. Clinical Pulmonary Medicine. 2002 Jul 1;9(4):213-20.
https://doi.org/10.1097/00045413-200207000-00004  
 
14. Stevens JP, Wall MJ, Novack L, Marshall J, Hsu DJ, Howell MD. The critical care crisis of opioid overdoses in the United States. Annals of the American Thoracic Society. 2017 Dec;14(12):1803-9.
https://doi.org/10.1513/AnnalsATS.201701-022OC
PMid:28800256 PMCid:PMC5802515  
 
15. Krantz MJ, Haigney MC. Methadone, synthetic opioids and torsades de pointes. Torsades de Pointes: Elsevier; 2022. p. 267-84.
https://doi.org/10.1016/B978-0-12-821446-6.00004-3  
 
16. Boyle, J.S., Bechtel, L.K. & Holstege, C.P. Management of the critically poisoned patient. Scand J Trauma Resusc Emerg Med17, 29 (2009).
https://doi.org/10.1186/1757-7241-17-29
PMid:19563673 PMCid:PMC2720377  
 
17. Duncan R, Thakore S. Decreased Glasgow Coma Scale score does not mandate endotracheal intubation in the emergency department. J Emerg Med. 2009;37(4):451-455.
https://doi.org/10.1016/j.jemermed.2008.11.026
PMid:19272743  
 
18. Adnet F, Borron SW, Finot MA, Lapandry C, Baud FJ. Intubation difficulty in poisoned patients: association with initial Glasgow Coma Scale score. Acad Emerg Med. 1998;5(2):123-127.
https://doi.org/10.1111/j.1553-2712.1998.tb02596.x
PMid:9492132  
 
19. Downes MA, Calver LA, Isbister GK. Intralipid therapy does not improve level of consciousness in overdoses with sedating drugs: a case series. Emerg Med Australas. 2014;26(3):286-290
https://doi.org/10.1111/1742-6723.12237
PMid:24810248  
 
20. Jang DH, Manini AF, Trueger NS, Duque D, Nestor NB, Nelson LS, Hoffman RS. Status epilepticus and wide-complex tachycardia secondary to diphenhydramine overdose. Clin Toxicol (Phila) 2010;48(9):945-948.
https://doi.org/10.3109/15563650.2010.527850
PMid:21171853 PMCid:PMC4091778  
 
21. Thundiyil JG, Rowley F, Papa L, Olson KR, Kearney TE. Risk factors for complications of drug-induced seizures. J Med Toxicol. 2011;7(1):16-23.
https://doi.org/10.1007/s13181-010-0096-4
PMid:20661684 PMCid:PMC3056005  
 
22. Unverir P, Atilla R, Karcioglu O, Topacoglu H, Demiral Y, Tuncok Y. A retrospective analysis of antidepressant poisonings in the emergency department: 11-year experience. Hum Exp Toxicol. 2006;25(10):605-612.
https://doi.org/10.1177/096032706072470
PMid:17165627  
 
23. Jay SJ, Johanson WG, Jr, Pierce AK. Respiratory complications of overdose with sedative drugs. Am Rev Respir Dis. 1975;112(5):591-598.  
 
24. Rollin M, Jaulim A, Vaz F, Sandhu G, Wood S, Birchall M, Dawas K. Caustic ingestion injury of the upper aerodigestive tract in adults. Ann R Coll Surg Engl. 2015;97(4):304-307.
https://doi.org/10.1308/003588415X14181254789286
PMid:26263940 PMCid:PMC4473870  
 
25. Turner A, Robinson P. Respiratory and gastrointestinal complications of caustic ingestion in children. Emerg Med J. 2005;22(5):359-361.
https://doi.org/10.1136/emj.2004.015610
PMid:15843706 PMCid:PMC1726769  
 
26. Dadpour, Bita, Hatami, Liaghat, Eshraghi, Najari, Fars, Najari, Dorsa. Study of QT dispersion in electrocardiogram of patients with methadone poisoning. Journal of the Faculty of Medicine, Tehran University of Medical Sciences. 2019 Oct 10;77(7):453-7.  
 
27. ‎Masoumi G, Eizadi-Mood N, Akabri M, Sohrabi A, Khalili Y. Pattern of poisoning in Isfahan. J Isfahan Med Sch. 2012;29: 1317-24.  
 
28. Bakhsha F (MSc), Behnampour N (MSc), Charkazi A (MSc). The prevalency of attempted suicide in Golestan province, North of Iran during 2003-07. J Gorgan Univ Med Sci 2011; 13 (2) :79-85.  
 
29. Yaraghi Yaraghi A, Talaei-Zavareh AS, Mansourian M, Eizadi-Mood N. Naltrexone in unintentional methadone poisoning. Journal Isfahan Medical School, 2016. 34(384):p. 580-8.  
 
30. Farzaneh E, Amani F, Etemad F. A Clinico-Epidemiologic Study on Patients with Opium Toxicity Treated at Ardabil Hospitals, Iran, 2014-2015. Asia Pac J Med Toxicol. 2016; 5:111-4.  
 
31. Afzali S. Pattern of mortality due to poisoning by drugs and chemical agents in Hamadan, Iran, 2005-2007. Qom Uni Med Sci J. 2012;2(2):15-22.  
 
32. Ayatollahi V, Behdad S, Oliwiaie H, Hajiesmaili MR, Dehghan M, Mehrpour O. Characteristic features of patients hospitalized with Narcotic poisoning in Yazd. Iran. Iran J Toxicol. 2011;4(4):362-6.  
 
33. Nafei Z, Sabouhi N, Ferdosian F, Shamsi F. The pattern of acute poisoning in hospitalized children under 18 years old of Yazd, Iran. Asia Pac J Med Toxicol.2021;10:44-7.  
 
34. Kudo K, Ishida T, Hikiji W, Usumoto Y, Umehara T, Nagamatsu K, Tsuji A, Ikeda N. Pattern of poisoning in Japan: selection of drugs and poisons for systematic toxicological analysis. Forensic Toxicology. 2010 Jan;28:25-32.
https://doi.org/10.1007/s11419-009-0088-8  
 
35. Shayesteh M.A Survey on the Pattern of Aluminum Phosphide Poisoning in Gorgan, North of Iran. Sabzavar J Univ Med Sci2017;1-9.  
 
36. Mehrpour O, Akbari A, Jahani F, Amirabadizadeh A, Allahyari E, Mansouri B, et al. Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017) BMC Emerg Med. 2018;18:1-9
https://doi.org/10.1186/s12873-018-0181-6
PMid:30231863 PMCid:PMC6146606  
 
37. Roya B. In-Hospital Mortality and Long-Term Survival of Patients With Acute Intoxication Admitted to the ICU. Critical Care Medicine 2014; 42(6): 1471-1479.
https://doi.org/10.1097/CCM.0000000000000245
PMid:24584062  
 
Razavi International Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 29 June 2025

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