An audit of intensive care unit admission in a pediatric cardio-thoracic population in Enugu, Nigeria

Abstract

Introduction: The study aimed to perform an audit of intensive care unit admissions in the paediatric cardio-thoracic population in Enugu, Nigeria and examine the challenges and outcome in this high risk group. Ways of improvement based on this study are suggested. Methods: The hospital records of consecutive postoperative pediatric cardiothoracic admissions to the multidisciplinary and cardiothoracic intensive care units of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria to determine their Intensive Care Unit management and outcome over a 2 year span -June 2002 to June 2004 were retrospectively reviewed. Data collected included patient demographics, diagnosis, duration of stay in the intensive care unit, therapeutic interventions and outcome. Results: There were a total of thirty consecutive postoperative paediatric admissions to the intensive care unit over the 2 year study period. The average age of the patients was 5.1 years with a range of 2 weeks to 13 years. Twelve patients had cardiac surgery with cardiopulmonary bypass (CPB), three patients had colon transplant, four patients had pericardiotomy/pericardicectomy, and five patients had diagnostic/therapeutic bronchoscopy. The remaining patients had the following surgeries, thoracotomy for repair of diaphragmatic hernia/decortications, delayed primary repair of esophageal atresia and gastrostomy. Two patients had excision of a cervical teratoma and cystichygroma. The average duration of stay in the intensive care unit was 6.2 days. Ten patients (33%) received pressor agents for organ support. Five patients (17%) had mechanical ventilation, while twenty-five patients (83%) received oxygen therapy via intranasal cannula or endotracheal tube. Seven patients (23%) received blood transfusion in the ICU. There was a 66% survival rate with ten deaths. Conclusion: Paediatric cardio-thoracic services in Nigeria suffer from the problems of inadequate funding and manpower flight to better paying jobs. Government should invest in their people by introducing insurance schemes for cardiac patients.Training programmes for members of cardio-thoracic units in countries with advanced health care systems and hands on experience should be encouraged. Otherwise for a majority of children with heart disease, it will be a slow painful wait for the inevitable.

ICU utilization by cardio-thoracic patients in a Nigerian Teaching Hospital: Any role for HDU?

“…The 15% mortality observed amongst cardio-thoracic patients in this review is much lower than the 33% recorded by Okafor and Ezike[14] in their two year review of pediatric cardio-thoracic admissions in Enugu, Nigeria. This difference may be because our review involved other age groups with a lower group specific mortality.…”

Pediatric cardiovascular care in Uganda

“…Cardiovascular care programs have tended to be in the lower strata in most government public health delivery priority lists in many of these resource-challenged countries. [3] As a result, many children in low- and middle-income countries of the world continue to suffer high morbidity and mortality from both acquired heart disease and congenital heart disease (CHD). This is because of the unavailability or lack of sufficient subspecialized cardiac care facilities in many of these nations.…”

Analysis of the characteristics of unplanned admission to the intensive care unit after general surgery

“…Unplanned ICU admission has been studied largely in the postoperative period, and for emergency hospitalization. Despite study-based differences, generally, time to admittance to ICU is 1-2 days after surgery or leaving the emergency room [4,10,11]. Here, we aimed to identify patient and surgical characteristics associated with unplanned ICU admissions immediately after surgery, because a delay before ICU admission may result in situations that anesthesiologists cannot control and may introduce factors unrelated to perioperative periods.…”