Survival and predictors of mortality among patients admitted to the intensive care units in southern Ethiopia: A multi-center cohort study

Factors associated with good death for end-of-life patients in the intensive care unit based on nurses' perspectives: A systematic review

BACKGROUND

Ensuring a good death in the intensive care unit (ICU) is crucial due to high global mortality rates. Despite the central role of nurses in end-of-life care, existing reviews often focus on patients or families and overlook nurses' perspectives.

OBJECTIVES

This study aims to investigate the factors associated with a good death for end-of-life patients in the ICU based on nurses' perspectives by systematically summarizing current evidence.

METHODS

The researchers utilized a systematic review followed the PRISMA 2020 guidelines and was registered with PROSPERO. Databases searched included Scopus, ProQuest, PubMed, ScienceDirect, EBSCOhost, and Google Scholar. Inclusion criteria covered English-language quantitative studies published from the inception until February 20, 2024, that reported factors influencing a good death from the perspective of ICU nurses, and were available in full text. The exclusion criteria included studies with mixed participants if separate analyses for nurses were not provided. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies, and a narrative synthesis was performed.

RESULTS

Five high-quality studies were included, involving 1,654 ICU nurses with an average age between 28.64 and 41.40 years, predominantly female (54.8 % to 91 %). Identified factors included nurses' personal factors, nurses' job characteristics, nurses' clinical competence in end-of-life care, and process of healthcare.

CONCLUSIONS

The review highlights the vital factor influencing a good death from ICU nurses' perspectives. Awareness of personal and job-related factors, along with enhanced clinical competence in end-of-life care, are essential for supporting patients to achieve a good death.

IMPLICATIONS FOR CLINICAL PRACTICE

ICU nurses can enhance their clinical competence in end-of-life care. Hospital managers should take into account nurses' work experience when assigning staff and consider implementing fixed shifts. Future research should explore these factors globally and develop interventions to support a good death in the ICU.

Incidence and predictors of mortality among patients admitted to adult intensive care unit at public hospitals in Western Ethiopia: a retrospective cohort study

Introduction

In resource-constrained countries, the incidence of mortality among patients admitted to adult intensive care units is higher than that in developed countries, which has a physical, economic, and emotional impact on the lives of patients and their families. However, there is limited evidence on factors related to nursing care that can potentially contribute to predicting and reducing mortality rates in intensive care units. Therefore, this study aimed to assess the incidence of mortality and its predictors in patients admitted to an adult intensive care unit.

Methods

A retrospective cohort study was conducted among 403 patients admitted to the adult intensive care unit from 1 January 2021 to 31 December 2021. The collected data were entered into Epi Data Manager v4.6.0.6 and exported to SPSS version 24 for analysis. Binary logistic regression was used to identify the predictors of mortality. Variables with a p-value less than 0.25 in bivariable logistic regression were selected for multivariable logistic regression. A p-value <0.05 was used to indicate a significant association in multivariable analysis. Finally, the adjusted relative risk (RR) with 95% CI was calculated.

Results

A total of 403 patients were included in the analysis. The cumulative incidence of death was 40.9% (95% CI 36, 45.9%). Mortality was significantly associated with the need for mechanical ventilation (adjusted RR = 1.45; 95% CI: 1.04, 1.85), the Glasgow Coma Scale score < 8 (adjusted RR, 3.52; 95% CI: 2.90, 4.05), presence of comorbidity (adjusted RR, 1.47; 95% CI: 1.09, 1.83), length of stay in ICU < 24 h (adjusted RR, 1.84; 95% CI: 1.37, 2.04), oxygen saturation level, and Feeding, Analgesia, Sedation, Thrombosis prophylaxis, Head elevation, Ulcer prophylaxis, and Glucose control (FASTHUG) treatment received were significantly associated with mortality.

Conclusion

The study found a high incidence proportion of death. The need for mechanical ventilation, length of stay, comorbidity, and the Glasgow Coma Scale score were significantly associated with mortality. Therefore, close monitoring and evaluation of patients are essential to improve treatment outcomes.

Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis

BACKGROUND

In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger's regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses.

RESULTS

In this systematic review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality.

CONCLUSION

Our review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.

Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study

Background

Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit.

Methods

A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant.

Results

The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction.

Conclusion and recommendation

The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.

Determinants of Mortality of Patients Admitted to the Intensive Care Unit at Debre Berhan Comprehensive Specialized Hospital: A Retrospective Cohort Study

Background

The provision of intensive care services is advancing globally. However, in resource-limited settings, it is lagging far behind and intensive care unit mortality is still higher due to various reasons. This study aimed to assess determinants of mortality among medical patients admitted to the intensive care unit.

Methods

A five-year facility-based retrospective Cohort Study was conducted. A total of 546 medical patients admitted to the intensive care unit from March 2017 to February 2022 were included. Document review using a structured questionnaire was implemented to collect data. Data entered into Epi Data were analyzed by STATA and summarized using frequency tables and graphs. Binary and multivariate logistic regression analyses were performed to identify determinants of mortality.

Results

The overall mortality was 35.9%. Approximately half of the deaths were attributed to septic shock, congestive heart failure, severe community-acquired pneumonia, and stroke. The most common immediate cause of death was cardio-respiratory arrest. Source of admission, GCS level at admission, duration of ICU stay, treatment with inotropes, septic shock, and retroviral infection status were found to have a statistically significant association with ICU mortality.

Conclusion and Recommendations

This study revealed a significantly higher mortality rate among patients admitted to the intensive care unit. Early identification and admission of patients to the intensive care unit are important factors that could decrease mortality. Patient selection is essential since some patients with a high likelihood of mortality might not benefit from intensive care unit admission in an area with high resource limitations.

Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study

BACKGROUND

The present study aimed to assess variables associated to ICU-mortality among patients admitted to surgical intensive care unit in Ethiopia.

METHODS

A Hospital-based retrospective follow-up study was conducted on all patients who were admitted to the surgical intensive care unit. Data were extracted from patients' charts with a pretested data extraction tool, entered into Epi-data 4.6.0, and analyzed with STATA- 14. Bivariate and multivariate Cox proportional hazards regression models were fitted.

RESULTS

Of the total study participants (388), 148 (38.1%) patients admitted to the surgical intensive care unit died during the follow-up period with a median survival time of 11 days. Potassium level < 3.5 mmol/L (adjusted hazard ratio ( AHR): 3.46, 95% CI (1.83 6.55), potassium level > 5.0 mmol/L (AHR:2.41, 95% CI (1.29-4.51), hypoxia (AHR:1.66, 95% CI (1.10-2.48), Glasgow Coma Scale (GCS) score < 9 (AHR: 4.06, 95% CI (1.51-10.89), mechanical ventilation (AHR:12, 95%CI (3-45), absence of thromboprophylaxis (AHR:10.8,95% CI (6.04-19.29), absence of enteral feeding (AHR:3.56, 95% CI (2.20-5.78) were variables associated with ICU-mortality among patients admitted to surgical intensive care unit.

CONCLUSIONS

The overall ICU-mortality of patients admitted to our surgical intensive care unit was higher compared to patients admitted to similar intensive care unit in developed countries. The variables associated to ICU-mortality among patients admitted to surgical intensive care unit were abnormal serum potassium level, lower GCS score, mechanical support, hypoxia, absence of thromboprophylaxis, and enteral feeding.

The magnitude of mortality and its predictors among adult patients admitted to the Intensive care unit in Amhara Regional State, Northwest Ethiopia

Despite mortality in intensive care units (ICU) being a global public health problem, it is higher in developing countries, including Ethiopia. However, insufficient evidence is established concerning mortality in the ICU and its predictors. This study aimed to assess the magnitude of ICU mortality and its predictors among patients at Tibebe Ghion specialized hospital, Northwest Ethiopia, 2021. A retrospective cross-sectional study was conducted from February 24th, 2019, to January 24th, 2021. Data were collected from medical records by using pretested structured data retrieval checklist. The collected data was entered into Epi-data version 3.1 and analyzed using R version 4.0 software. Descriptive statistics computed. A simple logistic analysis was run (at 95% CI and p-value < 0.05) to identify the determinants for ICU mortality. A total of 568 study participants' charts were reviewed. The median length of ICU stay was four days. Head trauma and shock were the leading causes of ICU admissions and mortality. The overall mortality rate of the ICU-admitted patients was 29.6% (95% CI: 26%, 33%). Admission in 2020 (AOR = 0.51; 95%CI: 0.31, 0.85), having altered mentation (AOR = 13.44; 95%CI: 5.77, 31.27), mechanical ventilation required at admission (AOR = 4.11; 95%CI: 2.63, 6.43), and stayed < 5 days in the ICU (AOR = 3.74; 95%CI: 2.31, 6.06) were significantly associated with ICU mortality. The magnitude of the ICU mortality rate was moderate. Years of admission, altered mentation, mechanical ventilation required at admission, and days of stay in the ICU were the predictors for ICU mortality. This finding underscores the importance of interventions to reduce ICU mortality.

A health systems approach to critical care delivery in low-resource settings: a narrative review

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.

Survival Status and Predictors of Mortality Among Patients Admitted to Pediatric Intensive Care Unit at Selected Tertiary Care Hospitals in Ethiopia: A Prospective Observational Study

Background

Advances in pediatric intensive care have dramatically improved the prognosis for critically ill patients. The study aimed to determine the survival status and predictors of mortality among patients admitted to the pediatric intensive care unit at selected tertiary care hospitals in Ethiopia.

Methods

A health facility-based prospective observational study from October 2020 to May 30, 2021, was conducted in a selected tertiary care hospital in Ethiopia. Kaplan Meier was used to compare patient survival experiences and Cox regression was used to identify independent predictors of ICU mortality. The hazard ratio was used as a measure of the strength of the association, and a P-value of <.05 was considered to declare statistical significance.

Results

Of 206 study participants, 59 (28.6%) patients died during follow-up time, and the incidence of mortality was 3.6 deaths per 100 person-day observation (95% CI: 2.04-5.04 deaths per 100 person-days). Respiratory failure 19 (32.2%) was the commonest cause of death followed by septic shock 11(18.6). In-ICU complications (AHR: 2.13; 95% CI: 1.02, 4.42; P = .04), sepsis diagnosis (AHR: 2.43; 95% CI: 1.24, 4.78; P = .01), GCS < 8 (AHR: 1.96; 95% CI: 1.12, 3.43; P = .02), use of sedative drugs (AHR: 2.40; 95% CI: 1.16, 4.95; P = .02) were linked with increased risk of in-ICU mortality. In contrast, the use of mechanical ventilation was associated with decreased mortality (AHR: 0.45; 95% CI: 0.21, 0.92; P = .03).

Conclusion

The study found a high incidence of in-ICU mortality among admitted pediatric patients in selected Ethiopian tertiary care hospitals. In-ICU complications, sepsis diagnosis, GCS < 8, and patient use of sedative drugs were independent predictors of in-ICU mortality. Prudent follow-up is warranted for those patients with the aforementioned risk factors.

Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia

BACKGROUND

Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units.

METHODS

Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan-Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively.

RESULT

The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients.

CONCLUSION

The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality.

Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis

BACKGROUND

The global mortality rate of patients with MV is very high, despite a significant variation worldwide. Previous studies conducted in Sub-Saharan Africa among ICU patients focused on the pattern of admission and the incidence of mortality. However, the body of evidence on the clinical outcomes among patients with MV is still uncertain.

OBJECTIVE

The objective of this study was to investigate the pattern of disease and determinants of mortality among patients receiving mechanical ventilation in Southern Ethiopia.

METHODS

Six hundred and thirty patients on mechanical ventilation were followed for 28 days, and multilevel analysis was used to account for the clustering effect of ICU care in the region.

RESULTS

The incidence of 28-day mortality among patients with MV was 49% (95% CI: 36-58). The multilevel multivariate analysis revealed that being diabetic, having GSC < 8, and night time admission (AOR = 7.4; 95% CI: 2.96-18.38), (AOR = 5.9; (5% CI: 3.23, 10.69), and (AOR = 2.5; 95% CI: 1.24, 5.05) were predictors.

CONCLUSION

The higher 28-day mortality among ICU patients on mechanical ventilation in our study might be attributed to factors such as delayed patient presentation, lack of resources, insufficient healthcare infrastructure, lack of trained staff, and financial constraints.

TRIAL REGISTRATION

The protocol was registered retrospectively on ( NCT05303831 ).

