Severe acute poisoning (SAP) is an uncommon reason for admission to intensive care units (ICU), with a highly variable severity spectrum.1,2 The SARS-CoV-2 pandemic has led to an increase in psychological disorders and may have increased the risk of substance abuse and self-harm attempts.3 The aim of this study is to review the incidence and characteristics of admissions to the ICU due to SAP in two periods: before and after the declaration of the SARS-CoV-2 pandemic.
This is a descriptive, observational and retrospective study of patients diagnosed with SAP admitted to the Anaesthesia ICU (adult medical-surgical) of the Consorci Hospital General Universitari of València (CHGUV) establishing the pre-declaration period from 2015 to March 2020 (declaration of pandemic by the WHO) and post-declaration from April 2020 to July 2022. The study was approved by the CREC. R statistical software (version 4.0.3 http://www.R-project.org/) was used to process the data.
It was observed that the number of SAPs admitted to the ICU during the entire study period was 105 cases. The number of patients admitted to our ICU during the same period was 14,610. The ratio of all-cause anaesthesia ICU admissions to each admission per poisoned patient was 1/216 in 2015 and became 1/55 in 2022, with no significant difference regarding the day of the week on which the poisoning occurred.
Gender and age remained stable, with a significant increase in recreational poisoning (pre-declaration 5 [10%] vs. post-declaration 10 [21%] p<0.05) (Table 1). The subgroup of patients with a psychiatric history in the post-declaration period had significantly more substance addiction and the first cause of poisoning (pre- and post-declaration) was self-harm. The main reason for admission to the ICU for SAP in the pre-declaration period was the use of vasoactive substances and, in the post-declaration period, orotracheal intubation and connection to mechanical ventilation. There were no significant differences in ICU and hospital stay pre- and post-declaration, although we observed an increase in mortality (from 0% pre- to 16% post-declaration, p<0.05). The SAPS II of patients who died was high (mean 73.5, SD 2). We consider that acute poisoning is an uncommon cause of admission to the ICU and the few published studies show great heterogeneity.4
Patient and poisoning characteristics.
| Pre-pandemic (n=56) | Post-pandemic (n=49) | ||
|---|---|---|---|
| Age | 47 years (SD 17) | 48 years (SD 18) | |
| Gender (male) | 51% (n=31) | 59% (n=29) | |
| Medical history | |||
| Psychiatric history | 61% (n=34) | 64% (n=31) | |
| Psychiatric patients in psychiatric treatment | 33/34 | 27/31 | |
| Severe alcoholism | 32% (n=18) | 15 (30%) | |
| Substance addiction | 29% (n=16) | 31% (n=16) | |
| Day the week of hospital admission | |||
| M (8), T (11), W (10), T (3), F (11), Sa (2), Su (11) | M (6), T (11), W (3), T (9), F (5), Sa (9), Su (6) | ||
| Type, reason and place of SAP | |||
| Drug poisoning | 53% (n=30) | 51% (n=25) | |
| Substance abuse poisoning | 20% (n=12) | 22% (n=11) | |
| Household product poisoning | 16% (n=9) | 4% (n=1) | |
| Industrial product poisoning | 0% (n=56) | 4% (n=1) | |
| Poisoning by animals or plants | 0% (n=0) | 0% (n=0) | |
| Self-harming attempt | 31 (55%) | 27 (57%) | |
| Accidental poisoning | 15 (29%) | 10 (21%) | p<0.05 |
| Recreational poisoning | 5 (10%) | 10 (21%) | p<0.05 |
| Place of poisoning: community | 100% (n=56) | 100% (n=49) | |
This review shows an increasing trend of admission to the ICU for SAP in our setting, reaching 1.8% of all admissions to the ICU in 2022. Recreational intentionality for recreational drugs and various types of substances is increasingly common, with self-harm intentionality being the main cause of poisoning in patients with a psychiatric history. Although median hospital and ICU admission times have not altered, an increase in mortality has been observed in recent years.
FundingNo funding has been received from any entity.
Conflict of interestNo conflict of interest on the part of the authors is reported.
Benjamín Climent Díaz, internist and head of the Clinical Toxicology Unit of the Hospital General of Valencia, and the Poisoning Working Group of the Anaesthesia ICU of the Hospital General Universitari of València:
Isabel Aisa, María Teresa Ballester, Carolina Ferrer, Tania Gabaldón, María José Hernández-Cadiz, Dolores López, Ruth Martínez-Plumed, Eva Mateo, Susana Moliner, Carmen Reina and Paula Solís from the Anaesthesiology, Resuscitation and Pain Therapy Department of the Consorci Hospital General Universitari of València.
