title: Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors.
abstract: BACKGROUND
  Drug overdose is the leading cause of injury-related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality.
  
  
  OBJECTIVE
  We aimed to identify the incidence and risk factors for endotracheal intubation after acute drug overdose.
  
  
  METHODS
  This secondary data analysis was performed on a 5-year prospective cohort at two urban tertiary-care hospitals. The present study analyzed adult patients with suspected acute drug overdose to derive independent clinical predictors of endotracheal intubation.
  
  
  RESULTS
  We analyzed 2497 patients with acute drug overdose, of whom 87 (3.5%) underwent endotracheal intubation. Independent clinical risk factors for endotracheal intubation were: younger age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.98), and history of obstructive lung disease (OR 6.6, 95% CI 3.5-12.3); however, heart failure had no association. Patients with obstructive lung disease had significantly more hypercapnia (mean difference 6.8 mm Hg, 95% CI 2.3-11.3) and a higher degree of acidemia (mean pH difference 0.04, 95% CI 0.01-0.07) than patients without obstructive lung disease. Lack of rapid sequence sedative/paralytic was associated with in-hospital fatality. Early complications of endotracheal intubation itself included desaturation (3.4%) and bradycardia (1%).
  
  
  CONCLUSIONS
  Endotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease.
authors.affiliation: Emergency Medicine Residency, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Angela
authors.initials: A
authors.lastname: Hua
authors.affiliation: University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Haight
authors.affiliation: Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: Division of Medical Toxicology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Manini
mesh_terms: D000328:Adult; D062787:Drug Overdose / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: intubation; overdose; risk factors