Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature.

Autor: Burket GA; SCL Health St Mary's Medical Center, 2635 North 7th Street, Grand Junction, CO, 81501, USA.; Mesa County EMS, 215 Rice St, Grand Junction, CO, 81501, USA., Horowitz BZ; Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA.; Oregon Poison Center, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA., Hendrickson RG; Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA.; Oregon Poison Center, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, USA., Beauchamp GA; Lehigh Valley Health Network Department of Emergency and Hospital Medicine, Division of Medical Toxicology, USF Morsani College of Medicine, Lehigh Valley Campus, Cedar Crest Boulevard & I-78, Allentown, PA, 18101, USA. beauchamp.gillian@gmail.com.
Jazyk: angličtina
Zdroj: Journal of medical toxicology : official journal of the American College of Medical Toxicology [J Med Toxicol] 2021 Jan; Vol. 17 (1), pp. 61-69. Date of Electronic Publication: 2020 May 11.
DOI: 10.1007/s13181-020-00779-3
Abstrakt: Introduction: Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated.
Discussion: A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm.
Conclusions: ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.
Databáze: MEDLINE
Externí odkaz: