A pattern of admission and outcome of patients admitted to the intensive care unit of a tertiary hospital in a low resource setting: a cohort study

Abstract

Background: ICU is a specialized department designed to serve critical care for severely ill patients. It needs an adequate number of highly trained and skilled human power and costly materials, which has limited its number and functionality in low resource settings. As a result, intensive care medicine or critical care services are poorly developed, or at most, still in the infancy stage. Due to the multifactorial limitations, ICU treatment outcomes were lower compared to high-income countries from the limited available literature. The objective of this study was to depict ICU treatment patterns and patient outcomes at low resources and limited setup. Methods: A retrospective cohort study was conducted on patients admitted to ICU from January 2017 to 31 December 2020, on a sample of 420 cases using a systematic sampling technique. Patient data were collected from the medical record and filled into a prevalidated checklist from admission to discharge or death. Data were analyzed using a statistical package for social sciences version 25.0. Result: A total of 419 patients’ data was qualified for analysis with ICU mortality being 40.8%. The majority of the admissions to the ICU were from the surgical department followed by trauma admissions. Some of the factors significantly associated with ICU mortality were: vasopressor use during the course of ICU follow up adjusted odd ratio (aOR)=4.3 with 95% CI: 1.83–10.03, P-value <0.001, patients who were put on mechanical ventilator aOR=3.6 with 95% CI: 1.90–6.63, P-value <0.001, enteral feeding aOR=0.31 at 95% CI: 0.16–0.59, P-value <0.001and admissions from internal medicine aOR=4.2, 95% CI: 1.66–10.41, P-value=0.01. Conclusion: The pattern of ICU admissions in developing countries were characterized by surgical and trauma related, younger patients, and high mortality rate. Hypotension, being on mechanical ventilator, vasopressor use, and enteral feeding were some of the factors associated with ICU outcome.