Outcome of acute heroin overdose requiring intensive care unit admission

Abstract

Background: Heroin use carries a large burden of morbidity and mortality. Heroin overdose and in particular events that need intensive care unit (ICU) admission have not been widely examined. The aim of this study was to describe the causes of ICU admission and the outcome of patients with a heroin overdose.Methods: A retrospective chart review of all patients with a heroin overdose admitted to the ICU between 1987 and 2006 was conducted.Results: Forty-two records were available for review. The average age of the patients was 28 years. In the field, 19 persons were found in coma Glasgow Coma Scale (GCS < 8) and respiratory depression and were treated with naloxone. The reasons for ICU admission included hypoxemia in 37 (88 percent), 28 of whom had acute lung injury (ALI) and nine aspiration pneumonia, shock in three (7.2 percent) and persistent mental compromise in two patients (4.8 percent). Intubation and mechanical ventilation (MV) were instituted in 37 patients. In 19 of the 37 patients, weaning and extubation became possible within the first 24 hours. Sixteen patients suffered complications and received MV for 5 ± 2 days, with a mean length of ICU stay of 8 ± 1 days, while two patients succumbed because of anoxemic encephalopathy and brain death. The complications observed were acute respiratory distress syndrome in eight patients, severe sepsis in four, catheter-related bacteremia in one, iatrogenic pneumothorax in one, and rhabdomyolysis in two, while four among them died due to severe sepsis.Conclusions: In our study, ALI and aspiration pneumonia were the most frequently observed respiratory complications after acute heroin overdose requiring intubation and ICU admission. Mortality rate was 14.2 percent and was attributed to septic complications and irreversible brain damage.

Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study

“…A potential link between opioid overdose and encephalopathy has been reported in case reports and case series 3 5 7–19. Additionally, a prospective observational study reported that 1 of 573 patients visiting the emergency department for opioid overdose suffered from cerebral anoxia, ARDS and death,4 and a retrospective chart review reported that 2 of 42 ICU patients with heroin overdose suffered from anoxemic encephalopathy and death 6. Our finding that 77 (3%) of 2554 admissions related to accidental overdose included a diagnosis of encephalopathy provides additional data on this association.…”

“…We included both anoxic brain damage and toxic encephalopathy in the definition of encephalopathy in our study, because case reports raise concerns about a potential association between opioid overdose about these outcomes, and these diagnoses describe important brain injuries 6–9. In addition, studies that use administrative health data face the limitation that coding of outcomes in the data will often not be precise, so we have included unspecified encephalopathy in the outcome definition.…”

“…The evidence linking these events to opioid poisoning has primarily, but not exclusively, been limited to case reports. Neurological events include cerebral hypoxia,3–5 anoxic encephalopathy,6 toxic encephalopathy,7–9 delayed encephalopathy10 11 and leukoencephalopathy9 12–14 or delayed leukoencephalopathy 15–19. Respiratory adverse events include adult respiratory distress syndrome (ARDS),4 6 20 respiratory failure,20–22 pulmonary haemorrhage21 23–25 and aspiration pneumonia 6 26 27.…”

“…Neurological events include cerebral hypoxia,3–5 anoxic encephalopathy,6 toxic encephalopathy,7–9 delayed encephalopathy10 11 and leukoencephalopathy9 12–14 or delayed leukoencephalopathy 15–19. Respiratory adverse events include adult respiratory distress syndrome (ARDS),4 6 20 respiratory failure,20–22 pulmonary haemorrhage21 23–25 and aspiration pneumonia 6 26 27. A retrospective cohort study of opioid overdose leading to intensive care unit admission found that most patients admitted experienced respiratory failure requiring mechanical ventilation, approximately 10% died, and among those who died, half experienced hypoxic brain injury 28.…”

Epidemiology, Outcomes, and Trends of Patients With Sepsis and Opioid-Related Hospitalizations in U.S. Hospitals*

“…The types of organ dysfunction among sepsis patients with and without opioid-related hospitalizations were similar, with the notable exception of higher rates of respiratory failure requiring mechanical ventilation in the opioid-related hospitalization group. Respiratory failure is a known source of morbidity and mortality associated with opioid overdose, typically due to direct respiratory suppression, aspiration, acute lung injury, and/or septic emboli (37, 38).…”