The American journal of emergency medicine · 2018
Clinical effects of reported synthetic cannabinoid exposure in patients admitted to the intensive care unit.
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Tatusov Michael, Mazer-Amirshahi Maryann, Abbasi Aleeza, Goyal Munish
Аннотация
OBJECTIVE: To characterize the clinical presentation and hospital course of patients with reported synthetic cannabinoid (SC) exposure requiring Intensive Care Unit (ICU) admission.
DESIGN: Retrospective case series of patients admitted to medical or cardiac ICU.
SETTING: Urban tertiary care center.
PARTICIPANTS: Adults ≥18 years old admitted from the emergency department (ED) in 2015.
MEASUREMENTS: Demographics, Sequential Organ Failure Assessment (SOFA) scores, and clinical parameters documenting the effects and hospital course.
RESULTS: 23 patients met inclusion criteria. Median age was 47 years (interquartile range [IQR], 32-54); 83% male; 78% black. Patients were generally tachycardic (HR > 100), (65%) and hypertensive (SBP > 140), (65%) on admission. The initial chest X-ray and ECG were abnormal in 43% and 68% of patients, respectively. Pulmonary edema and tachycardia were the most common findings. Head CT imaging was abnormal in 5% of patients. Troponin was elevated >1.0 ng/ml in 3 of 19 patients (16%). Other exposures detected on admission were marijuana (30%), alcohol (30%), and benzodiazepines (26%). The median SOFA score was 6 on admission and decreased over the next 3 days. SOFA scores were primarily driven by altered neurologic status and respiratory failure. 91% required mechanical ventilation, 30% had seizures as a part of presentation, 18% required vasopressors, and 5% needed dialysis. Median hospital and ICU lengths of stay were 2.6 (IQR 1.4-3.5) and 1.6 (IQR 0.9-2.5) days, respectively. The median hospital charge was $37,008. All patients survived the index hospitalization.
CONCLUSIONS: Patients admitted to ICU after SC exposure exhibit significant organ dysfunction, particularly neurologic and respiratory. Prognosis is good with supportive care.
DESIGN: Retrospective case series of patients admitted to medical or cardiac ICU.
SETTING: Urban tertiary care center.
PARTICIPANTS: Adults ≥18 years old admitted from the emergency department (ED) in 2015.
MEASUREMENTS: Demographics, Sequential Organ Failure Assessment (SOFA) scores, and clinical parameters documenting the effects and hospital course.
RESULTS: 23 patients met inclusion criteria. Median age was 47 years (interquartile range [IQR], 32-54); 83% male; 78% black. Patients were generally tachycardic (HR > 100), (65%) and hypertensive (SBP > 140), (65%) on admission. The initial chest X-ray and ECG were abnormal in 43% and 68% of patients, respectively. Pulmonary edema and tachycardia were the most common findings. Head CT imaging was abnormal in 5% of patients. Troponin was elevated >1.0 ng/ml in 3 of 19 patients (16%). Other exposures detected on admission were marijuana (30%), alcohol (30%), and benzodiazepines (26%). The median SOFA score was 6 on admission and decreased over the next 3 days. SOFA scores were primarily driven by altered neurologic status and respiratory failure. 91% required mechanical ventilation, 30% had seizures as a part of presentation, 18% required vasopressors, and 5% needed dialysis. Median hospital and ICU lengths of stay were 2.6 (IQR 1.4-3.5) and 1.6 (IQR 0.9-2.5) days, respectively. The median hospital charge was $37,008. All patients survived the index hospitalization.
CONCLUSIONS: Patients admitted to ICU after SC exposure exhibit significant organ dysfunction, particularly neurologic and respiratory. Prognosis is good with supportive care.