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Review
. 2021 Jan;17(1):61-69.
doi: 10.1007/s13181-020-00779-3. Epub 2020 May 11.

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature

Glenn A Burket  1   2 , B Zane Horowitz  3   4 , Robert G Hendrickson  3   4 , Gillian A Beauchamp  5
Affiliations
Review

Endotracheal Intubation in the Pharmaceutical-Poisoned Patient: a Narrative Review of the Literature

Glenn A Burket et al. J Med Toxicol. 2021 Jan.

Abstract

Introduction: Endotracheal intubation (ETI) is an essential component of the supportive care provided to the critically ill patient with pharmaceutical poisoning; however, specific nuances surrounding intubation including techniques and complications in the context of pharmaceutical poisoning have not been well elucidated.

Discussion: A search of the available literature on ETI in pharmaceutical-poisoned patients was undertaken using Medline, ERIC, Cochrane database, and PsycINFO using the following MeSH and keyword terms: ("toxicology" OR "poisons" OR "drug overdose" OR "poisoning") AND ("intubation, intratracheal" OR "intubation, endotracheal" OR "airway management" OR "respiration, artificial"). A hand-search was also performed when the literature in the above search required additional conceptual clarification, including using the "Similar Articles" feature of PubMed, along with reviewing articles' reference lists that discussed intubation in the context of a poisoning scenario. Articles with any discussion around the ETI process in the context of a pharmaceutical poisoning were then included. Intubation may be performed in patients poisoned with pharmaceuticals in the context of both single and multiple organ dysfunction including central and peripheral nervous system, pulmonary, or cardiovascular toxicity with hemodynamic instability, or localized effects resulting in mechanical airway obstruction. Certain classes of poisonings may require modifications to the standard rapid sequence induction airway management algorithm.

Conclusions: ETI is a key component of the supportive care provided to the patient poisoned by a pharmaceutical agent. Clinicians should be aware of the spectrum of toxicities that can necessitate intubation, as well as airway management nuances that are specific to various poisoning presentations.

Keywords: Airway management; Endotracheal intubation; Pharmaceutical poisoning; Supportive care.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

The authors have no commercial associations or sources of support that might pose a conflict of interest. This work has not been published or presented elsewhere and did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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