Debebe Finot, Goffi Alberto, Haile Tewodros, Alferid Fetiya, Estifanos Haimanot, Adhikari Neill K J
Addis Ababa University, Addis Ababa, Ethiopia.
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Crit Care Res Pract. 2022 Dec 8;2022:7797328. doi: 10.1155/2022/7797328. eCollection 2022.
Mechanical ventilation is a life-saving intervention for patients with critical illnesses, yet it is associated with higher mortality in resource-constrained settings. This study intended to determine factors associated with the mortality of mechanically ventilated adult intensive care unit (ICU) patients.
A one-year retrospective inception cohort study was conducted using manual chart review in ICU patients (age >13) admitted to Tikur Anbessa Specialized Hospital (Addis Ababa, Ethiopia) from September 2019 to September 2020; mechanically ventilated patients were followed to hospital discharge. Demographic, clinical, and outcome data were collected; logistic regression was used to determine mortality predictors in the ICU.
A total of 160 patients were included; 85/160 (53.1%) were females and the mean (SD) age was 38.9 (16.2) years. The commonest indication for ICU admission was a respiratory problem ( = 97/160, 60.7%). ICU and hospital mortality were 60.7% ( = 97/160) and 63.1% ( = 101/160), respectively. Coma (Glasgow Coma Score <8 or 7 with an endotracheal tube (7T)) (adjusted odds ratio [AOR] 6.3, 95% confidence interval 1.19-33.00), cardiovascular diagnosis (AOR 5.05 [1.80-14.15]), and a very low serum albumin level (<2 g/dl) (AOR 4.9 [1.73-13.93]) were independent predictors of mortality ( < 0.05). The most commonly observed complication was ICU acquired infection ( = 48, 30%).
ICU mortality in ventilated patients is high. Coma, a very low serum albumin level (<2 g/dl), and cardiovascular diagnosis were independent predictors of mortality. A multifaceted approach focused on developing and implementing context appropriate guidelines and improving skilled healthcare worker availability may prove effective in reducing mortality.
机械通气是危重病患者的一项挽救生命的干预措施，但在资源有限的环境中，它与较高的死亡率相关。本研究旨在确定与机械通气的成人重症监护病房（ICU）患者死亡率相关的因素。
采用人工病历审查的方式，对2019年9月至2020年9月入住提库尔·安贝萨专科医院（埃塞俄比亚亚的斯亚贝巴）的ICU患者（年龄>13岁）进行了为期一年的回顾性队列研究；对接受机械通气的患者进行随访直至出院。收集了人口统计学、临床和结局数据；采用逻辑回归确定ICU中的死亡率预测因素。
共纳入160例患者；85/160（53.1%）为女性，平均（标准差）年龄为38.9（16.2）岁。入住ICU最常见的指征是呼吸问题（=97/160，60.7%）。ICU死亡率和医院死亡率分别为60.7%（=97/160）和63.1%（=101/160）。昏迷（格拉斯哥昏迷评分<8或气管插管（7T）时评分为7）（调整优势比[AOR]6.3，95%置信区间1.19 - 33.00）、心血管疾病诊断（AOR 5.05[1.80 - 14.15]）以及极低的血清白蛋白水平（<2 g/dl）（AOR 4.9[1.73 - 13.93]）是死亡率的独立预测因素（<0.05）。最常见的并发症是ICU获得性感染（=48，30%）。
机械通气患者的ICU死亡率很高。昏迷、极低的血清白蛋白水平（<2 g/dl）和心血管疾病诊断是死亡率的独立预测因素。一种侧重于制定和实施适合当地情况的指南以及提高熟练医护人员可及性的多方面方法可能在降低死亡率方面被证明是有效的。
