Emergency adjunctive therapy for organophosphate poisoning: A meta-analysis

IF 1.8 4区医学 Q2 NURSING

International Emergency Nursing Pub Date : 2025-07-25 DOI:10.1016/j.ienj.2025.101659

Liang Wang , Xue Wang

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引用次数: 0

Abstract

Aims

This meta-analysis aims to assess the efficacy and safety of adjunctive therapies in patients with organophosphate poisoning.

Methods

A comprehensive literature search was performed in PubMed, EMBASE, Cochrane Library, and Web of Science from database inception to August 21, 2024. Prospective randomized controlled trials (RCTs) evaluating emergency interventions for organophosphate poisoning were included in the analysis. Clinical outcomes including mortality, duration of mechanical ventilation, length of stay (LOS) and need for mechanical ventilation were collected.

Results

Compared with atropine alone, the atropine plus pralidoxime group showed a significantly higher risk of mortality (P = 0.020) and a longer LOS (P < 0.001), while no significant differences were observed in the need for mechanical ventilation or its duration. For the atropine plus FFP group, no significant differences were found in outcomes including mortality, LOS, or ventilatory parameters. Hemopurification combined with atropine significantly reduced both mortality (P = 0.020) and LOS (P = 0.001). NAC showed a trend towards reduced LOS, although the result was not statistically significant. MgSO₄ and glycopyrrolate exhibited potential benefits in reducing LOS, although the results were not statistically significant. NaHCO₃ significantly reduced LOS (P = 0.05).

Conclusion

The use of pralidoxime may be associated with an increased risk of adverse outcomes, calling into question its routine application in organophosphate poisoning. In contrast, hemopurification was associated with a significant reduction in mortality and may represent a promising adjunctive therapeutic strategy.

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有机磷中毒的紧急辅助治疗：荟萃分析

目的：本荟萃分析旨在评估辅助治疗对有机磷中毒患者的疗效和安全性。方法检索PubMed、EMBASE、Cochrane Library、Web of Science自建库至2024年8月21日的文献。评估有机磷中毒紧急干预措施的前瞻性随机对照试验（rct）被纳入分析。收集临床结果，包括死亡率、机械通气时间、住院时间（LOS）和机械通气需求。结果与单用阿托品组相比，阿托品联合普拉多嗪组的死亡率明显增高（P = 0.020），生存时间明显延长(P <；0.001)，而在机械通气需求或持续时间方面没有观察到显著差异。对于阿托品加FFP组，在包括死亡率、LOS或通气参数在内的结局方面没有发现显著差异。血液净化联合阿托品可显著降低死亡率（P = 0.020）和LOS （P = 0.001）。NAC显示出LOS降低的趋势，尽管结果没有统计学意义。MgSO4和甘罗酸盐在降低LOS方面表现出潜在的益处，尽管结果没有统计学意义。NaHCO3显著降低LOS （P = 0.05）。结论哌拉西肟的使用可能与不良后果的风险增加有关，值得对其在有机磷中毒中的常规应用提出质疑。相反，血液净化与死亡率的显著降低相关，可能是一种很有前途的辅助治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Emergency Nursing NURSING-

CiteScore

3.20

自引率

11.10%

发文量

期刊介绍： International Emergency Nursing is a peer-reviewed journal devoted to nurses and other professionals involved in emergency care. It aims to promote excellence through dissemination of high quality research findings, specialist knowledge and discussion of professional issues that reflect the diversity of this field. With an international readership and authorship, it provides a platform for practitioners worldwide to communicate and enhance the evidence-base of emergency care. The journal publishes a broad range of papers, from personal reflection to primary research findings, created by first-time through to reputable authors from a number of disciplines. It brings together research from practice, education, theory, and operational management, relevant to all levels of staff working in emergency care settings worldwide.