Intubations for Drug Overdose: Can we Predict Short Intubations?

Patients with drug overdose and reduced consciousness may require intubation; others can be safely observed.

We describe a cohort of patients intubated for drug overdose and identify factors associated with short intubations (≤12-hours).

This retrospective cohort study included patients intubated for drug overdose between February 2021-March 2023 at two Emergency Departments in Queensland, Australia. Demographics, clinical characteristics, vital signs, outcomes and complications were recorded. Univariable and multivariate modeling identified factors associated with "short" intubation times (≤12-hours).

Overall, 170 patients were intubated for drug overdose during the study period. Median duration of intubation was 18-hours (IQR 11-36), with 117 (69.0%) patients intubated >12-hours. On univariable modeling, short intubation time (≤12-hours) was associated with age <40 years old (OR 2.10, 95% CI 1.04-4.22); no prior medical conditions (OR 4.43, 95% CI 1.71-11.48); gamma-hydroxybutyrate (OR 6.21, 95% CI 2.76-13.96); recreational intent (OR 4.97, 95% CI 2.40-10.30); intubation at night (OR 2.02, 95% CI 1.11-3.66); Glasgow Coma Scale ≤8 (OR 4.44, 95% CI 1.63-12.07). Three factors remained significant in multivariable modeling: recreational intent (OR 13.10, 95% CI 4.80-35.40); intubation at night (OR 4.40, 95% CI 1.50-12.80); Glasgow Coma Scale ≤8 (OR 4.10, 95% CI 1.30-12.60). Aspiration occurred in 36 (21.2%) intubated patients.

Coma from gamma-hydroxybutyrate overdose tends to last <6 hours, reflecting short intubation times in these patients. A lower Glasgow Coma Score was associated with shorter intubation time. Rates of aspiration were similar to existing findings. An individualized risk assessment can determine the likely length of intubation for patients.