Incidence and Outcomes of Endotracheal Intubation in Patients Presenting With Acute Poisoning to the Emergency Department of a Tertiary Care Center in India: A Prospective Observational Study

ObjectivesEndotracheal intubation is a critical airway intervention in severe acute poisoning, but its indications, timing, and outcomes are inconsistently described, and there are limited prospective data from Indian emergency departments (EDs).The primary objective of this prospective observational study was to determine the incidence of endotracheal intubation in adults (≥18 years) presenting with acute poisoning to the ED of AIIMS Rishikesh, Rishikesh, India.The secondary objectives were to (i) identify the clinical indications prompting intubation, (ii) enumerate indications stratified by poison type, (iii) record the timing and duration of intubation among intubated patients, and (iv) compare mortality between intubated and non-intubated patients. MethodsA prospective observational study was conducted over 15 months (October 2024-December 2025) in the ED of AIIMS Rishikesh.Adult patients (≥18 years) presenting with acute poisoning were enrolled using consecutive sampling.Based on past departmental records, a sample size of 120 patients was estimated.Participants were followed for 28 days through hospital records or telephonic follow-up after discharge. ResultsThis study included predominantly young adults with a slight male predominance (51.7%; 62/120), and the majority of poisoning cases were suicidal in nature.Pesticides, particularly organophosphorus (OP) compounds, were the most common poisoning agents, followed by household corrosives.Endotracheal intubation was required in 15.8% (19/120) of patients, with threatened airway due to a reduced Glasgow Coma Scale being the most common indication, followed by respiratory distress and excessive secretions.OP poisoning frequently required intubation due to multiple indications, while paraquat poisoning often required delayed intubation because of progressive respiratory failure.The overall mortality was 9.2% (11/120), with significantly higher mortality among intubated patients.Most deaths were attributed to OP compounds and paraquat poisoning.Male patients had higher rates of intubation and mortality. ConclusionThis study found that 15.8% of adults with acute poisoning presenting to emergency required endotracheal intubation, with significantly higher mortality among intubated patients.OP compounds and paraquat were the leading causes of intubation and death.Most intubations were performed at presentation, emphasizing the importance of early airway assessment in the emergency while maintaining close monitoring for delayed respiratory deterioration, especially in paraquat poisoning.