Intensive Care Management of Poisoning in a Resource-Limited Health Care Setting in Western Kenya

Abstract

Poisoning due to pesticides is an important cause of morbidity and mortality worldwide. About three million cases of poisoning occur worldwide annually, mostly in developing countries with Organophosphates poisoning (OPP) being seen more commonly compared to others. With more than200,000 deaths each year in developing countries. The study setting was Intensive Care Unit (ICU) of Moi Teaching and Referral Hospital (MTRH), a public referral hospital serving North Rift and Western Kenya. Sampled were patients admitted to ICU due to poisoning, between 2006 and 2010, both years included. Objectives were to determine the number of poisoning cases in the critical care setting, clinical interventions given and establish the patients’ management outcomes among these patients at MTRH. The study adopted a retrospective records and charts review, where by poisoning cases possibly due to carbamates, amitraz and organophosphate were reviewed. Cases were identified through the use of Intensive Care Unit admission register and forwarded to the department of health records for retrieval of the case files. Data was collected by the researchers themselves by use of a predesigned patient records review check list and charts review. Results showed that the ages ranged from 1 year to 63 years old patients with a mean of 25 +14.8years. The male to female ratio was 1.5:1. During the study period there were total of 1063 ICU admissions of whom 85 were poisoning cases. Categorizations of poisoning for purposes of diagnosis or management as organophosphate, amitraz or any other was rarely done hence all were usually treated as ‘organophosphate poisoning (OPP)’.Atropine injection and mechanical ventilation remained the mainstay treatment of these poisoning cases. The mortality rate due to poisoning in ICU was 10.4% and none died in the wards after being discharged from the ICU. Whether or not PAM was used did not seem to make significant difference. Though management of these cases was found to be inadequate due to lack of protocols, clinical judgment, some essential drugs and equipment it still yielded some positive outcomes.