Critically ill COVID-19 patients in Africa: it is time for quality registry data

Pisani, Luigi; Waweru-Siika, Wangari; Sendagire, Cornelius; Beane, Abi

doi:10.1016/s0140-6736(21)01549-x

Cited by 7 publications

(11 citation statements)

References 5 publications

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“…This was key as ventilator availability and critical care capacity was stretched globally, with particular concern in Uganda and other LMICs with limited critical care capacity (1,19). The availability of CPAP in Uganda and other LMICs, is unfortunately severely limited, even outside of the pandemic (25). There is very little literature on use of CPAP in adults in Uganda to gauge its level and distribution of use, but there are a number of barriers to its implementation.…”

Section: Discussionmentioning

confidence: 99%

First use of a new frugal CPAP device: the LeVe CPAP System, in adult patients with COVID-19 pneumonitis at Mengo Hospital, Kampala, Uganda

Littlejohns

Please

Musasizi

et al. 2023

Preprint

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Background: Continuous positive airway pressure (CPAP) has been a key treatment modality for COVID-19 worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP device was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. It was designed using principles of frugal innovation to be oxygen efficient, compatible with a range of oxygen sources, simple to use and sustainable to maintain. Prior to formal trial approval, received in November 2021, these devices were used in extremisto support critically unwell adult patients requiring non-invasive ventilatory support. Methods: This is a retrospective review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Kampala, Uganda. Treatment was escalated as per standard local protocols for respiratory failure, and CPAP was the ceiling of care. Data were collected on patient demographics, length of time of treatment, clinical outcome, and any adverse events. Results: Overall 43 COVID-19 positive patients were included in the study. The majority (83.7%) received CPAP only, 4.7% received HFNO only, and 11.6% received a combination of HFNO/CPAP. In terms of demographics, 58% were female and the median age was 58 years (range 28-91 years). The median duration of advanced respiratory support was 7 days (range 1-18 days). Of all patients escalated to HFNO/CPAP, 65.1% were initially commended on the LeVe device. Overall (all device) mortality was 49% and this was similar between those started on LeVe and non-LeVe devices (50% vs 47%). Conclusions: The LeVe device was the most used CPAP device during the pandemic, bringing the hospital’s number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP device, therefore formal comparative studies are required to inform further use.

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Section: Discussionmentioning

confidence: 99%

First use of a new frugal CPAP device: the LeVe CPAP System, in adult patients with COVID-19 pneumonitis at Mengo Hospital, Kampala, Uganda

Littlejohns

Please

Musasizi

et al. 2023

Preprint

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“…However, with other pressing needs competing for already limited funds, a timeline for developing such registries is impossible to predict. Initiatives, such as the Crit Care Africa project funded by the UK government to collect COVID-19 data in the region, are encouraging 21 . However, with the COVID-19 pandemic transitioning to endemic status in many developed countries, it is unclear whether donors will remain incentivized to fund such initiatives.…”

Section: Discussionmentioning

confidence: 99%

Adult Intensive Care in Uganda: A Systematic Review

Asiimwe

Ayoola

Sabiiti

et al. 2022

Preprint

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Background: Intensive (ICU) care in many African countries, such as Uganda is comparatively underdeveloped and underprioritized, largely because of other pressing healthcare system needs. However, experiences like the COVID-19 pandemic, declines in infectious disease-associated mortality, and the ongoing epidemiologic transition make the current state of critical-care in the region important. But most countries in the region, including Uganda, do not collect ICU data, leaving published studies as one of few potential sources of robust data. Existing systematic reviews utilize this fact; however, these studies report their findings in aggregate, making country-specific conclusions impossible. As a result, aspects of critical care in several individual African countries remain unknown. Objective: To assess intensive care utilization in Uganda over time; specifically, we ascertain patient demographics and the most common reasons for ICU admission. Methods: We performed a systematic search of the following indexing databases: PuBMed, EMBASE, Google scholars, and African Journals Online prior to March 2020. To assess the gray literature, we searched the dissertation databases of the largest public universities in the country (Makerere & Mbarara University) for relevant papers. Inclusion criteria for studies were: (i) study conducted in Uganda at a facility with intensive care capacity, (ii) adult population; (iii) N>100 patients. Findings: A total of 10 papers, collectively reporting on 3519 adult patients and published between 2005 and 2018 met our study’s inclusion criteria. The median of the average age on admission was 35.50 [IQR: 26.11-43.4], with post-operative management as the most common reason for ICU admission. Median mortality was 37.50% [IQR: 28.5-40.5]. Conclusions: Our study provides evidence supporting previous anecdotal reports of a comparatively low median age of patients in Uganda’s ICUs. However, we also find that most ICU research is conducted at the national referral hospital, Mulago, in the country’s capital, Kampala. This second finding highlights a significant knowledge gap, as private ICUs (whose catchment population includes Uganda’s rapidly growing middle class), and other districts in the country are not represented. As a result, these results should be interpreted cautiously. Future research studies should attempt to include private hospitals and those outside Kampala. Systematic review registration: PROSPERO. Registration ID: CRD42020168940

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“…HR for death in ICU compared with HDU was 3.7 (95% CI, 3.1-4.5; p < 0.001). Duration of IMV for intubated patients was 7 days (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Median length of stay in critical care was 2 days (1-5), being shorter in the HDU as compared with ICUs (2 [1][2][3][4]…”

Section: Patient Outcomesmentioning

confidence: 99%

Epidemiology, Clinical Characteristics, and Outcomes of 4546 Adult Admissions to High-Dependency and ICUs in Kenya: A Multicenter Registry-Based Observational Study

Njoki,

Simiyu,

Kaddu

et al. 2024

Critical Care Explorations

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OBJECTIVES: To describe clinical, management, and outcome features of critically ill patients admitted to ICUs and high-dependency units (HDUs) in Kenya. DESIGN: Prospective registry-based observational study. SETTING: Three HDUs and eight ICUs in Kenya. PATIENTS: Consecutive adult patients admitted between January 2021 and June 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were entered in a cloud-based platform using a common data model. Study endpoints included case-mix variables, management features, and patient-centered outcomes. Patients with COVID-19 were reported separately. Of the 3892 of 4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs, and 1447 patients (37.2%) were from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38–68), with HDU patients being older but with a lower severity (Acute Physiology and Chronic Health Evaluation II 6 [3–9] in HDUs vs. 12 [7–17] in ICUs; p < 0.001). One in four patients was postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation was applied in 3.4% in HDUs versus 47.6% in ICUs (p < 0.001), with a duration of 7 days (IQR 3–21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; p < 0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1–5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (p < 0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality. CONCLUSIONS: We provide the first multicenter observational cohort study from an African ICU National Registry. Distinct management features and outcomes characterize HDU from ICU patients.

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Critically ill COVID-19 patients in Africa: it is time for quality registry data

Cited by 7 publications

References 5 publications

First use of a new frugal CPAP device: the LeVe CPAP System, in adult patients with COVID-19 pneumonitis at Mengo Hospital, Kampala, Uganda

First use of a new frugal CPAP device: the LeVe CPAP System, in adult patients with COVID-19 pneumonitis at Mengo Hospital, Kampala, Uganda

Adult Intensive Care in Uganda: A Systematic Review

Epidemiology, Clinical Characteristics, and Outcomes of 4546 Adult Admissions to High-Dependency and ICUs in Kenya: A Multicenter Registry-Based Observational Study

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