Background: Organophosphorus poisoning (OPs) is a global health issue leading to thousands of mortalities and morbidities annually. Respiratory failure remains the main mechanism of death. With the widespread use of ventilators, respiratory failure has been effectively treated. Aim of the work: The present study aimed to measure serum procalcitonin level in acute OPs poisoning and to assess its potential role as an early predictor for mechanical ventilation need in these patients. Patient and Method: The study was conducted on 42 acutely OPs intoxicated patients. Adding to the routine management of acute OPs patients, serum procalcitonin level was measured in all patients within 2-4 hours of exposure. Patients were categorized into 2 groups according to need for mechanical ventilation (MV), group 1 (needed MV) and group 2 did not require MV during management. Results: Nearly, 29% of intoxicated OPs patients required MV. Individuals presenting with lower GCS scores, some muscarinic and nicotinic manifestations were more likely to require mechanical ventilation. Median procalcitonin level showed a statistically significant difference between groups that needed MV and those who did not. Procalcitonin level was able to predict the need for MV in acute OPs poisoned patients with a cut-off value >0.4ng/ ml, sensitivity = 100.0%, specificity = 83.3%, and overall accuracy = 88.1%. Conclusions and Recommendations: Procalcitonin level rather than sepsis marking, may additionally have other predictive values. It may be used either even or with other scoring systems and biomarkers in early prediction of the need for MV in acute OPs poisoned patients.