Severe Acute Organophosphorus Pesticide Poisoning Research Articles

Evaluation and Use of Organs from Donors Poisoned by Organophosphorus Pesticide.

BACKGROUND The aim of this study was to explore the evaluation and use of donor organs from donors with brain death caused by acute severe organophosphorus pesticides and provide a basis for the use of such donor organs. MATERIAL AND METHODS Seven cases of brain dead donors caused by acute organophosphorus pesticide poisoning from January 2014 to December 2018 in the hospital were collected, and a retrospective analysis was made of the donors' age, race, physiological and pathological changes, donor organ function changes and the organ use, liver or kidney function recovery, and complications of the recipients. The 18 recipients were followed up until June 31, 2022. RESULTS We found that 71.42% of organ donors were male, and 71.42% of organ donors were under 50 years old. The main cause of death was respiratory failure caused by organophosphorus pesticide poisoning. The liver and kidney functions of 7 donors were damaged, and 3 livers could not be used due to severe functional damage, but the liver or kidney function of 18 recipients gradually recovered after transplantation. Delayed recovery of graft function occurred after transplantation accounted for 21.43%, and the grafts had good short-term to medium-term performance. CONCLUSIONS Although the function of organs from donor with brain death due to acute severe organophosphorus pesticide poisoning is seriously damaged, most of the organs can still be used for transplantation. Individualized functional maintenance according to the situation of donors is conducive to improving the quality of organs.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning: a meta-analysis

Abstract Background Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries. Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning. Methods Several databases were searched. After formulating relevant inclusion and exclusion criteria, qualified studies were included, and the data were extracted. The outcome indicators were the success rate of rescue, the time of hospitalization, the incidence of complications, the time for the cholinesterase level to return to normal, the coma time, and the atropine dosage. The results were analyzed using risk ratios, weighted mean difference, standard mean difference, and 95% confidence interval. The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies. In terms of statistical methods, we used RevMan software (version 5.3; The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) and Stata (versions 14 and 16; StataCorp, College Station, TX, USA) for the data analysis. Results We included 92 randomized controlled trials with 6899 participants. Compared with the conventional emergency treatment group (CET group), the hemoperfusion group (HP + CET group), and the hemodialysis group (HD + CET group), the use of hemoperfusion combined with hemodialysis based on CET (HP + HD + CET group) significantly increased the success rate of rescue and reduced hospitalization time, the incidence of complications, time for cholinesterase level to return to normal, coma time, and atropine dosage. Conclusion Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poisoning. In the future, more scientifically designed, large-scale, high-quality, multicenter randomized controlled trials are needed to validate this study further.

Application of Shewhart Control Chart in Controlling Adverse Events in Patients with Severe Acute Organophosphorus Pesticide Poisoning Undergoing Blood Purification.

Objective To explore the application effect of the Shewhart control chart in controlling adverse events in patients with severe acute organophosphorus pesticide poisoning (AOPP) undergoing blood purification. Methods A retrospective analysis was performed on the clinical data of 102 patients with severe AOPP admitted to the hospital between January 2020 and December 2021, including 47 cases in the control group and 55 cases in the observation group. The control group was given routine emergency nursing, while the observation group was given emergency nursing under the guidance of the Shewhart control chart on the basis of the control group. The specialized operations, basic operations, specialized theory, and basic theory of nursing staffs were scored to compare the comprehensive nursing quality. The total incidence of adverse nursing events in both groups was statistically analyzed. The dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time in both groups were recorded. The total incidence of complications in both groups was statistically analyzed. The satisfaction of family members was statistically analyzed by a satisfaction questionnaire. Results The scores of specialized operations, basic operations, specialized theory, and basic theory of nursing staffs in the observation group were significantly higher than those in the control group (P < 0.05), total incidence of adverse nursing events was significantly lower than that in the control group (P < 0.05), dosage of atropine, disappearance time of muscarinic symptoms, recovery time of CHE activity to 60%, and hospitalization time were significantly lower than those in the control group (P < 0.05), total incidence of complications was significantly lower than that in the control group (P < 0.05), and scores of nursing attitude, communication process, psychological relief, and drug preparation were significantly higher than those in the control group (P < 0.05). Conclusion The Shewhart control chart can effectively improve the clinical effect, comprehensive nursing quality, and satisfaction of patients with severe AOPP and effectively reduce complications and adverse events.

