Background Assessement of the pattern of admission and treatment outcomes of critically ill pediatrics admitted to pediatric intensive care units (PICU) in developing countries is crucial. In these countries with resource limitations, it may help to identify priorities for resource mobilization that may improve patient service quality. The PICU mortality rate varies globally, depending on the facilities of the intensive care unit, availability of experties, and admission patterns. This study assessed the admission pattern, treatment outcomes, and associated factors for children admitted to the PICU. Methods A retrospective cross-sectional study was implemented on 406 randomly selected pediatrics patients admitted to the PICU of Tikur Anbessa Specialized Hospital from 1-Oct-2018 to 30-Sept-2020. The data were collected with a pretested questionnaire. A normality curve was used to check for data the distribution. Both bivariable and multivariable analyses were used to see association of variables. A variable with a p-value of < 0.2 in the bivariable model was a candidate for multivariate analysis. The strength of association was shown by an adjusted odds ratio (AOR) with a 95% Confidence interval (CI), and a p-value of < 0.05 was considered statistically significant. Frequency, percentage,and tables were used to present the data. Results A total of 361 (89% response rate) patient charts were studied, 197 (54.6%) were male, and 164(45.4%) were female. The most common pattern for admission was a septic shock (27.14%), whereas the least common pattern was Asthma 9(2.50%). The mortality rate at the pediatric intensive care unit was 43.8%. Moreover, mechanical ventilation need (AOR = 11.2, 95%CI (4.3–28.9), P < 0.001), need for inotropic agents (AOR = 10.7, 95%CI (4.1–27.8), P < 0.001), comorbidity (AOR =8.4, 95%CI (3.5–20.5), P < 0.001), length of PICU stay from 2 to 7 days (AOR = 7.3, 95%CI (1.7–30.6), P = 0.007) and severe GCS (< 8) (AOR = 10.5, 95%CI (3.8–29.1), P < 0.001) were independent clinical outcome predictors (mortality). Conclusion The mortality rate at the PICU was 43.8%. Septic shock, and meningitis were the common cause of death and the largest death has happened in less than 7 days of admission.
Background: During routine preoperative assessment of patients one of the commonest practices is predicting difficulty of tracheal intubation from various factors detected. Whether the factors reliably predict the difficulty is subject of argument. This study was conducted to assess the predictors of difficult tracheal intubation in adult patients. Methods: In this prospective observational study, we studied 120 consecutive elective adult patients admitted for general, gynecologic and orthopedic surgeries. Socio-demographic parameters and test variables such as BMI, TMD, SMD, IIG and Mallampati class were collected during preoperative evaluation. CL grade and difficulty of intubation were observed while the anesthetist in duty performs the laryngoscopy. While the former obtained from the preoperative anesthesia note, the latter were filled to questionnaire based on what the anesthetist reports during or after laryngoscopy. The prevalence of difficult intubation and the sensitivity, specificity, PPV and NPV of the tests were analyzed. SPSS-20 and different formulas were used during analysis. Chi square test was used and P<0.05 was considered as statistically significant. Result: The overall prevalence of difficult tracheal intubation was 2.5%. The sensitivity, specificity, PPV & NPV of the tests were 0%, 98.3%, 0% & 97.46% for BMI; 0%, 97.5%, 0% & 100% for SMD; 100%, 96.64%, 20% & 100% for TMD; 0%, 99.17%, 0%, & 100% for IIG; and 100%, 99.14%, 75% & 100% for Mallampati test. Conclusion: The incidence is not quite small that anesthetists should use necessary tests to predict the difficult intubation. Probably combining the tests being the best option, Mallampati test alone can predict the difficult intubation in adult patients.
Background: Although modern anesthesiology has made great progress in the last decades, neuraxial anesthesia (NA) is still the keynote of regional blockade. It is popular for its effectiveness in producing anesthesia and analgesia. As the NA techniques popularly used in clinics, post dural puncture headache (PDPH), a common iatrogenic complication resulted from post-spinal taps or accidental dural puncture (ADP) subsequent to epidural block, frequently reported and becomes a challenging to health caregivers. The objective of the study was to assess the magnitude of post dural puncture headache (PDPH) and Associated Factors in Obstetric Mothers Undergone Spinal Anesthesia for Cesarean Section from February 1 – June 30, 2018 Methods and Materials: Institutional based cross-sectional study design conducted in Dilchora Hospital and Sabian Primary Hospital from February 1 – June 30, 2018. 391 obstetric mothers was systematically selected every 2 other patient interval. The data was collect from both patient chart review and interview using structured checklist. Results: 85/391 (21.7%) obstetric mothers present with headache characteristic of post-dural puncture headache (PDPH). Larger gauge spinal needle [AOR= 3.105: 95% CI (1.116 - 8.638), P = 0.03] and multiple spinal attempts [AOR 0.374; 95% CI (0.220 - 0.635) P = 0.000] was statistically significantly related with PDPH after Spinal anesthesia. Conclusion and Recommendation: In our study, we observe a relatively higher prevalence of PDPH (21.7%), as compared to other literatures. Large gauge spinal needles (≥ 23 G) and multiple spinal attempts is also find statistically significantly related with PDPH after Spinal Anesthesia. In order to decrease the higher prevalence of PDPH in those Hospitals, Anesthetists should avoid utilization of large gauge spinal needles, and repeated dural puncture during Spinal Anesthesia.
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