Acute Intoxications Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Abstract

Background: Acute intoxications are a critical yet underexplored area in intensive care. Poisoning ranks among the leading causes of injury-related death, but limited data and the lack of clinical guidelines hinder prompt recognition and effective management. This study aims to describe intensive care unit (ICU) admissions for acute intoxications at an Italian tertiary hospital and to identify key factors associated with patient outcomes. Methods: We conducted a retrospective cohort study of patients admitted for confirmed acute intoxication to the ICUs (general, cardiac, and neuro) at Fondazione IRCCS San Gerardo dei Tintori Hospital, Monza, from January 2009 to May 2024. Data included demographics, substance type, intoxication severity, treatments, and outcomes. Results: Among 117 patients (126 intoxication episodes), intentional self-poisoning, often involving psychotropic drugs, was most prevalent. Multiple-substance intoxications made up 55.6% of cases, typically involving medications and ethanol, and were associated with shorter ICU stays and lower mortality than single-substance cases, where toxic agents like cocaine and household/industrial agents led to more severe outcomes. The overall ICU mortality rate was 5.1% (hospital mortality 6%) with a median ICU length of stay of 3 days. Early recognition of intoxication was associated with higher hospital survival rates, whereas lower pH and higher lactate levels were associated with increased hospital mortality. Conclusions: Prompt identification of acute intoxications significantly impacts ICU and hospital outcomes. The findings suggest that early intervention, along with standardized treatment protocols, is crucial to improving patient prognosis and reducing mortality.

Keywords: ICU; acute intoxication; early recognition; multisubstance; single-substance.

Figure 1

Combinations of drugs in multiple-substance intoxications. Values represent counts.