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The following is a summary of “Tracheal Intubation and Mechanical Ventilation in Adults with Severe Salicylate Poisoning,” published in the September 2024 issue of Emergency Medicine by McDonald et al. 

Salicylate poisoning can cause severe acid-base disturbances, tracheal intubation and mechanical ventilation are discouraged for patients with severe salicylism.  

Researchers conducted a retrospective study to describe pH trends, complications, and outcomes in intubated individuals with salicylate poisoning.  

They included adults presenting to the emergency department (ED) with severe salicylate poisoning (serum salicylate concentration >40 mg/dL and admission to an intensive care unit) over 14 years (2007–2021). The primary outcome was the change in serum pH within 6 hours of presentation, while secondary outcomes were severe complications, including systolic blood pressure <80 mm Hg, oxygen saturation <80%, or cardiac arrest.  

The results showed that among 32 adults with severe salicylate poisoning (median serum salicylate level 64.2 mg/dL, interquartile range 52.5–70.7 mg/dL), 11 individuals (34%) underwent tracheal intubation. The initial mean pH (± standard deviation) was 7.48 ± 0.07 in those not intubated and 7.36 ± 0.04 in the intubation group. The mean absolute change in pH before and after intubation was -0.02 (95% CI −0.11 to 0.07). No severe complications, including systolic blood pressure <80 mm Hg, oxygen saturation <80%, or cardiac arrest, occurred during or within 6 hours after intubation and mechanical ventilation.  

Investigators concluded the tracheal intubation and mechanical ventilation in adults with severe salicylate poisoning were not associated with significant pH disturbances or severe complications. 

Source: sciencedirect.com/science/article/abs/pii/S073646792400132X