Outcomes of Patients on Mechanical Ventilation  among Adult Intensive Care Units of Tikur Anbesa Specialized Hospital, Addis Ababa , Ethiopia

Abstract

Background Mechanical ventilation is a supportive treatment for patients who are unable to maintain adequate oxygenation and/or removal of carbon dioxide. One of the most common indications of admission to the intensive care unit is the need for the ventilator support. Patients admitted to intensive care units who need mechanical ventilation had been higher mortality rates than those who do not require respiratory support. The objective of the study was to assess the clinical profile and outcomes of patients on mechanical ventilation among adult intensive care units of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020. Methods Retrospective cross-sectional study was employed using a principal investigator developed (PI) data extraction form. We reviewed retrospectively a one-year medical record of ventilated patient from September 1, 2018- August 30, 2019. Data were analyzed using statistical package for social science (SPSS) version 25. Description of median frequency and standard deviation (SD) on each variable were calculated. Multivarte logistic regression was assessed to association between dependent and independent variable. Results There were 693 patients admitted to AICU over the one year and 348(50.2%) were mechanically ventilated. The main source for admission was Adult emergency and operation room with same percent (37.6%). The main reason for ICU admission was respiratory (55.2%). The predominant indication of mechanical ventilation was respiratory failure (41.9%), neurological failure (36.7%) and sepsis (11.4%). Volume control ventilation was the most common initial mode of ventilation used. In multivariable regression analysis being medical diagnosis patients, multi organ dysfunction syndrome and sedation used were statistically positively associated with mortality at p-value of less than 0.05 with CI 95%. Conclusions The mortality rate of Adult patients on mechanical ventilation in Tikur Anbessa specialized hospital was high. This high mortality rate suggesting an urgent need for extensive improvement in protocols for ICU set up.

Prevalence of mortality and associated factors among ICU admitted adult patients with mechanical ventilation in Ethiopia; Systematic review and meta-analysis

“…Similarly, a decreased GCS score (≤8) at admission has been identified as another determinant of mortality in patients on MV. Despite an insignificant pooled OR, the literature review highlighted significant associations in three studies (22,23,25). It is consistent with other studies across globe (28).…”

“…Patients diagnosed with sepsis or septic shock were found to face a higher risk of mortality, as reported in the literature, particularly (25). However, conflicting results were observed in another study, where the association was deemed insignificant (24).…”

“…Sedation was also mentioned as a significant positive predictor of mortality in one study (24), and as a significant negative predictor in another one study (25); thus, the AOR ranges from 0.42 to 3.95. Finally, MODS has been identified as another relevant factor in mortality, with AORs ranging from 0.24 to 8.07 in two distinct studies (24,25).…”

“…Another critical determinant of mortality is the presence of sepsis or septic shock, as evidenced by AORs ranging from 1.938 to 7.4 in previous studies (11,24). Furthermore, a GCS level of ≤8 was identified as a predictor of mortality in two studies, with ORs ranging from 0.85 to 6.3 (12,(22)(23)(24)(25). Additionally, medical case admissions have shown a consistent association with mortality, with AORs ranging from 2.9 to 6.67 in two separate studies (22,25).…”

“…Furthermore, a GCS level of ≤8 was identified as a predictor of mortality in two studies, with ORs ranging from 0.85 to 6.3 (12,(22)(23)(24)(25). Additionally, medical case admissions have shown a consistent association with mortality, with AORs ranging from 2.9 to 6.67 in two separate studies (22,25). Sedation was also mentioned as a significant positive predictor of mortality in one study (24), and as a significant negative predictor in another one study (25); thus, the AOR ranges from 0.42 to 3.95.…”