Epidemiología y evolución temporal de las intoxicaciones agudas que precisan de ingreso en las unidades de medicina intensiva de España

Zusammenfassung

Introduction Characteristics of poisoned patients varies due to the availability of certain toxics in each community and consumption habits at a particular point. Although poisoning is an unusual disease at intensive care units (ICU), it is not exempt of morbimortality. Moreover, its variety can be challenging. So, it is important to be aware of which are the most frequent poisonings at our ICU to put diagnostic and management tools at clinician service. Furthermore, it is important to monitor the quality of the assistance given to poisoned patients to be able to implement plans for improvement if required. Methods This was a three-phase study: 1st 2002-06: prospective. 2nd 2013-14: retrospective. 3rd 2015-17: retrospective. Poisoned patients data being admitted to ICU forming part of the study during the different phases, from 37 ICU in total, were recorded. Results There were a total of 2634 cases, distributed irregularly between the three phases. Mean age was 46,72 years, with 46,60% being women. Prevalence of psychiatric history was 61,14%. Self-harm was the main cause of poisoning in 52,37%. The most frequent toxics were medicines, especially psychotropic drugs. The most frequent ones were benzodiazepines, which were present in 37,17% cases. Organ support was often required, with 56,04% needing for orotracheal intubation. Global mortality was 7,08%. Between the three phases an increase in patients age was observed. Accidental poisonings got more usual at phases 2 and 3, and toxics changed, with more antidiabetic and anticoagulant drugs involved in last phases. Ethanol poisoned increased, especially pure ones and heroin and cocaine decreased. Mortality at phase 1 was higher. Hospital acquired poisoning accounted for 6,92% of cases at phase 3. Patients were older and poisonings were mainly accidental and due to medicines. Psychiatric assessment was conducted in 91,86% of patients with self-harming purpose. Conclusions Poisoning continue being an unusual disease at ICU. Patients are getting older, which implies changes in poisoning purpose and in the poisons involved. Mortality was high, probably due to the severity of patients. Hospital acquired poisonings were different from community acquired and supposed a non-negligible number of cases. Most self-harming patients were assessed by a psychiatrist, but the Spanish Society of Intensive Care Medicine quality standard was not accomplished.