Respiratory Failure Following Organophosphate Poisoning: A Literature Review

Giyanwani, Pirthvi Raj; Zubair, Ujala; Salam, Osama; Zubair, Zarafshan

doi:10.7759/cureus.1651

Cited by 19 publications

(19 citation statements)

References 29 publications

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“…Pulmonary complications such as increased secretion, pneumonia, and acute respiratory distress syndrome are frequently seen in patients with organophosphorous poisoning which leads to longer duration of stay in ICU. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in Eastern Nepal

Rajbanshi¹,

Arjyal²,

Mandal³

2018

Indian Journal of Critical Care Medicine

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Background:Acute poisoning is a common health-care problem requiring admission in the intensive care unit (ICU) in the developing countries. The study was conducted to assess the epidemiological parameters of acute poisoning and factors affecting clinical course and outcome of the patients in ICU in the eastern part of Nepal.Methodology:This was a prospective observational study conducted at ICU of tertiary care hospital in the eastern part of Nepal for the duration of 2 years. All the acute poisoning cases admitted in the ICU were studied for epidemiological profiles, poisoning characteristics, and various clinical factors affecting the outcome of the patients.Results:Eighty-five patients with acute poisoning were included in the study. Suicidal attempt leading to acute poisoning was seen in majority of the young population. Majority of the poisoning was due to the organophosphorous compounds (43.5%). Patients with organophosphorous poisoning had a significantly longer duration of ICU stay (P = 0.020). The survival of the patients was significantly affected by age, duration of presentation to the hospital, Glasgow Coma Scale, Sequential Organ Failure Assessment score, need for mechanical ventilation, duration of ICU stay, hepatic failure, coagulopathy, and need for vasoactive drugs (P < 0.05). The independent predictors of mortality observed in the study were age, delayed presentation to the hospital, hepatic failure, and need for mechanical ventilation.Conclusion:Organophosphorous poisoning was the most common acute poisoning in young population leading to the ICU admission. Older age, delayed initiation of the resuscitative measures, need for mechanical ventilation, and hepatic failure significantly affected the mortality.

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Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in Eastern Nepal

Rajbanshi¹,

Arjyal²,

Mandal³

2018

Indian Journal of Critical Care Medicine

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“…However, respiratory slices can block these signal inputs, thereby enabling the verification of preBötC behaviour alone. Respiratory rhythm abnormalities are often observed with organophosphorus cholinesterase inhibitor poisoning 3 , 6 – 9 . Peripheral and central mechanisms are involved in this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

“…Peripheral and central mechanisms are involved in this phenomenon. However, the central mechanism develops in the early stage and is a highly lethal pathological condition accompanied by severe consciousness disorder 8,9 . In some in vivo studies with rodents, central apnoea or hypopnoea was reported to occur when organophosphorus drugs were administered within or nearby the preBötC region 7,10,11 .…”

mentioning

confidence: 99%

Mechanism of central hypopnoea induced by organic phosphorus poisoning

Nomura

Narimatsu

Inoue

et al. 2020

Sci Rep

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Whether central apnoea or hypopnoea can be induced by organophosphorus poisoning remains unknown to date. By using the acute brainstem slice method and multi-electrode array system, we established a paraoxon (a typical acetylcholinesterase inhibitor) poisoning model to investigate the time-dependent changes in respiratory burst amplitudes of the pre-Bötzinger complex (respiratory rhythm generator). We then determined whether pralidoxime or atropine, which are antidotes of paraoxon, could counteract the effects of paraoxon. Herein, we showed that paraoxon significantly decreased the respiratory burst amplitude of the pre-Bötzinger complex (p < 0.05). Moreover, pralidoxime and atropine could suppress the decrease in amplitude by paraoxon (p < 0.05). Paraoxon directly impaired the pre-Bötzinger complex, and the findings implied that this impairment caused central apnoea or hypopnoea. Pralidoxime and atropine could therapeutically attenuate the impairment. This study is the first to prove the usefulness of the multi-electrode array method for electrophysiological and toxicological studies in the mammalian brainstem.

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“…A substantial proportion of the elderly organophosphate patients (52.1%) suffered respiratory failure necessitating mechanical ventilatory support. In a review article, Giyanwani et al 24 found that 491 of 1996 (24.6%) patients suffered acute respiratory failure after organophosphate intoxication. One of the overwhelming cholinergic features of organophosphate intoxication is respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…One of the overwhelming cholinergic features of organophosphate intoxication is respiratory failure. The mechanisms of respiratory failure following organophosphate intoxication involve three components: respiratory center depression, respiratory muscle weakness, or cholinergic pulmonary effect (bronchospasm and bronchorrhea) 24 . Relatively impaired baseline functions of these systems in elderly adults may worsen respiratory depression during pesticide intoxication.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of elderly patients with organophosphate intoxication

Hou

et al. 2021

Sci Rep

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This study analysed the clinical patterns and outcomes of elderly patients with organophosphate intoxication. A total of 71 elderly patients with organophosphate poisoning were seen between 2008 and 2017. Patients were stratified into two subgroups: survivors (n = 57) or nonsurvivors (n = 14). Chlorpyrifos accounted for 33.8% of the cases, followed by methamidophos (12.7%) and mevinphos (11.3%). Mood, adjustment and psychotic disorder were noted in 39.4%, 33.8% and 2.8% of patients, respectively. All patients were treated with atropine and pralidoxime therapies. Acute cholinergic crisis developed in all cases (100.0%). The complications included respiratory failure (52.1%), aspiration pneumonia (50.7%), acute kidney injury (43.7%), severe consciousness disturbance (25.4%), shock (14.1%) and seizures (4.2%). Some patients also developed intermediate syndrome (15.5%) and delayed neuropathy (4.2%). The nonsurvivors suffered higher rates of hypotension (P < 0.001), shock (P < 0.001) and kidney injury (P = 0.001) than survivors did. Kaplan–Meier analysis indicated that patients with shock suffered lower cumulative survival than did patients without shock (log-rank test, P < 0.001). In a multivariate-Cox-regression model, shock was a significant predictor of mortality after intoxication (odds ratio 18.182, 95% confidence interval 2.045–166.667, P = 0.009). The mortality rate was 19.7%. Acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 15.5%, and 4.2% of patients, respectively.

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Respiratory Failure Following Organophosphate Poisoning: A Literature Review

Cited by 19 publications

References 29 publications

Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in Eastern Nepal

Clinical profile and outcome of patients with acute poisoning admitted in intensive care unit of tertiary care center in Eastern Nepal

Mechanism of central hypopnoea induced by organic phosphorus poisoning

Outcomes of elderly patients with organophosphate intoxication

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