The retrospektif evaluation of organophosphat intoksication cases followed in i̇ntensive care unit

Aim: Because of their low price and easy accessibility, organophosphate insecticides are used in farming often and in an uncontrolled way. They are one of the most common reasons of poisoning by insecticides in the world. The rate of mortality caused by organophosphates is considerably high and the general reason of mortality is late or inappropriate treatment. In this study, demographic, biochemical, clinical findings of the patients, who were treated between January 2006-December 2011 in Anesthesia Intensive Care Unit, were retrospectively explored to see effects on mortality by examining the scores of GKS and APACHE II.Method: 47 patients who were older than 18 years old and who drank pesticides including organophosphate or exposed to organophosphate were included in this study in Intensive Care Unit (ICU) of The Department of Anesthesiology and Reanimation, The Faculty of Medicine, Dicle University between January 2006-December 2011. Gathered from the patient files, all the data which affect morbidity and mortality and provide information about prognosis such as age, gender, the type of exposure and intake, the time of ventilation use, duration of the stay in ICU, the laboratory surveys (hemogram, biochemical tests, arterial blood gas), GKS and APACHE II scores were analyzed. Their effects on mortality were analyzed. Data were analyzed with Pearson correlation test, Mann-Whitney U and Chi-Square Test.Findings: 33 (70,2%) patients out of 47 were female, 14 (29,8%) were male. The mean age of the patients was 25,8±11,8. 38 (80,9%) of patients were exposed to organophosphate with the intent of suicide, 9 (19,1%) of them were exposed accidentally. 45(95,7%) patients were exposed orally, 2(4,3%) patients were exposed by inhaling organophosphate. 41 (87,2%) patients out of 47, who were under the supervision of ICU, were discharged and 6 (12,8%) of them died. The average of GKS of the patients was 10,9±4,1. The average score of APACHE II was 18,3±9,1. The average duration of the stay in ICU was 5,9±5,4 (min-max:1-25) days. The average duration of MV was 2,02±3,26.Correlation between mortality, MV, GKS, APACHE II and the duration of stay in intensive care unit was evaluated with Pearson correlation test. When negative correlation between mortality and GKS was determined (p<0,0001), positive correlation was determined between mortality and APACHE II (p<0,0001). A negative correlation among GKS and mortality, APACHE II and MV duration was determined (p<0,0001). A negative correlation between MV and the duration of the stay in ICU was also determined (p<0,0001). The decrease of GKS and the increase of the mortality were found out to be very significant (p<0,0001). Statistically significant correlation was found between the predicted death rate and real mortality with APACHE II intensive care score (p=0,0001). There was a statistically significant correlation between the level of BUN and Creatinine and the rate of mortality (p=0,050)(p=0,0001). The relation between the height of the level of Amylase and the rate of mortality was found out to be significant (p=0,0001). In clinical findings, the relation between the existence of fasciculation and the mortality was found out to be significant as well (p=0,02).Results: In our study, it has been understood that the amounts of APACHE II and GKS have prognostic significance in poisoning of organophosphate. It has also been decided that both GKS and APACHE II can be good indicators in heaviness of poisoning and prediction of prognosis.