Clinical Analysis of Acute Organophosphorus Pesticide Poisoning and Successful Cardiopulmonary Resuscitation: A Case Series.

Acute organophosphorus pesticide poisoning (AOPP) with cardiac arrest has an extremely high mortality rate, and corresponding therapeutic strategies have rarely been reported. Therefore, this study aimed to explore the prognostic factors and effective treatments of AOPP-related cardiac arrest. This retrospective study was conducted in our department in the years 2018–2021. We conducted a descriptive analysis of the clinical manifestations, rescue strategies, and prognosis of patients with AOPP who had experienced cardiac arrest and successful cardiopulmonary resuscitation. This study included six cases of patients with AOPP in addition to cardiac arrest; in four cases, cardiac arrest occurred <12 h after ingestion, and in two, cardiac arrest occurred more than 48 h after ingestion. Five patients had not undergone hemoperfusion therapy before cardiac arrest, and all six were treated with atropine during cardiopulmonary resuscitation and subsequent pralidoxine. Four patients recovered and were discharged from the hospital, one died in our department, and one was transferred to a local hospital and died there 2 h later. The last two patients had severe pancreatic injuries and disseminated intravascular coagulation. This, along with their death, might have been related to their prognosis. Cardiac arrest can occur in patients with severe AOPP for whom antidote administration was insufficient or not timely. Application of atropine and pralidoxine in a timely manner after cardiac arrest following AOPP is the key to successful treatment. This study provides useful guidelines for the treatment of similar cases in the future.

Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning: A systematic review and meta-analysis.

Background:Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP.Materials and Methods:A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1.Results:A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD −147.34 mg, 95% CI [−199.49, −95.18], P < 0.001), duration of mechanical ventilation (WMD −2.34 days, 95% CI [−3.77, −0.92], P < 0.001), cholinesterase recovery time (WMD −2.49 days, 95% CI [−3.14, −1.83], P < 0.001), and length of stay (WMD −4.52 days, 95% CI [−5.31, −3.73], P < 0.001).Conclusion:Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.

Fatal Case of Severe Acute Organophosphorus Pesticide Poisoning Complicated with Secondary Hemophagocytic Lympho-Histiocytosis, Severe Lower Intestinal Hemorrhage and Intestinal Mucormycosis

A man in his 50’s, under influence of alcohol, accidentally ingested a pesticide, and was referred for further management and admitted to our hospital. An empty can of Curacron® was found at the site in his farm where he took the alleged pesticide. This raised the suspicion of organophosphorus pesticide poisoning and he was managed at two medical centres before getting admitted to our hospital. His hospital course was complicated with multiorgan dysfunction, shock, respiratory failure and intermediate syndrome. On day five he developed secondary hemophagocytic lymphohistiocytosis (sHLH) and had hematochezia on day six. Colonoscopy revealed multiple circumferential ulcerations in descending and sigmoid colon with luminal narrowing. Biopsy of colonic tissue showed evidence of intestinal Mucormycosis. The clinical presentation of organophosphorus pesticide poisoning in this patient was complicated with multiple issues and included sHLH, chemical gastroenteritis, hemorrhagic ulcers and intestinal zygomycosis. The organophosphorus pesticide ingested by the patient was a 50% emulsifiable concentrate of profenofos along with vegetable oil, soyabean oil and polyglycol ether alkyl aryl sulphate calcium salt 5.25% w/w as an emulsifier/spreading agent. The management of the patient is discussed. Due to the possibility of the emulsifier adhering to the gastrointestinal tract and causing mucosal injury, it is necessary to identify the drug composition and ingredients of the pesticide as soon as possible when managing organophosphorus poisoning.

