Abstract

We designed this study to identify the factors associated with time to successful weaning in mechanically ventilated organophosphate (OP)-poisoned patients as the primary outcomes while duration of mechanical ventilation (MV) support, intensive care unit (ICU), and hospital length of stay (LOS) and in-hospital mortality as the secondary outcomes. We conducted a retrospective study of mechanically ventilated OP-poisoned patients admitted to the ICU of Poison Control Center of Ain Shams, Cairo, Egypt, starting from January 2019 to December 2019. Weaning was considered successful if the patient succeeded in the first spontaneous breathing trial of weaning and did not need reinstitution of MV. We used Cox proportional hazards regression models to identify factors associated with time to successful weaning in the studied patients. A total of 55 patients were enrolled in the study. Thirty-eight patients were weaned successfully. Lower initial red cell distribution width (RDW) levels [adjusted hazard ratio (HR), 0.299, 95% confidence interval (CI) (0.184–0.486)] and lower initial doses of atropine [adjusted HR, 0.97, 95% CI (0.935–0.999)] were independently associated with shorter time to achieve successful weaning. Successfully weaned patients had significantly longer hospital LOS (p = 0.019) and no reported in-hospital mortality (p < 0.001) compared with patients who failed to wean. We concluded that initial RDW and initial doses of atropine were found to be the strongest factors associated with time to successful weaning in mechanically ventilated OP-poisoned patients. RDW and atropine can be used as simple risk assessment tools in OP poisoning.

摘要

我们设计该研究的目的是确定与机械通气的有机磷酸盐（OP）中毒患者成功断奶的时间相关的因素，并将其作为主要结果，同时采用机械通气（MV）的持续时间，重症监护病房（ICU）和住院时间（LOS）和院内死亡率作为次要结果。我们对从2019年1月至2019年12月开始进入埃及开罗Ain Shams毒物控制中心ICU的机械通气OP中毒患者进行了回顾研究。断奶并且不需要MV的恢复。我们使用Cox比例风险回归模型来确定与研究患者成功断奶的时间相关的因素。共有55名患者参加了研究。38例患者成功断奶。降低初始红细胞分布宽度（RDW）水平[调整后的危险比（HR），0.299、95％置信区间（CI）（0.184-0.486）]和降低阿托品的初始剂量[调整后的HR，0.97、95％CI（0.935） –0.999）]与更短的时间独立实现成功的断奶。成功断奶的患者住院LOS明显更长（p = 0.019），与没有 断奶的患者相比，没有住院死亡率（p <0.001）。我们得出的结论是，在机械通气的OP中毒患者中，初始RDW和阿托品的初始剂量是与成功断奶时间相关的最强因素。RDW和阿托品可以用作OP中毒的简单风险评估工具。