Indications for and complications of endotracheal intubation in gamma-hydroxybutyrate (GHB) overdoses admitted to a toxicology unit.

Background: Gamma-hydroxybutyrate is a central nervous system depressant that can lead to a severely reduced level of consciousness, necessitating endotracheal intubation and intensive care admission. This study aims to analyse the clinical reasoning for endotracheal intubation in gamma-hydroxybutyrate overdoses, the incidence of complications, and length of stay.

Method: We conducted a retrospective review of gamma-hydroxybutyrate overdoses between January 2000 and December 2024 in a single toxicology centre. Data collected included demographics, reason for endotracheal intubation, presence of aspiration pneumonitis, and length of stay.

Results: There were 159 gamma-hydroxybutyrate presentations and 37 patients (23%) required endotracheal intubation. Aspiration pneumonitis was confirmed in 11 patients (30%), including six of eleven with vomiting, three of five with laryngeal obstruction and two of fourteen intubated for airway protection.

Discussion: Vomiting and a perceived risk of inadequate airway protection were the main indications for endotracheal intubation in gamma-hydroxybutyrate overdose, which did not entirely prevent aspiration pneumonitis. Use of the Glasgow Coma Scale alone for airway risk assessment in toxicology presentations may result in unnecessary intervention and may increase complications.

Conclusion: These data highlight the need to better identify patients requiring airway intervention and develop strategies to reduce aspiration risk in patients with gamma-hydroxybutyrate overdose.