Abstract
BackgroundMechanical ventilation is a resource intensive organ support treatment, and historical studies from low-resource settings had reported a high mortality. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting.MethodsWe prospectively studied the characteristics and outcomes (disease-related, mechanical ventilation-related, and process of care-related) in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012. Vital status of patients discharged from hospital was ascertained on Day 90 or later.ResultsMean age of the patients was 40 ± 17 years; 140 (51%) were men. Poisoning and envenomation accounted for 98 (41%) of 237 admissions. In total, 87 (37%) patients died in-hospital; 16 (7%) died after discharge; 115 (49%) were alive at 90-day assessment; and 19 (8%) were lost to follow-up. Weaning was attempted in 171 (72%) patients; most patients (78 of 99 [79%]) failing the first attempt could be weaned off. Prolonged mechanical ventilation was required in 20 (8%) patients. Adherence to head-end elevation and deep vein thrombosis prophylaxis were 164 (69%) and 147 (62%) respectively. Risk of nosocomial infections particularly ventilator-associated pneumonia was high (57.2 per 1,000 ventilator-days). Higher APACHE II score quartiles (adjusted HR [95% CI] quartile 2, 2.65 [1.19–5.89]; quartile 3, 2.98 [1.24–7.15]; quartile 4, 5.78 [2.45–13.60]), and new-onset organ failure (2.98 [1.94–4.56]) were independently associated with the risk of death. Patients with poisoning had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001). But, their mortality was significantly lower compared to the rest (24% vs. 44%; P = 0.002).ConclusionsThe case-mix considerably differs from other settings. Mortality in this low-resource setting is similar to high-resource settings. But, further improvements in care processes and prevention of nosocomial infections are required.
Highlights
We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting
We prospectively studied the characteristics and outcomes in 237 adults mechanically ventilated for a medical illness at a teaching hospital in southern India during February 2011 to August 2012
Mechanical Ventilation in a Low-Resource Setting had higher risk of reintubation (43% vs. 20%; P = 0.001) and ventilator-associated pneumonia (75% vs. 53%; P = 0.001)
Summary
Mechanical ventilation is an important organ support treatment given to patients admitted in intensive care units (ICUs). Apart from requiring specialised equipment and logistics, trained healthcare personnel are needed to provide care to mechanically ventilated patients Availability of all these elements is essential for effective care delivery. Despite the availability of mechanical ventilation services in the public- and private-run healthcare facilities in low-resource settings for more than three decades very few studies have systematically looked at the outcomes in unselected patient groups receiving mechanical ventilation in these settings To address this gap, we conducted the present study looking at the characteristics, care practices, 90-day survival, and factors influencing the latter in adults receiving mechanical ventilation for non-surgical illnesses at a teaching hospital in southern India. We aimed to study the outcomes in patients receiving mechanical ventilation in a contemporary low-resource setting
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