The role of noninvasive hemodynamic monitoring in the evaluation of acute and severe pesticide poisoning

Objective: To explore the method of noninvasive hemodynamic monitoring system (NICaS) in monitoring the hemodynamics of patients with acute pesticide poisoning, and to analyze the clinical guiding value of NICaS in hemodynamics of patients with severe pesticide poisoning. Methods: In August 2019, 200 patients with severe acute organophosphorus pesticide poisoning (AOPP) or moderate severe acute paraquat pesticide poisoning (APP) admitted to Harrison international peace hospital from January 2017 to August 2019 were randomly divided into NICaS group (n=68) , transpulmonary thermodilution method (n=67) and empirical treatment group (n=65) . The relationship between acute physiology and chronic health score (APACHE Ⅱ) , heart rate, hemodynamic indexes, survival rate and complications were analyzed. Results: There were no significant differences in age, sex ratio, body mass index, heart rate, systolic blood pressure, no treatment period and admission APACHE II score between NICaS group, Picco group and experience group (P>0.05) ; Compared with the experience group, the mortality of AOPP and app in NICaS group and Picco group were lower, and the differences were statistically significant (P<0.05) .The cardiac output (CO) had a significant correlation in the interval of 2.8-6.7 L·min(-1) (r=0.738, r(2)=0.545, P<0.01) , and peripheral vascular resistance index (SVRI) had a significant correlation in the interval of 410-1 950 d·s·cm(-5)·m(2) (r=0.792, r(2)=0.627, P<0.01) . Bland Altman analysis showed that CO and SVRI measured by Picco and NICaS had 97.01% and 95.52% consistency, respectively. Compared with the experience group, the average daily infusion volume and daily colloid infusion volume of NICaS group and Picco group were lower, the differences were statistically significant (P<0.05) . Conclusion: NICaS can effectively monitor the hemodynamic indexes of patients with acute pesticide poisoning.

Predictive value of early detection of hs-cTnI and sST2 for secondary cardiac damage in severe acute organophosphorus pesticide poisoning

Objective: To investigate the value of high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity 2 (sST2) in predicting cardiac complications of severe acute organophosphorus pesticide poisoning (SAOPP) . Methods: All 274 SAOPP patients from September 2014 to February 2019 were selected. According to the results of hs-cTnI detection, the patients were divided into non-elevated troponin group (78 cases) and troponin elevation group (196 cases) at 1 hour after admission. 3 days after admission, there were 109 cases of complication and 165 cases of non-complication according to the presence or absence of cardiac complications. The changes of hs-cTnI, sST2, N-terminal B-type brain natriuretic peptide (NT proBNP) , acute physiology and chronic health (APACHE-Ⅱ) , cholinesterase activity, left ventricular ejection fraction (LVEF) , short axis shortening rate (FS) were observed and analyzed. The predictive value of hs-cTnI and sST2 were evaluated by receiver operating characteristic curve (ROC) analysis. Results: The sST2 level in patients with troponin elevation group was significantly higher than that in non-elevated troponin group (P<0.05) . Compared with the non-complication and non-elevated troponin group, the patients with non-complication and troponin elevation group had elevated hs-cTnI, sST2 and decreased cholinesterase (P<0.05) . Compared with other groups, the hs-cTnI, sST2, NT-proBNP, and APACHE-Ⅱ scores in the complication and troponin elevation group were significantly increased, and cholinesterase was significantly reduced (P<0.05) . In the non-complication group, LVEF and FS were in the normal range, and there was no significant difference between the groups (P>0.05) . Compared with other groups, the LVEF and FS of patients with elevated troponin in the complications group were significantly decreased (P<0.05) . Correlation analysis showed that hs-cTnI and sST2 were positively correlated in patients with SAOPP complications (r=0.725, P<0.01) . hs-cTnI, sST2 and APACHE-Ⅱ scores were positively correlated in the complications group (r=0.846, 0.885, P<0.01) . ROC results showed that the areas under the curve for predicting SAOPP secondary heart damage of hs-cTnI (1 hour after admission) and sST2 (3 days after admission) were 0.945 and 0.833, respectively. Conclusion: hs-cTnI and sST2 may have important clinical value in the early diagnosis and prognosis evaluation of patients with SAOPP secondary cardiac damage.

