Organophosphate Poisoning Predicting the Need for Mechanical Ventilator Support

Background: The easy availability and lack of legal strictures have made organophosphorus compound poisoning the deadly bane for the people of the lower socioeconomic strata, i.e., farmers and laborers. This study was conducted to predict the need for ventilator support in organophosphate poisoning and to identify the factors which help in predicting the need for ventilatory support in organophosphorous compound poisoning. Materials and Methods: A total of 100 consecutive patients presenting with organophosphate poisoning admitted to New Civil Hospital, Surat, from September 2014 to October 2015 are studied. A provisional diagnosis of organophosphorus poisoning was made on the basis of a definite history of organophosphorus poisoning by patient or attendants and examination of the container when available. The diagnosis was further substantiated by typical clinical features (hypersalivation, miosis, and fasciculations) and characteristic odor of stomach wash or vomitus and serum cholinesterase level and analyzed using proper statistical test, i.e., Chi-square test. Results: With regard to grading of poisoning and its correlation of symptoms, 67% were of mild grade, 19% were of moderate grade, and 14% were of severe grade. Respiratory failure was the most common complication which may develop with 24 h after exposure. Only 2 out of 67 patients required ventilatory support with mild poisoning, 4 out of 19 patients with moderate poisoning required ventilator support, and 8 out of 14 patients with severe poisoning required ventilator support with significant (P > 0.001) association between severity by grading system and need of ventilation. Conclusions: A grading system is developed to assess the patients at the time of admission so as to grade the severity of poisoning and deciding requirement of assisted ventilation and thereafter intensive care unit stay is to be decided. Ventilators are boon to patients with respiratory failure due to poisoning and decrease the mortality secondary to organophosphorus related respiratory failure.