Background: Organophosphorus insecticides are one of the most important causes of accidental and suicidal poisoning in India. There is a high mortality associated with this condition. Methods: The aim of this study was to find out the frequency, need for artificial airway and ventilation, evaluate the management and to determine the clinical outcomes of organophosphorous poisoning patients in a tertiary hospital in Udupi district. A total of 177 patients were included in this retrospective study over 3 years (Jan 2005 to Dec 2007). Results: Majority of the patients had normal respiratory rate while 44 were tachypnoeic. Out of the 49.15% patients requiring tracheal intubation, 40.1% required mechanical ventilation while 17.24% eventually required tracheostomy. The duration of ICU stay ranged between 1 – 28 days with an average of 6.51 days. The duration of hospital stay ranged between 1 – 63 days with an average of 11.9 days. The in hospital mortality rate was 18.6%. The management of organophosphorous poisoning in this hospital consisted of gastric wash and atropine. The use of pralidoxime, glycopyrrolate and activated charcoal was not uniform. Conclusion: Organophosphate poisoning has significantly high rate of requirement for tracheal intubation and mechanical ventilation. Despite appropriate management, it carries a high risk of in-hospital mortality. Mainstay of management of these patients is gastric wash, atropine and mechanical ventilation.