Prognostic Value of Antithrombin Activity Levels in the Early Phase of Intensive Care: A 2-Center Retrospective Cohort Study

To investigate the relationship between antithrombin (AT) activity level and prognosis in patients requiring intensive care. Patients whose AT activity was measured within 24 h of intensive care unit (ICU) admission were enrolled for analysis. The primary endpoint was mortality at discharge. Prognostic accuracy was examined using receiver operating characteristic (ROC) curves and cox hazard regression analysis. Patients were divided into 6 groups based on predicted mortality, and a χ2 independence test was performed on the prognostic value of AT activity for each predicted mortality; P < .05 was considered significant. A total of 281 cases were analyzed. AT activity was associated with mortality at discharge (AT% [interquartile range, IQR]): survivor group, 69 (56-86) versus nonsurvivor group, 56 (44-73), P = .0003). We found an increasing risk for mortality in both the lowest level of AT activity (<50%; hazard ratio [HR] 2.43, 95% confidence interval [CI] 1.20-4.89, P = .01) and the middle-low level of AT activity (≥ 50% and < 70%; HR 2.06, 95% CI 1.06-4.02, P = .03), compared with the normal AT activity level (≥ 70%). ROC curve analysis showed that the prediction accuracy of AT was an area under the curve (AUC) of 0.66 (cutoff 58%, sensitivity 61.4%, specificity 68.2%, P = .0003). AT activity was significantly prognostic in the group with 20% to 50% predicted mortality (AUC 0.74, sensitivity: 24.0%-55.5%, specificity: 83.3%-93.0%). An early decrease in AT activity level in ICU patients may be a predictor of mortality at discharge.

In-ICU Outcomes of Critically Ill Patients in a Reference Cameroonian Intensive Care Unit: A Retrospective Cohort Study

Introduction

Mortality rate amongst critically ill patients admitted to the intensive care unit (ICU) is disproportionately high in sub-Saharan African countries such as Cameroon. Identifying factors associated with higher in-ICU mortality guides more aggressive resuscitative measures to curb mortality, but the dearth of data on predictors of in-ICU mortality precludes this action. We aimed to determine predictors of in-ICU mortality in a major referral ICU in Cameroon. Methodology. This was a retrospective cohort study of all patients admitted to the ICU of Douala Laquintinie Hospital from 1st of March 2021 to 28th February 2022. We performed a multivariable analysis of sociodemographic, vital signs on admission, and other clinical and laboratory variables of patients discharged alive and dead from the ICU to control for confounding factors. Significance level was set at p < 0.05.

Results

Overall, the in-ICU mortality rate was 59.4% out of 662 ICU admissions. Factors independently associated with in-ICU mortality were deep coma (aOR = 0.48 (0.23-0.96), 95% CI, p = 0.043), and hypernatremia (>145 meq/L) (aOR = 0.39 (0.17-0.84) 95% CI, p = 0.022).

Conclusion

The in-ICU mortality rate in this major referral Cameroonian ICU is high. Six in 10 patients admitted to the ICU die. Patients were more likely to die if admitted with deep coma and high sodium levels in the blood.

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

Introduction

Despite mortality in intensive care units being a global burden, it is higher in low-resource countries, including Ethiopia. A sufficient number of evidence is not yet established regarding mortality in the intensive care unit and its determinants. This study intended to determine the prevalence of ICU mortality and its determinants in Ethiopia.

Methods

PubMed, Google Scholar, The Cochrane Library, HINARI, and African Journals Online (AJOL) databases were systematically explored for potentially eligible studies on mortality prevalence and determinants reported by studies done in Ethiopia. Using a Microsoft Excel spreadsheet, two reviewers independently screen, select, review, and extract data for further analysis using STATA/MP version 17. A meta-analysis using a random-effects model was performed to calculate the pooled prevalence and odds ratio with a 95% confidence interval. In addition, using study region and sample size, subgroup analysis was also performed.

Results

9799 potential articles were found after removing duplicates and screening for eligibility, 14 were reviewed. Ethiopia's pooled national prevalence of adult intensive care unit mortality was 39.70% (95% CI: 33.66, 45.74). Mechanical ventilation, length of staying more than two weeks, GCS below 9, and acute respiratory distress syndrome were major predictors of mortality in intensive care units of Ethiopia.

Conclusion

Mortality in adult ICU is high in Ethiopia. We strongly recommend that all health care professionals and other stakeholders should act to decrease the high mortality among critically ill patients in Ethiopia.

