Martina Lombardo, Roberta Garberi, Emanuele Rezoagli, Matteo Pozzi, Francesco Bartoli, Roberto Rona, Giuseppe Citerio, Giuseppe Foti, Marco Giani
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引用次数: 0
摘要
背景:急性中毒是重症监护中一个关键但尚未充分开发的领域。中毒是伤害相关死亡的主要原因之一,但有限的数据和缺乏临床指南阻碍了及时识别和有效管理。本研究的目的是描述重症监护病房(ICU)入院的急性中毒在意大利三级医院,并确定与患者结果相关的关键因素。方法:我们对2009年1月至2024年5月在蒙扎基金会IRCCS圣杰拉尔多德丁托里医院(Fondazione IRCCS San Gerardo dei Tintori Hospital)因确诊急性中毒而入院的icu(普通、心脏和神经)患者进行了回顾性队列研究。数据包括人口统计、物质类型、中毒严重程度、治疗和结果。结果:117例患者(126次中毒)中,以故意自我中毒为主,常涉及精神药物。多物质中毒占55.6%,通常涉及药物和乙醇,与单一物质中毒病例相比,多物质中毒病例的ICU住院时间更短,死亡率更低,而可卡因和家用/工业药物等有毒物质会导致更严重的后果。ICU总死亡率为5.1%(住院死亡率为6%),中位ICU住院时间为3天。早期识别中毒与较高的住院生存率相关,而较低的pH值和较高的乳酸水平与较高的住院死亡率相关。结论:及时识别急性中毒显著影响ICU和医院的预后。研究结果表明,早期干预以及标准化的治疗方案对于改善患者预后和降低死亡率至关重要。
Acute Intoxications Admitted to the Intensive Care Unit: A Retrospective Cohort Study.
Background: Acute intoxications are a critical yet underexplored area in intensive care. Poisoning ranks among the leading causes of injury-related death, but limited data and the lack of clinical guidelines hinder prompt recognition and effective management. This study aims to describe intensive care unit (ICU) admissions for acute intoxications at an Italian tertiary hospital and to identify key factors associated with patient outcomes. Methods: We conducted a retrospective cohort study of patients admitted for confirmed acute intoxication to the ICUs (general, cardiac, and neuro) at Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, from January 2009 to May 2024. Data included demographics, substance type, intoxication severity, treatments, and outcomes. Results: Among 117 patients (126 intoxication episodes), intentional self-poisoning, often involving psychotropic drugs, was most prevalent. Multiple-substance intoxications made up 55.6% of cases, typically involving medications and ethanol, and were associated with shorter ICU stays and lower mortality than single-substance cases, where toxic agents like cocaine and household/industrial agents led to more severe outcomes. The overall ICU mortality rate was 5.1% (hospital mortality 6%) with a median ICU length of stay of 3 days. Early recognition of intoxication was associated with higher hospital survival rates, whereas lower pH and higher lactate levels were associated with increased hospital mortality. Conclusions: Prompt identification of acute intoxications significantly impacts ICU and hospital outcomes. The findings suggest that early intervention, along with standardized treatment protocols, is crucial to improving patient prognosis and reducing mortality.
期刊介绍:
Journal of Toxicology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of toxicological sciences. The journal will consider articles looking at the structure, function, and mechanism of agents that are toxic to humans and/or animals, as well as toxicological medicine, risk assessment, safety evaluation, and environmental health.