title: Aggressive atropinisation and continuous pralidoxime (2-PAM) infusion in patients with severe organophosphate poisoning: experience of a northwest Indian hospital.
abstract: 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 of 2-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%).
  
  
  CONCLUSIONS
  Continuous 2-PAM infusion along with aggressive atropinisation after initial decontamination improved the outcome but not the duration of MV in severely intoxicated patients with organophosphate compounds who required assisted ventilation in this case series.
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Singh
authors.forename: D
authors.initials: D
authors.lastname: Chaudhry
authors.forename: D
authors.initials: D
authors.lastname: Behera
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.forename: S K
authors.initials: SK
authors.lastname: Jindal
mesh_terms: D000293:Adolescent; D000328:Adult; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D002801:Cholinesterase Reactivators / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care; D005260:Female; D006801:Humans; D007194:India; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D062025:Organophosphate Poisoning; D011220:Pralidoxime Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial; D012189:Retrospective Studies
chemical_list: D002801:Cholinesterase Reactivators; D018727:Muscarinic Antagonists; D011220:Pralidoxime Compounds; D001285:Atropine