Admission and Mortality Patterns in Intensive Care Delivery at Enugu State University of Science and Technology Teaching Hospital: A Three-Year Retrospective Study

Background

The intensive care unit (ICU) provides critical care to high-risk patients to prevent morbidity and mortality. This requires closer monitoring and better management than the care provided to patients in normal admission wards and non-critical care units. Mortality rates in ICUs in developing countries are remarkably high compared to rates in more developed countries. Evaluating outcomes of treatment is a way to improve the quality of care. Therefore, this study was conducted to review the pattern of admission and outcome in the ICU of Enugu State University of Science and Technology Teaching Hospital (ESUT-TH).

Methodology

This study was a three-year retrospective, descriptive review of all patients admitted to the ICU of ESUT-TH between January 1, 2019, and December 21, 2021. Data were collected from admissions and discharge registers of the ICU ward. Data were analyzed and expressed as frequencies and percentages. Categorical parameters were compared using the chi-squared test, and the significance level was set at p < 0.05.

Results

A total of 179 patients were admitted in the three-year period. Of them, 49.2% were postoperative patients while 21.2% were admitted from the accident and emergency unit. There were a total of 74 (41.3%) medical cases and 81 (45.3%) surgical cases, and the rest were unspecified. Among surgical cases, 19% were from the general surgery department followed by obstetrics and gynecology (18.4%) and neurosurgery (16.8%). Cerebrovascular accidents and traumatic brain injury were the most common specific diagnoses recorded among ICU admitted patients. The most common reason for admission was close monitoring of high-risk patients. The mortality rate during the studied period was 34.1%, and this was significantly associated with patient age and type of illness at presentation (p < 0.05). Stratified by year of admission, the highest rate of mortality was noted in the year 2020 (46.7%).

Conclusion

There is a high level of mortality among ICU admissions in our center. This calls for the improvement of intensive care delivery in the healthcare facility, including training and retraining of manpower and provision of essential facilities for high-quality healthcare delivery.

Time to recovery and its predictors among critically ill patients on mechanical ventilation from intensive care unit in Ethiopia: a retrospective follow up study

Introduction

For critically ill patients, mechanical ventilation is considered a pillar of respiratory life support. The mortality of victims in intensive care units is high in resource-constrained Sub-Saharan African countries. The recovery and prognosis of mechanically ventilated victims are unknown, according to evidence. The goal of the study was to see how long critically ill patients on mechanical ventilation survived.

Methods

A retrospective follow-up study was conducted. A total of 376 study medical charts were reviewed. Data was collected through reviewing medical charts. Data was entered into Epi-data manager version 4.6.0.4 and analyzed through Stata version 16. Descriptive analysis was performed. Kaplan- Meier survival estimates and log rank tests were performed. Cox proportional hazard model was undertaken.

Results

Median recovery time was 15 days (IQR: 6–30) with a total recovery rate of 4.49 per 100 person-days. In cox proportional hazard regression, diagnosis category {AHR: 1.690, 95% CI: (1.150- 2.485)}, oxygen saturation {AHR: 1.600, 95% CI: (1.157- 2.211)}, presence of comorbidities {AHR: 1.774, 95% CI: (1.250–2.519)}, Glasgow coma scale {AHR: 2.451, 95% CI: (1.483- 4.051)}, and use of tracheostomy {AHR: 0.276, 95% CI: (0.180–0.422)} were statistically significant predictors.

Discussion

Based on the outcomes of this study, discussions with suggested possible reasons and its implications were provided.

Conclusion and Recommendations

Duration and recovery rate of patients on mechanical ventilation is less than expected of world health organization standard. Diagnosis category, oxygen saturation, comorbidities, Glasgow coma scale and use of tracheostomy were statistically significant predictors. Mechanical ventilation durations should be adjusted for chronic comorbidities, trauma, and use of tracheostomy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00689-3.

Intensive Care in Sub-Saharan Africa: A National Review of the Service Status in Ethiopia

BACKGROUND

The burden of critical illness in low-income countries is high and expected to rise. This has implications for wider public health measures including maternal mortality, deaths from communicable diseases, and the global burden of disease related to injury. There is a paucity of data pertaining to the provision of critical care in low-income countries. This study provides a review of critical care services in Ethiopia.

METHODS

Multicenter structured onsite surveys incorporating face-to-face interviews, narrative discussions, and on-site assessment were conducted at intensive care units (ICUs) in September 2020 to ascertain structure, organization, workforce, resources, and service capacity. The 12 recommended variables and classification criteria of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) taskforce criteria were utilized to provide an overview of service and service classification.

