Endotracheal Intubation for Toxicologic Exposures: A Retrospective Review of Toxicology Investigators Consortium (ToxIC) Cases

• Published in: The Journal of emergency medicine 2016-10, Vol.51 (4), p.382-388.e11
• Main Authors: Beauchamp, Gillian A., MD, Hendrickson, Robert G., MD, Hatten, Benjamin W., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenergic alpha-2 Receptor Agonists - poisoning; Adult; Age Distribution; Aged; Aged, 80 and over; airway management; Analgesics, Opioid - poisoning; Antidepressive Agents - poisoning; Child; Child, Preschool; drug overdose; Drug Overdose - therapy; Emergency; endotracheal intubation; Female; Humans; Hypnotics and Sedatives - poisoning; Infant; Intubation, Intratracheal; Male; Middle Aged; poisoning; Registries; resuscitation; Retrospective Studies; toxicology; Young Adult
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.05.056

Abstract Background Endotracheal intubation remains a cornerstone of early resuscitation of the poisoned patient, but little is known about which substances are associated with intubation. Objectives Our objective was to describe patient exposures to substances reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC) that were managed with intubation between 2010 and 2014. Methods We performed a retrospective review of cases managed with endotracheal intubation in the ACMT ToxIC Registry from January 1, 2010 through December 31, 2014. Descriptive statistics were used to describe patient exposures. Results A total of 2724 exposures to substances were managed with endotracheal intubation. Intubated patients were 52% male and 82% adults. For all ages taken together, the most common known single-substance exposures managed with intubation were sedative hypnotics (9.8%), antidepressants (8.7%), and opioids (8.0%). The most common single ingestions associated with intubation in various age groups were: opioids (65 years old). Multiple substances were involved in 29.0% of exposures. Decontamination and elimination processes were used in 12.8% of patients. Conclusions The most common substances involved in single- and multiple-substance exposures managed with intubation varied by age group. Most patients were managed with supportive care. Knowledge of substances commonly involved in exposures managed with intubation may inform triage and resource planning in the emergency department resuscitation of critically ill poisoned patients.