Evidence-Based Management for Acute Organophosphorus Pesticide Poisoning in Emergency ICU_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Rongle ,  WU Hongmei

Department of Geriatrics, West China Hospital, SiChuan University, Chengdu 610041, China;

Corresponding author：

WU Hongmei, Email: drwhm@163.com

Keywords：

Acute organophosphorus pesticide poisoning; Oximes; Cholinesterase Reactivators; Atropine

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Objective 　To formulate an optimal treatment for patients with acute organophosphorus pesticide poisoning through the evidence-based approach.
Methods 　Based on the clinical questions raised from a real-life patient of acute organophosphorus pesticide poisoning (OP poisoning) in Emergency ICU (EICU), we searched ACP journal club (1991-April, 2006), The Cochrane Library (Issue 1, 2006), MEDLINE (1966-May 2006) and Chinese Biological Medical Database(1978-May 2006) for systematic reviews , clinical randomized controlled trials, cohort and case-control studies using the keywords of “organophosphorus compounds, poisoning, insecticides, oximes, cholinesterase reactivators, and intermediate syndrome”. The quality of the included studies was assessed.
Results 　One Cochrane systematic review and one meta-analysis were included. These two studies concluded that there was no clear evidence on the benefits of oximes for acute organophosphorus pesticide poisoning. Based on the current evidence, integrated with clinical expertise and the patients’ values, the oximes were not used for this patient, only low-dose atropine was administered with other supportive therapies. After one week of treatment, the patient was discharged since her vital signs were stable and clinical symptoms were relieved.
Conclusions 　The appropriate management for acute organophosphorus pesticide poisoning has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.

Citation： ZHOU Rongle,WU Hongmei. Evidence-Based Management for Acute Organophosphorus Pesticide Poisoning in Emergency ICU. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 839-842. doi: Copy

1.	秦桂玺.中毒. 见: 叶任高, 等. 主编. 内科学. 第6版. 北京: 人民卫生出版社; 2004. 948~991.
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3.	Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM, 2000; 93(11): 715–731.
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5.	Guyatt GH, R ennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical L iterature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
6.	Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available for URL: http://www.cebm.net.
7.	Buckley NA, Eddleston M, Szinicz L. Oximes for acute organophosphate pesticide poisoning. The Cochrane Database of Systematic Reviews, 2005, Issue 1.
8.	John P, John M, Petra G. Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta-analytic techniques. Crit Care Med, 2006; 34(2): 502–510.
9.	Johnson S, Peter JV, Thomas K, et al. Evaluation of two treatment regimens of pralidoxime (1 gm single bolus vs 12 gm infusion) in the management of organophosphorus poisoning. A randomized, double blind controlled clinical trial. J Assoc Physicians India, 1996; 44(8): 529–531.
10.	Cherian AM, Peter JV, Samuel J, et al. Effectiveness of P2AM (PAM–Pralidoxime) in the treatment of organophosphate poisoning (OPP). A randomized, double blind placebo controlled clinical trial. J Assoc Physicians India, 1997; 45: 22–24.
11.	Cherian MA, Roshini C, Visalakshi J, et al. Biochemical and clinical profile after organophosphate poisoning-A placebo-controlled trial using pralidoxime. J Assoc Physicians India, 2005; 53: 427–431.
12.	de Silva HJ, Wijewickrema R, Senanayake N. Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet, 1992; 339(8802): 1136–1138.
13.	Balali-Mood M, Shariat M.Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effect of oximes. J Physiol Paris, 1998; 92(5-6): 375–378.
14.	Abdollahi M, Jafari A, Jalali N, et al. A new approach to the efficacy of oximes in the management of acute organophosphorus poisoning. Ir J Med Sci, 1995; 20: 105–109.
15.	Sungur M, Guven M. Intensive care management of organophosphate insecticide poisoning. Crit Care (London), 2001; 5(4): 211–215.15 Medicis JJ, Stork CM, Howland MA, et al. Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers. J Toxicol Clin Toxicol, 1996; 34(3): 289–295.
16.	Xue SZ, Ding XJ, Ding Y. Clinical observation and comparison of the effectiveness of several oxime cholinesterase reactivators. Scan J Work Environ Health, 1985; 11(Suppl 4): 46–48.
17.	Taylor P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, et al. The Pharmacological Basis of Therapeutics. New York, Macmillan;1985. 122.

