Acute drug overdose in an ICU: 15 years experience
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KeywordsCocaine Mechanical Ventilation Ketamine Amphetamine Opium
The aim of our study is to identify the epidemiology of patients admitted to an ICU following severe acute drug overdose.
The study is a retrospective observational study of a 20-bed medical/surgical ICU during a 15-year period. We reviewed the clinical records of patients admitted from 1994 to 2008 with acute drug overdose. Data on demographics, mean length of stay, days on mechanical ventilation (MV), Glasgow Coma Scale (GCS) on admission, and mortality were recorded. The type of drug was also stated.
A total of 12,881 patients were admitted to our ICU from 1994 to 2008, of them 621 patients (4.8%) had a diagnosis of acute intoxication on admission. From these 621 patients, 159 (25.6%) were drug overdoses, which represented 1.2% from the total admissions. The median age was 33 years, the range 15 to 87, with a standard deviation of 12.5. A total of 50.9% were male. The median GCS on admission was 6 and the APACHE II score was 16, with a range 3 to 31 and a standard deviation of 6.7. MV was required by 71.1% with a median duration of 2.38 days, with a range 0 to 45 and a standard deviation of 6.9. The median length of stay was 3.2 days, the range 0 to 41 and a standard deviation of 6.1. The types of drugs found were ethanol, cocaine, opioids (methadone, heroin, opium), LSD, ketamine, GHB, amphetamines, cannabis, and PCP. Ethanol was the most commonly encountered in 57%, followed by cocaine in 37%, and opioids in 27% of patients. Global mortality was 2%, and 50% of these were due to ethanol.
In our study, severe acute drug overdose accounts for a low percentage of patients admitted to the ICU. The profile is that of a middle-aged male patient with acute ethanol, cocaine, or opioids overdose, in that order of frequency, and with rates similar to those of national and European statistics, of short length of stay (3.2 days) and a mortality inferior to that expected for the APACHE II score.