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Pulmonary complications after tricyclic antidepressant overdose
T M Roy1, M A Ossorio, L M Cipolla
1Division of Respiratory and Environmental Medicine, University of Louisville School of Medicine, Ky.
Chest
|October 1, 1989
Summary
Tricyclic antidepressant overdose frequently causes respiratory issues, including impaired oxygen exchange and the need for mechanical ventilation. Higher drug levels correlate with more severe lung complications like acute lung injury.
Area of Science:
- Critical Care Medicine
- Toxicology
- Pulmonary Medicine
Background:
- Tricyclic antidepressant (TCA) overdose is a significant cause of critical illness.
- Respiratory complications are common but not fully characterized in TCA overdose patients.
Purpose of the Study:
- To investigate the incidence and nature of respiratory complications in patients with tricyclic antidepressant overdose.
- To identify factors associated with respiratory complications, including drug levels and aspiration.
Main Methods:
- Prospective study of 82 consecutive ICU patients with TCA overdose.
- Analysis of arterial blood gas (PaO2/PAO2 ratio), need for mechanical ventilation, and chest radiograph findings.
- Assessment of activated charcoal aspiration and its impact on outcomes.
Main Results:
- 80.4% of patients had impaired oxygen exchange (decreased PaO2/PAO2 ratio).
- 76.8% required mechanical ventilation; 39% developed chest radiograph abnormalities.
- Higher TCA levels were associated with radiographic abnormalities and acute lung injury (11% of patients).
- Aspiration of activated charcoal did not significantly impact respiratory complications or survival.
Conclusions:
- Tricyclic antidepressant overdose frequently leads to significant respiratory compromise.
- Higher drug concentrations increase the risk of severe lung injury.
- Activated charcoal aspiration does not appear to worsen respiratory outcomes in this setting.