Kalinga Bommankatte Eranaik
BACKGROUND
Organophosphorus compound poisoning is the most common poisonings in India because of easy availability, often requiring ICU care and ventilator support. Clinical research has indicated that respiratory failure is the most important cause of death due to Organophosphorus poisoning. It results in respiratory muscle weakness, pulmonary oedema, respiratory depression, increased secretions and bronchospasm. These complications and death can be prevented with timely Institution of ventilator support.
The aim of present study was to identify the factors and predicting the need for ventilator support and outcome.
Aim of the Study- To predict the need for ventilator support and outcome in organophosphate poisoning.
MATERIALS AND METHODS
Seventy consecutive patients admitted with a history of organophosphorus poisoning at KIMS, Hubli were taken for study after considering the inclusion and exclusion criteria. Detailed history, confirmation of poisoning, examination and other than routine investigations serum pseudocholinesterase and arterial blood gas analysis was done. The severity of organophosphorus poisoning was graded as mild, moderate and severe based on the factors which influence the need for ventilator support.
RESULTS
This study was conducted in 70 patients, out of which 48 (68.6%) were male patients and 22 (31.4%) were female patients. Among them 37 (53%) patients required ventilation and 33 (47%) expired. Chlorpyrifos, Dichlorvos and Monocrotophos were most commonly consumed poisons. 74% patients who consumed these compounds required ventilator support and 73% patients expired. 100% of patients presented with pin point pupil, fasciculation score > 4, respiratory rate > 20, GCS score < 7 and severe grade of poisoning required ventilator support and pseudocholinesterase < 900 U/L, 70% of metabolic acidosis and atropine requirement more than 180 mg within 48 hours required ventilator support and associated with high mortality.
CONCLUSION
Patients who presented with pinpoint pupils, bradycardia, higher respiratory rate, generalised fasciculation, low GCS score, low pseudocholinesterase levels, moderate-to-severe grade of poisoning, metabolic acidosis and higher requirement of atropine within 48 hours were the strong predictors of ventilation in organophosphorus poisoning and associated with high mortality.