Changes of intestinal mucosal barrier function and effects of early enteral nutrition in patients with severe organophosphorus poisoning

Objective: To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP) and the effect of early enteral nutrition on them. Methods: A single-center, single-sample, prospective, randomized controlled clinical trial was conducted. A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization. The two groups received equal calorie nutritional support, and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO) were detected immediately after admission and at 48 h, 72 h and 144 h. At the same time, the worst value of APACHE-Ⅱ score was recorded, and the correlation between DAO, D-LA and APACHE-Ⅱ score was analyzed. The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group. Results: There was no statistical difference in gender, age, poisoning time and organophosphorus pesticide components between group A and B (P>0.05). The distribution of D-LA concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (66±19) μg/L, (68±21) μg/L, (66±19) μg/L, (63±17) μg/L, while in group B they were (62±15) μg/L, (58±17) μg/L, (58±16) μg/L, (67±9) μg/L. There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L, P>0.05]. The distribution of DAO concentration in group A poisoned patients at admission, 48 h, 72 h and 144 h was (2.1±0.6) μg/ml, (2.1±0.5) μg/ml, (2.2±0.4) μg/ml, (2.2±0.5) μg/ml, while in group B they were (2.1±0.5) μg/ml, (2.1±0.5) μg/ml, (2.2±0.5) μg/ml, (2.1±0.4) μg/ml. DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1±0.0 μg/ml) (P<0.05). There is no statistical difference in DAO concentration between group A and B at different time points (P>0.05). The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2+1.7, 5.5+2.1) was significantly lower than that in group B (14.1+2.4, 8.2+2.6) (P<0.05). D-LA, DAO concentration at different time points was not correlated with APACHE-Ⅱ score (P>0.05). D-LA (r, P) was immediate admission (-0.17, 0.24), 48 h (0.04, 0.79), 72 h (0.32, 0.06), 144 h (0.29, 0.07), and DAO (r, P) was immediate admission (-0.12, 0.43), 48 h (0.02, 0.92), 72 h (0.03, 0.85), 144 h (0.03, 0.82). Conclusions: Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h), but the intestinal permeability is normal. Early enteral nutrition therapy can promote the recovery of patients, but has low correlation with intestinal barrier function improvement.

The effect of predictable aid support in tracheal intubation with severe acute organophosphorus pesticide poisoning patients

Objective To explore the effect of predictable aid support in tracheal intubation with severe acute organophosphorus pesticide poisoning(SAOPP)patients. Methods A total of 109 patients were randomly divided into treatment group(n=55) and control group(n=54). All the patients were treated with the gastric lavage and catharsis, and accepted atropine, pralidoxime chloride and ventilatory support as prescribed.More predictability ambulance measures were applied to the treatment group such as: reinforcement tracheal intubation, endotracheal intubation tube off alarm device and joint of thermostatic wetting with oxygen driving atomization.The therapy efficacy were compared between the two groups. Results There was no statistically significant difference between the two groups of patients before treatment, such as respiration, heart rate and blood oxygen saturation(P>0.05). The observation group was compared with the control group of 72 hours after treatment, and the difference was statistically significant(P<0.01). The mechanical ventilation time, endotracheal intubation time, monitoring time and length of hospital stay of the observation group were(25.63±3.24) hours, (32.17±3.50) hours, (5.65±1.63) days and (8.52±2.13) days respectively, while the control group were (37.82±3.75) hours, (43.64±3.83) hours, (9.78±1.85) days and(13.79±2.17) days.The differences between the two groups were statistically significant(P<0.01). The incidence of UE and complications of the observation group was significantly lower than those in the control group, while the success rate of rescue was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusions Foresight rescue support plan in endotracheal intubation can increase the success rate, enhance the efficacy, reduce complications and improve prognosis of SAOPP patients. Key words: Organophosphorus pesticide poisoning; Tracheal intubation; Medical support; Prognosis

Observation of the effect of blood perfusion combined with penehyclidine hydrochloride injection in the treatment of acute severe organophosphorus pesticide poisoning