RESULTS

A total of 51 of 53 (96%) ICUs were included, representing 324 beds, for a population of 114 million; this corresponds to approximately 0.3 public ICU beds per 100,000 population. Services were concentrated in the capital Addis Ababa with 25% of bed capacity and 51% of critical care physicians. No ICU had piped oxygen. Only 33% (106) beds had all of the 3 basic recommended noninvasive monitoring devices (sphygmomanometer, pulse oximetry, and electrocardiography). There was limited capacity for ventilation (n = 189; 58%), invasive monitoring (n = 9; 3%), and renal dialysis (n = 4; 8%). Infection prevention and control strategies were lacking.

CONCLUSIONS

This study highlights major deficiencies in quantity, distribution, organization, and provision of intensive care in Ethiopia. Improvement efforts led by the Ministry of Health with input from the acute care workforce are an urgent priority.

Admission Pattern and Treatment Outcome in Pediatric Intensive Care Unit, Tertiary Hospital, Addis Ababa, Ethiopia

BACKGROUND

Knowledge of the clinical profile and outcomes of critically ill children admitted to Pediatric Intensive Care Unit (PICU) in developing countries aids with the identification of priorities and the resources needed to improve the outcome of critically ill patients. This study aimed to assess the admission pattern, outcomes, and associated factors of patients admitted to the PICU of St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

METHODS

Institutional-based cross-sectional study was done. Data was collected through chart abstraction from patients admitted to the PICU between January 2017 and December 2018. SPSS 20.0 was used to analyze the data. Descriptive statistics, cross-tabulations, and logistic regressions were used.

RESULTS

A total of 260 pediatric patients were analyzed. The mean age at admission was 48.13 ± 53.65 months, with M: F ratio of 1.4:1. The mean and median duration of PICU stay was 7.26 ±6.87 days, and 6.0 days respectively. The most commonly affected organ systems were the central nervous system (79, 33.2%) and respiratory system (55, 23.1%). Mechanical ventilation and admission after cardiopulmonary resuscitation (p < 0.001) were independent predictors of mortality. Infectious causes of illnesses were the leading causes of admission and death in the PICU.

CONCLUSION

The mortality rate of our PICU was 21.1 %. In this study, post-cardiopulmonary resuscitation admission and use of mechanical ventilation were statistically significant predictors of mortality indicating the need for well equipping and staffing the PICU to improve the outcome of such critically sick patients.

Patterns of presentation, prevalence and associated factors of mortality in ICU among adult patients during the pandemic of COVID 19: A retrospective cross-sectional study

Background

There is concern that patients admitted to the intensive care unit (ICU) with Corona Virus Disease 2019 (COVID-19) have variable prevalence reports of mortality. The survival rates are also inconsistently reported due to varying follow-up periods. Even if data on outcomes and baseline characteristics of ICU patients with COVID-19 is essential for action planning to manage complications, it is still left undisclosed in our study setting.

Materials and method

This cross-sectional study was conducted on 402 samples using a retrospective chart review of patient's data who were admitted in the past 2 years of the adult ICUs. All the data were entered and analyzed with SPSS version 21. A multivariable Logistic regression analysis was used to identify the association between outcome variables with independent factors and a p-value of less than 0.05 was taken as statistically significant with a 95% confidence interval. We used text, tables, and figures for the result.

Result

The overall prevalence of mortality among adult patients admitted to ICU during COVID-19 pandemics was 67.4%. From the multivariable logistic regression analysis, factors that were shown to have an association with an increase in ICU patient mortality were; lack of Vasopressor support, patients who had confirmed COVID 19 infection, core body temperature at admission greater than 37.5 °c, SPO2 at admission less than 90%, patients who had diagnosed ischemic heart disease (IHD), patients with acute respiratory distress syndrome (ARDS), patients who were intubated and mechanically ventilated (MV), and patient's ICU length of stay longer than two weeks.

Conclusion

The prevalence of ICU mortality in adult patients was higher in Debre Tabor Comprehensive specialized hospital. Therefore, clinicians need to minimize factors that maximize patient mortalities like ARDS, hyperthermia, Desaturation, Covid infection, IHD, intubation and MV, lack of Vasopressor use, and prolonged ICU stay.