1. 秦桂玺.中毒. 见: 叶任高, 等. 主编. 内科学. 第6版. 北京: 人民卫生出版社; 2004. 948~991.
2. Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev, 2003; 22(3): 165–190.
3. Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM, 2000; 93(11): 715–731.
4. Qin GX. Poisoning. In: Ye RG, et al. Editor-in-chief. Internal Medicine. 6th ed. Beijing: People’s Medical Publishing House; 2004. 948–991.
5. Guyatt GH, R ennie D, Editors. The Evidence-Based Medicine Working Group. Users’ Guides to the Medical L iterature: A Mannual for Evidence-Based Clinical Practice. Chicago: AMA Press; 2002.
6. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Available for URL: http://www.cebm.net.
7. Buckley NA, Eddleston M, Szinicz L. Oximes for acute organophosphate pesticide poisoning. The Cochrane Database of Systematic Reviews, 2005, Issue 1.
8. John P, John M, Petra G. Oxime therapy and outcomes in human organophosphate poisoning: An evaluation using meta-analytic techniques. Crit Care Med, 2006; 34(2): 502–510.
9. Johnson S, Peter JV, Thomas K, et al. Evaluation of two treatment regimens of pralidoxime (1 gm single bolus vs 12 gm infusion) in the management of organophosphorus poisoning. A randomized, double blind controlled clinical trial. J Assoc Physicians India, 1996; 44(8): 529–531.
10. Cherian AM, Peter JV, Samuel J, et al. Effectiveness of P2AM (PAM–Pralidoxime) in the treatment of organophosphate poisoning (OPP). A randomized, double blind placebo controlled clinical trial. J Assoc Physicians India, 1997; 45: 22–24.
11. Cherian MA, Roshini C, Visalakshi J, et al. Biochemical and clinical profile after organophosphate poisoning-A placebo-controlled trial using pralidoxime. J Assoc Physicians India, 2005; 53: 427–431.
12. de Silva HJ, Wijewickrema R, Senanayake N. Does pralidoxime affect outcome of management in acute organophosphorus poisoning? Lancet, 1992; 339(8802): 1136–1138.
13. Balali-Mood M, Shariat M.Treatment of organophosphate poisoning. Experience of nerve agents and acute pesticide poisoning on the effect of oximes. J Physiol Paris, 1998; 92(5-6): 375–378.
14. Abdollahi M, Jafari A, Jalali N, et al. A new approach to the efficacy of oximes in the management of acute organophosphorus poisoning. Ir J Med Sci, 1995; 20: 105–109.
15. Sungur M, Guven M. Intensive care management of organophosphate insecticide poisoning. Crit Care (London), 2001; 5(4): 211–215.15 Medicis JJ, Stork CM, Howland MA, et al. Pharmacokinetics following a loading plus a continuous infusion of pralidoxime compared with the traditional short infusion regimen in human volunteers. J Toxicol Clin Toxicol, 1996; 34(3): 289–295.
16. Xue SZ, Ding XJ, Ding Y. Clinical observation and comparison of the effectiveness of several oxime cholinesterase reactivators. Scan J Work Environ Health, 1985; 11(Suppl 4): 46–48.
17. Taylor P. Anticholinesterase agents. In: Gilman AG, Goodman LS, Rall TW, et al. The Pharmacological Basis of Therapeutics. New York, Macmillan;1985. 122.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Management for Acute Organophosphorus Pesticide Poisoning in Emergency ICU

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