Management of pharmaceutical and recreational drug poisoning
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Published:2020-11-23
Issue:1
Volume:10
Page:
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ISSN:2110-5820
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Container-title:Annals of Intensive Care
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language:en
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Short-container-title:Ann. Intensive Care
Author:
Mégarbane BrunoORCID, Oberlin Mathieu, Alvarez Jean-Claude, Balen Frederic, Beaune Sébastien, Bédry Régis, Chauvin Anthony, Claudet Isabelle, Danel Vincent, Debaty Guillaume, Delahaye Arnaud, Deye Nicolas, Gaulier Jean-Michel, Grossenbacher Francis, Hantson Philippe, Jacobs Frédéric, Jaffal Karim, Labadie Magali, Labat Laurence, Langrand Jérôme, Lapostolle Frédéric, Le Conte Philippe, Maignan Maxime, Nisse Patrick, Sauder Philippe, Tournoud Christine, Vodovar Dominique, Voicu Sebastian, Claret Pierre-Géraud, Cerf Charles
Abstract
Abstract
Background
Poisoning is one of the leading causes of admission to the emergency department and intensive care unit. A large number of epidemiological changes have occurred over the last years such as the exponential growth of new synthetic psychoactive substances. Major progress has also been made in analytical screening and assays, enabling the clinicians to rapidly obtain a definite diagnosis.
Methods
A committee composed of 30 experts from five scientific societies, the Société de Réanimation de Langue Française (SRLF), the Société Française de Médecine d’Urgence (SFMU), the Société de Toxicologie Clinique (STC), the Société Française de Toxicologie Analytique (SFTA) and the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP) evaluated eight fields: (1) severity assessment and initial triage; (2) diagnostic approach and role of toxicological analyses; (3) supportive care; (4) decontamination; (5) elimination enhancement; (6) place of antidotes; (7) specificities related to recreational drug poisoning; and (8) characteristics of cardiotoxicant poisoning. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology.
Results
The SRLF-SFMU guideline panel provided 41 statements concerning the management of pharmaceutical and recreational drug poisoning. Ethanol and chemical poisoning were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for all recommendations. Six of these recommendations had a high level of evidence (GRADE 1±) and six had a low level of evidence (GRADE 2±). Twenty-nine recommendations were in the form of expert opinion recommendations due to the low evidences in the literature.
Conclusions
The experts reached a substantial consensus for several strong recommendations for optimal management of pharmaceutical and recreational drug poisoning, mainly regarding the conditions and effectiveness of naloxone and N-acetylcystein as antidotes to treat opioid and acetaminophen poisoning, respectively.
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
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