Objective To explore the clinical effect of blood perfusion combined with penehyclidine hydrochloride injection in the treatment of acute severe organophosphorus pesticide poisoning. Methods 58 patients with severe organophosphorus pesticide poisoning were selected as the research subjects.By using digital table method, they were randomly divided into observation group and control group, 29 cases in each group.The two groups were given conventional treatment and blood perfusion treatment after admission, the observation group was treated with penehyclidine hydrochloride injection on this base.Before and after treatment, the myocardial enzymes, liver, kidney function index, blood gas analysis, cholinesterase activity, as well as other treatment of the two groups were observed, and the results were compared. Results Compared with the control group, after treatment, the myocardial enzyme, transaminase, serum amylase and creatinine levels in the observation group were significantly lower, cholinesterase level was significantly increased, the oxygen partial pressure increased, the partial pressure of carbon dioxide decreased obviously, the differences were statistically significant(all P<0.05). The hospitalization time and cholinesterase activity recovery time of the observation group were significantly shorter than those of the control group[(12.57±2.14)d vs.(16.35±2.73)d, (5.46±2.29)d vs.(7.61±3.47)d], and the cure rate of the observation group was significantly higher than that of the control group(100.00% vs.82.76%), the differences were statistically significant(t=2.139, 2.208, χ2=5.472, all P<0.05). Conclusion Blood perfusion can directly adsorb organophosphorus pesticide, shorten the recovery time of cholinesterase and reduce the case fatality rate, and it combined with penehyclidine hydrochloride injection not only can improve the clinical curative effect of blood perfusion, but also can protect the organ. Key words: Poisoning; Pesticides; Organophosphorus compounds; Perfusion; Penehyclidine hydrochloride

Application of hemoperfusion in severe acute organophosphorus pesticide poisoning

Background/aim: The aim of this research is to investigate the clinical efficacy of hemoperfusion in the treatment of severe acute organophosphorus pesticide poisoning (AOPP). Materials and methods: Patients meeting the inclusion criteria were divided into Groups 1 and 2 according to whether hemoperfusion was applied or not. Group 2 was observed as the control group. Conventional therapy for AOPP was given to Groups 1 and 2. Besides conventional treatment, patients in Group 1 were also treated with hemoperfusion therapy. Cholinesterase activity and blood glucose concentration were tested before hemoperfusion and for the first 3 days afterwards. The recovery time of 50% cholinesterase was recorded. At the same time, the incidence and mortality of intermediate syndrome was observed and compared. Results: The incidence and mortality of intermediate syndrome in Group 1 was obviously decreased, and the recovery time of cholinesterase activity was significantly shortened compared with Group 2. Conclusion: Hemoperfusion, used for treating severe AOPP, contributes to the improvement of cholinesterase activity, low incidence and mortality of intermediate syndrome, and increase in curative rate.

Severity and prognosis of acute organophosphorus pesticide poisoning are indicated by C-reactive protein and copeptin levels and APACHE II score.

The aim of the present study was to investigate the plasma levels of C-reactive protein (CRP) and copeptin, in addition to the acute physiology and chronic health evaluation II (APACHE II) scores, in patients with acute organophosphorus pesticide poisoning (AOPP). A total of 100 patients with AOPP were included and divided into mild, moderate and severe groups according to AOPP diagnosis and classification standards. Blood samples were collected from all patients on days 1, 3 and 7 following AOPP. The concentrations of CRP and copeptin in the plasma were determined using enzyme-linked immunosorbent assay. All AOPP patients underwent APACHE II scoring and the diagnostic value of these scores was analyzed using receiver operating characteristic curves (ROCs). On days 1, 3 and 7 after AOPP, the levels of CRP and copeptin were increased in correlation with the increase in AOPP severity, and were significantly higher compared with the control groups. Furthermore, elevated CRP and copeptin plasma levels were detected in patients with severe AOPP on day 7, whereas these levels were reduced in patients with mild or moderate AOPP. APACHE II scores, blood lactate level, acetylcholine esterase level, twitch disappearance time, reactivating agent dose and inability to raise the head were the high-risk factors that affected the prognosis of AOPP. Patients with plasma CRP and copeptin levels higher than median values had worse prognoses. The areas under curve for ROCs were 0.89, 0.75 and 0.72 for CRP levels, copeptin levels and APACHE II scores, respectively. In addition, the plasma contents of CRP and copeptin are increased according to the severity of AOPP. Therefore, the results of the present study suggest that CRP and copeptin levels and APACHE II scores may be used for the determination of AOPP severity and the prediction of AOPP prognosis.

