A retrospective comparison of the burden of organophosphate poisoning to an Intensive Care Unit in Soweto over two separate periods.

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Abstract

Organophosphate poisoning (OPP) is a major health-care burden in South Africa. Recently, we have observed that patients admitted to our Intensive Care Unit (ICU) with OPP have followed a more complicated course in comparison to previous years.

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Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

Lucienne TQ Cardoso, Cintia Grion, Tiemi Matsuo … (2011)

Introduction When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients. Methods A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge. Results A total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001). Conclusions There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.

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Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study

S Maweni, JB de Wet, B Dedekind … (2018)

There is a need to increase access to surgical treatments in African countries, but perioperative complications represent a major global health-care burden. There are few studies describing surgical outcomes in Africa.

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Organophosphate pesticides: biochemistry and clinical toxicology.

Jeffrey Kwong (2002)

Organophosphate pesticides are used extensively worldwide, and poisoning by these agents, particularly in developing nations, is a serious public health problem. The toxicokinetics and toxicodynamics of organophosphate poisoning vary not only with the route and extent of exposure, but also the chemical structure of the agent. The mechanism of toxicity is the inhibition of acetylcholinesterase, resulting in an accumulation of the neurotransmitter acetylcholine and the continued stimulation of acetylcholine receptors. The standard treatment consists of reactivation of the inhibited acetylcholinesterase with an oxime antidote and reversal of the biochemical effects of acetylcholine with atropine. Patients who receive treatment promptly usually recover from acute toxicity but may suffer from neurologic sequelae.

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Author and article information

Journal

Journal ID (iso-abbrev): Afr J Emerg Med

Title: African journal of emergency medicine : Revue africaine de la medecine d'urgence

Publisher: Elsevier BV

ISSN (Electronic): 2211-4203

ISSN (Print): 2211-419X

Publication date (Electronic): Mar 2021

Volume: 11

Issue: 1

Affiliations

[1 ] Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.