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Aggressive atropinisation and continuous pralidoxime (2-PAM) infusion in patients with severe organophosphate poisoning: experience of a northwest Indian hospital

OBJECTIVE: The aim of the study was to find whether continuous pralidoxime (2-PAM) infusion along with aggressive atropinisation improves the outcome in patients with severe organophosphate poisoning who require assisted ventilation. METHODS: Sixteen patients admitted to the respiratory intensive care unit (RICU) with severe organophosphate poisoning and requiring assisted ventilation were included in the study. The compounds involved were phorate (six), dichlorvos (four), oxydimeton methyl (one), monocrotophos (one), methyl parathion (one) and in three it was unknown. After decontamination, they were given intravenous (iv) bolus atropine 5 mg at onset and then 2.5 mg every 5-10 min till atropinisation was achieved, and then maintained either by intermittent bolus doses or by continuous infusion if the required dose was large. They were also given continuous iv infusion of 2-PAM in dose of 7.5 mg/kg body weight/h (maximum 500 mg/h) after an initial bolus dose of 2 g. RESULTS: The mean (± S.D.) dose of atropine was 735.02 ± 742.98 mg (range 85-3000 mg) with maximum dose on day 1. The mean (± S.D) duration of2-PAM infusion was 96.4±49.4 h (range 10-216 h). The mean (±S.D) duration of mechanical ventilation (MV) was 131.5 ± 95.65 h (range 4-336 h). Fourteen patients could be successfully extubated and two died of bronchopneumonia and sepsis (mortality 12.5%6). CONCLUSION: Continuous 2-PAM infusion along with aggressive atropinisation after initial decontamination improved the outcome but notthe duration of MV in severely intoxicated patients with organophosphate compounds who required assisted ventilation in this case series.