Effects of different blood purification methods on serum cytokine levels and prognosis in patients with acute severe organophosphorus pesticide poisoning.

The aim of the present study was to investigate the impact of three different blood purification methods, hemoperfusion (HP), continuous blood purification (CBP), and on-line high-volume hemodiafiltration (OL-HDF), on the survival rate of patients with acute severe organophosphorus pesticide poisoning (ASOPP), as well as on major pro-inflammatory (interleukin [IL]-1, IL-6, tumor necrosis factor-α [TNF-α]) and anti-inflammatory (IL-10) cytokines in the serum. Eighty-one ASOPP patients were randomly divided into three groups: HP (N = 23), HP + CBP (N = 26), HP + OL-HD (N = 32). Serum IL-1, IL-6, TNF-α, and IL-10 levels were assessed by ELISA before treatment and at 24 and 48 h post-treatment and survival rates were determined. Patient survival rate was significantly higher in OL-HDF and CBP treated patients compared with HP group (P < 0.05). A significantly greater clearance effect in serum IL-1, IL-6, and TNF-α levels at 24 and 48 h post-treatment was observed in CBP and OL-HDF groups compared with the HP group (P < 0.05). The levels of serum anti-inflammatory cytokine IL-10 increased significantly in CBP and OL-HDF groups compared with the HP group (P < 0.05 at 48 h post-treatment). In addition, OL-HDF treatment achieved similar changes in serum TNF-α, IL-1, IL-6 and IL-10 levels as CBP (P > 0.05). Compared with the HP method, CBP or OL-HDF combined with HP can rapidly clear inflammatory cytokines, reduce systemic inflammatory response syndrome, and improve the survival of ASOPP patients. Compared with CBP, OL-HDF is an economical and effective method to treat ASOPP with less technical difficulty and more suitability for rural areas and primary hospitals.

Effect of predictable aid support on the prognosis of patients with tracheal intubation for severe acute organophosphorus pesticide poisoning

Objective To explore the effect of predictable aid support on the prognosis of patients with tracheal intubation for severe acute organophosphorus pesticide poisoning (SAOPP).Methods One hundred and nine patients with tracheal intubation for SAOPP were randomly divided into the treatment group (n =55)and control group (n =54).All patients in control group were treated with the gastric lavage and catharsis,accepted atropine and pralidoxime chloride and ventilatory support as prescribed.More predictability ambulance measures were applied to the treatment group such as reinforcement tracheal intubation,endotracheal intubation tube off alarm device and joint of thermostatic wetting with oxygen driving atomization.The therapy efficacy was compared between the two groups.Results Before treatment,breathing,heart rate,oxygen saturation and blood gas indexes had no differences (P ＞0.05) between the two groups.After a-72 h-treatment,the treatment group had significant differences on the above indicators compared with those of the control group (t =14.414,10.037,10.199,11.139,13.604,9.772,respectively; P ＜ 0.05).The duration of mechanical ventilation,tracheal intubation,monitoring and hospitalization were respectively (25.63 ± 3.24) h,(32.17 ± 3.50) h,(5.65 ±1.63) d,(8.52 ±2.13) d in the treatment group,and (37.82 ±3.75) h,(43.64 ±3.83) h,(9.78 ± 1.85) d,(13.79 ± 2.17) d in the control group,and the differences were statistically significant (t =18.170,16.326,12.372,12.795,respectively; P ＜ 0.05).The unplanned extubation and incidence of complication was 7.27％ in the treatment group,and 29.63％ in the control group,and the difference was statistically significant (x2 =9.090,P ＜ 0.05).The rescue success rate was 96.36％ in the treatment group,and 29.63％ in the control group,and the difference was statistically significant (x2 =5.099,P ＜ 0.05).Condusions The predictable aid support in endotracheal intubation can increase the success rate,enhance the efficacy,reduce complications and improve prognosis of SAOPP patients. Key words: Organophosphorus pesticide poisoning; Tracheal intubation; Aid support; Prognosis

Repeated pulse intramuscular injection of pralidoxime chloride in severe acute organophosphorus pesticide poisoning

