Abstract
While several large-scaled multicenter studies have changed the approach to the diagnosis and treatment of hypotension and shock in septic patients in recent years, the evidence base for the appropriate management of circulatory failure in poisoned patients is much more precarious. Toxicological research is often limited to case reports, small case series, or animal studies and most clinical recommendations or treatment guidelines are based on expert consensus or even personal experience rather than on criteria of evidence-based medicine [1]. Additionally, there may be a significant reporting bias from positive cases responding to different treatments, including extraordinary resuscitation measures. However, given the infrequency of many of these poisoning events, the likelihood of confirmatory randomized controlled trials to prove effectiveness will be low [2].
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Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition
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I
Evidence obtained from at least one properly randomized controlled trial.
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II-1
Evidence obtained from well-designed controlled trials without randomization.
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II-2
Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
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II-3
Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.
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III
Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.
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Eyer, F. (2016). Hypotension and Shock in the Poisoned Patient. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_55-2
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Hypotension and Shock in the Poisoned Patient- Published:
- 22 September 2016
DOI: https://doi.org/10.1007/978-3-319-20790-2_55-2
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Hypotension and Shock in the Poisoned Patient- Published:
- 14 September 2015
DOI: https://doi.org/10.1007/978-3-319-20790-2_55-1