Poisoning-Induced Non-Cardiogenic Pulmonary Edema: Mechanism and Outcome

Abstract Background: pulmonary edema results from the shift of excessive fluid into the alveoli space and can be clinically classified into cardiogenic or non-cardiogenic by pathophysiology. This study aimed to elucidate the mechanism, outcomes, and prevention of poisoning induced non-cardiogenic pulmonary edema (PINCPE). Materials and methods: we conducted a study on etiology, epidemiology, mechanism, risk, and length of hospital stay in PINCPE. A PubMed search using terms: poisoning and non-cardiogenic pulmonary edema. From 1986 to 2017, a total of 15 articles with 16 cases (2 cases in one article) were included. Cut-off value of mean age was used for classification of subjects into younger group and older group, and length of stay (LOS) was compared between the two groups. Results: the age range of the patients was 7 to 72 years, and the average age (mean ± SD [standard deviation]) was 35.7±19.5 years. Among the reported substances in PINCPE, calcium channel blockers (CCBs) were most frequently used (n=8; 50%). In electrocardiogram (ECG), sinus tachycardia (n=8; 50%) was the most common finding. The overall rate of intubation with mechanical ventilator support was 81.3%. The mortality rate was 12.5%. Among patients with PINCPE, LOS was significantly shorter in the younger group aged <35.7 years than in the older group (5.7 vs. 8.9; p=.022). Conclusion: CCB was the most common etiologic agent in PINCPE. Up to 81.3% of PINCPE cases required intubation with ventilator support due to respiratory failure. LOS may increase 3.2 days if the case is complicated with extra-pulmonary organ failure.