États de choc d'origine toxique

Deye, Nicolas; Amoli, A. Mohebbi; Cholley, Bernard; Baud, Frédéric J.

doi:10.1016/b978-2-84299-931-5.50014-5

Cited by 3 publications

(1 citation statement)

References 51 publications

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“…In the 2001 US guidelines [73], the experts stated that, due to the high risk of ventricular arrhythmia induced by the high doses of catecholamines sometimes required to treat certain forms of toxic shock, haemodynamic monitoring should be performed systematically with careful selection of treatments and catecholamine titration. No recommendations are available concerning the preferred monitoring technique; nevertheless, echocardiography appears to be a useful, if not essential, tool for the management of toxic shock [67,74]. Determination of the cardiac index is the mainstay of poisoned patient monitoring in the presence of cardiovascular failure.…”

Section: Question 32: Should a Haemodynamic Assessment Be Performed mentioning

confidence: 99%

Management of pharmaceutical and recreational drug poisoning

Mégarbane

Oberlin

Alvarez

et al. 2020

Ann. Intensive Care

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Background Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis. Methods A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology. Results The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature. Conclusions The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.

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Section: Question 32: Should a Haemodynamic Assessment Be Performed mentioning

confidence: 99%