ObjectiveThis study aimed to clarify the efficacy of 2 therapies for patients with severe acute organophosphorus pesticide poisoning, including atropine adverse effects, the length of intensive care unit (ICU) stay, complications, and mortality. MethodsA retrospective cohort study of 152 cases collected from May 2008 to November 2012 at 2 urban university hospitals was conducted. Patients admitted to the hospital for organophosphate poisoning were divided into 2 groups with different therapeutic regimens: group A was administered a repeated pulse intramuscular injection of pralidoxime chloride, and group B received the same initial dosage of atropine and pralidoxime chloride, but pralidoxime chloride intravenous therapy was administered for only 3 days, regardless of the length of atropine therapy. Subsequently, atropine adverse effects, length of ICU stay, complications, and mortality were statistically analyzed and compared between the 2 groups. ResultsThe total dose of atropine was 57.40 ± 15.14 mg in group A and 308.26 ± 139.16 mg in group B; group A received less atropine than did group B (P = .001). The length of ICU stay in group A was reduced (P = .025), and group A had fewer atropine adverse effects (P = .002). However, there was no significant difference in the mortality or complication rate between the 2 groups (P > .05). ConclusionIn patients with severe poisoning, group A used less atropine, had fewer atropine adverse effects, and had a shorter ICU stay. We suggest that therapy should be started as early as possible using a sufficient amount of pralidoxime chloride started intramuscularly in combination with atropine and that the drugs should not be prematurely discontinued.

Observation on curative effect of CRRT in treatment for acute severe organophosphorus pesticide poisoning

Objective To explore the clinical curative effect of CRRT in acute severe organophosphorus pesticide poisoning treatment.Methods 21 cases of acute severe organophosphorus pesticide poisoning from February 2011 to February 2012 in our emergency department were chosen as the experiment group,given CRRT based on conventional treatment,other 30 patients with acute severe organophosphorus pesticide poisoming from October 2009 to January 2011 in our hospital were selected as control group,with the routine treatment.The following indexes in the two groups were analyzed and compared:coma time,cholinesterase activity,recovery time,intermediate syndrome incidence rate,average hospitalization time,cure rate and the mean survival time of death patients.Results As for the experiment group,we had coma duration (11.52-3.93) hours,cholinesterase activity recovery time (5.04 ± 1.72) days,the average hospitalization time (8.36±1.29) days,intermediate syndrome incidence (6.58％),the cure rate (93.3％),dead patients with a mean survival time of (13.22 ± 2.83) days,and there were significant differences compared to those of control group (P＜0.05).Conclusion CRRT can obviously improve the clinical curative effect in severe acute organic phosphorus poisoning. Key words: CRRT; Severe acute organic phosphorus poisoning

Clinical study of effect of penehyclidine hydrochloride and atropine sequential therapy in the treatment of severe acute organophosphorus pesticide poisoning

To investigate the clinical efficacy of penehyclidine hydrochloride sequential to atropine in severe acute organophosphorus pesticide poisoning (AOPP). A retrospective analysis of the clinical data of 180 patients with severe AOPP admitted to the Emergency Center of Wuwei City People's Hospital from January 2007 to August 2011 was conducted. The patients were divided into penehyclidine hydrochloride sequential to atropine group, atropine group and penehyclidine hydrochloride group according to difference of anti-choline drugs using, with 60 cases in each group. The complication rate, time of recovery of cholinesterase (ChE) activity to 70％, hospital stay time and cost, the cure rate, mortality rate in three groups were analyzed. In penehyclidine hydrochloride sequential to atropine group, except for 1 case of cancer of gastric cardia with poisoning after operation showing intermediate syndrome of poisoning, the remaining patients did not have any complication, and the incidence of complications was 1.67％.No death occurred in all the patients, and the cure rate was 100.00％.Time of recovery from ChE activity to 70％ was (4.0 ± 1.1 ) days; hospital stay was (7.0 + 2.2) days; hospital expenses were (6268 ± 238 ) yuan. In atropine group, 3 patients were found to have atropine resistance, 3 patients showed intermediate syndrome, rebound was observed in 2 cases, atropine poisoning in 2 patients, and the incidence of complications was 16.67％.Three patients died of respiratory or circulatory failure, and the mortality rate was 5.00％.Fifty-seven patients were cured, the cure rate was 95.00％.The time of ChE activity recovery to 70％ was (8.0 ± 0.9) days. Hospital stay was (12.0 ± 2.1) days. Hospital expenses were (7160 ± 110) yuan. In penehyclidine hydrochloride group, 1 patient was found to have respiratory failure, 1 case suffered from pulmonary edema, and the complication rate was 3.33％.Two patients died, the mortality rate wan 3.33％.Fifty-eight patients were cured, the cure rate was 96.67％.The time of ChE activity recovery to 70％ was (6.0 ± 0.7) days, hospital stay was (9.0 ± 1.5) days, and hospital expenses were (7921 ± 230) yuan. Compared with atropine group, penehyclidine hydrochloride sequential to atropine group had a low death rate, high cure rate, less complications, ChE activity recover fast, short hospital days, and the hospitalization expenses were lower than that of the single use of atropine or single use of penehyclidine hydrochloride group, and the differences were statistically significant (all P＜0.01). In treatment of severe AOPP by penehyclidine hydrochloride sequential to atropine, curative effect was more significant, with fewer adverse reactions, short hospital stay, and lower cost.

