Clinical Outcome of Mechanically Ventilated Patients of Organo-Phosphorous Compound Poisoning

Author(s): Prakash S.1, Ramamoorthy G.2, Shankar R.3

Organo phosphorous compound poisoning is one of the most common suicidal
poisonings in India. The various clinical entities that determine the clinical course
and outcome in the ICU of OPC poisoning patient are type of the compound and
dose of poison. Delayed presentation and multi-organ failure are some of the
major factors that decide the outcome of the patient. This study was conducted
to assess the clinical outcome of patients with OPC poisoning on assisted
ventilation and assess the various factors that determine the outcome.
A prospective observational study was conducted for a period of 6 months at a
government tertiary care hospital in Chennai. All patients with history and clinical
signs of OPC poisoning requiring mechanical ventilation for respiratory support
were included as our study subjects. Outcome of patients was measured in terms
of either recovery or death and factors influencing the outcome such as type of
OPC compound, amount consumed, onset and duration of respiratory muscle
weakness and pseudocholinesterase levels were considered.
In the 172 subjects, 108 (62.7 %) patients were successfully extubated from
mechanical ventilator and 64 (37.2 %) patients expired. Patients aged more than
40 years, patients who consumed methyl parathion with quantity of poison more
than 50 ml, patients with serum cholinesterase levels less than 500, patients who
were atropinised for more than 3 days and who were on mechanical ventilation
for more than 3 days were the factors found to have a statistically significant
association (P < .05) for causing death among patients with OPC poisoning.
The mortality among the OPC poisoning patients who were on mechanical
ventilation was found to be very high. Early resuscitation of patients with OPC
poisoning might reduce the morbidity and mortality.