Tracheal Intubation and Mechanical Ventilation in Adults with Severe Salicylate Poisoning

Abstract

BackgroundSalicylate poisoning may lead to critical acid-base disturbances. Tracheal intubation and mechanical ventilation for patients with severe salicylism has been strongly discouraged. ObjectiveThis study aims to describe pH trends, complications, and outcomes in a cohort of salicylate-poisoned patients who were intubated. MethodsThis retrospective observational study included adults presenting to the emergency department (ED) with severe salicylate poisoning (serum salicylate concentration > 40 mg/dL and admission to an intensive care unit [ICU]) over a 14-year period (2007-2021). The primary and secondary outcomes were the change in serum pH and the occurrence of severe complications (systolic blood pressure < 80 mm Hg, oxygen saturation < 80%, or cardiac arrest), respectively, in the 6 hours after presentation. ResultsAmong 32 adults with severe salicylate poisoning (median serum salicylate level 64.2, interquartile range [IQR] 52.5 to 70.7), 11 (34%) underwent tracheal intubation. The initial mean pH (± SD) in the no intubation group was 7.48 ± 0.07 and was 7.36 ± 0.04 in the intubation group. The mean absolute difference in pH measured before and after intubation was -0.02 (95% CI -0.11 to 0.07). No severe complications were observed during or up to 6 hours after tracheal intubation and mechanical ventilation. ConclusionIn our single-center experience managing adults with severe salicylate poisoning, tracheal intubation and mechanical ventilation were not associated with substantial perturbation of serum pH or severe complications. These findings challenge the current paradigm that these interventions should be avoided in salicylate-poisoned patients.