The diagnostic value of butyrylcholinesterase in acute organophosphorus pesticide poisoning

To assess the value of butyrylcholinesterase (BuChE) in the diagnosis of acute organophosphorus pesticide poisoning (AOPP), and to investigate the relationship between the activity of whole blood acetylcholinesterase (AChE) and plasma BuChE in patients of AOPP in order to re-evaluate the diagnostic value of BuChE. An improved Ellman method was employed to determine the activity of AChE and BuChE in 21 AOPP inpatients due to different kinds of pesticides (from April to September in 2009) during the course of the illness, with 26 healthy volunteers as normal control. The relationship between BuChE activity and other clinical indicators of 113 inpatients (from January 2008 to April 2009) was also retrospectively analyzed. The normal value of AChE and BuChE were (105 + or - 33) U/Hb and (15 807 + or - 3 495) U/L . The inhibition levels of these two enzymes were different. When the AChE activity was lower than 50%, 30% or 20%, the activity of BuChE was lower than 20%, 10% or 5% correspondingly. The tendency of changes in the two enzymes was similar and coincided well with the clinical symptoms after poisoning. The results of sequential detection showed that a significant decrease or persistent inhibition of BuChE activity by less than 5% indicated a high level of organophosphorus pesticide in the body. However, an elevation of BuChE indicated a favorable outcome. BuChE is one of the ideal diagnostic and classification criteria for AOPP. When the inhibition level of BuChE reaches 20%, AOPP is of moderate degree, when it reaches 10%, severe AOPP can be diagnosed, with different kinds of organophosphorus pesticides taken into consideration.

Therapy with continous intravenous infusim pralidoxime chloride therapy in acute organophosphorus pesticide poisoning

Objective To investigate the therapeutic effect of continuous intravenous pralidoxime chloride infusion in acute organophosphorus pesticide poisoning(AOPP).Methods The patients with severe AOPP were randomly divided into 3 groups:(1)group 1(n =51)received a bolus injection of pralidoxime chloride 2.Og followed by continuous intravenous infusion at 0.25 g/h.(2)group 2(n = 51)received a bolus injection of pralidoxime 2.Og followed by continuous intravenous infusion at 0.5g/h.(3)group 3(n = 50)received intravenous drip of pralidoxime 2.Og for 3 times a day.Efficacy was compared among 3 groups on the basis of time to reach atropinization,recovery of cholinesterase activity .cumulative amount of atropine,incidence of recurrence of pesticide poisoning,intermediate syndrome,and hospitalization days,etc.Results Efficacy in patients receiving continuous intravenous therapy was significantly different from the third group.But there was no significant difference in efficacy between the first and second groups.Conclusion The patients with AOPP can be effectively treated by a loading dose followed with continous intravenous pralidoxime chloride infusion. Key words: Pralidoxime chloride; Continuous infusion therapy; Organophosphorus pesticide; Poisoning