OBJECTIVES:To identify the prevalence of over-assistance from mechanical ventilation (MV) and to assess whether reducing MV support could be done safely in neurosurgical ICU patients in terms of risk of under-assistance and brain’s oxygenation.DESIGN:Prospective observation study.SETTING:Neurosurgical trauma ICU, Toronto, ON, Canada.PATIENTS:Twenty-seven brain-injured patients on MV having indication of a spontaneous breathing trial (SBT).INTERVENTIONS:Level of pressure support ventilation (PSV).MEASUREMENTS AND MAIN RESULTS:In neurosurgical patients, regional ventilation distribution using electrical impedance tomography, patient’s respiratory drive (airway occlusion at 100 ms [P0.1]), respiratory muscle pressure (Pmus), diaphragm and parasternal intercostal (PI) thickening fraction, brain oximetry, and electroencephalogram were assessed at clinical PSV (ClinPS), low PSV (LowPS, pressure support [PS] 5 cm H2O, positive end-expiratory pressure [PEEP] 5 cm H2O), SBT, PS 0 cm H2O, and PEEP 0 cm H2O. Over-assistance was defined by pressure muscle index less than 0 cm H2O; under-assistance was defined as Pmus greater than or equal to 15 cm H2O. Mixed effects models were used for analysis. Imbalanced dorsal/ventral distribution of ventilation improved by reducing assistance while respiratory effort increased. Over-assistance was present in ten cases (37%) during ClinPS and in none at LowPS and SBT; under-assistance was present in two, four, and seven cases at ClinPS, LowPS, and SBT. During SBT, compliance and end-expiratory lung volume decreased (p < 0.0001). Brain activity did not vary. P0.1 greater than or equal to 4 cm H2O was associated with Pmus greater than or equal to 15 cm H2O with 80% sensitivity and 91% specificity during SBT.CONCLUSIONS:Neurosurgical patients seem to frequently be overassisted under PSV. Reducing the ventilatory support is often feasible and Pmus and P0.1 can help with detecting under-assistance.

Pendelluft and expiratory muscle activity during spontaneous breathing should be minimized to reduce potential harmful effects. This study aimed to describe pendelluft and expiratory muscle activity in hypoxemic patients recovering spontaneous breathing after ≥ 72h of lung-protective, fully controlled mechanical ventilation (MV) and assess the effect of pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP). A physiological, randomized crossover study was conducted in hypoxemic patients receiving three levels of PSV: 5, 10, and 15 cmH₂O, and two PEEP levels: based on electrical impedance tomography before spontaneous breathing (PEEPEIT) or according to PEEP-FiO2 tables (PEEPARDS). Pendelluft was defined as the percentage of volume displaced from non-dependent to dependent lung regions during inspiration. Expiratory muscle activity was assessed by the expiratory rise in gastric pressure (ΔPgaEXP), and inspiratory effort was estimated using muscular pressure (Pmus). Statistical analyses included linear mixed-effects models and mediation analyses. Fifteen patients were enrolled (mean PaO2/FiO2 ratio: 262 ± 51mmHg; median duration of MV: 9 [5-13] days; 6 females). PEEPEIT was 11 [10-13] cmH₂O and PEEPARDS 6 [5-7] cmH₂O. Expiratory muscle activity was observed in 13 patients. Compared to PS 5 cmH2O, PS to 10 and 15 cmH2O, adjusted for PEEP, significantly reduced both pendelluft and ΔPgaEXP (p < 0.001). When adjusted for PS, PEEPEIT was associated with a slight reduction in pendelluft (p = 0.039) but a concomitant increase in ΔPgaEXP (p = 0.007) compared to PEEPARDS. The mediation analysis revealed a significant negative mediating effect of ΔPgaEXP on the relationship between PEEPEIT and pendelluft (p < 0.001). Pmus, which was also significantly associated with pendelluft magnitude (p < 0.001), mediated the effect of PS on reducing pendelluft (p = 0.048), but not that of PEEP (p = 0.46). In patients with ARDS transitioning to spontaneous breathing, increasing PS reduces pendelluft and expiratory muscle activity. Higher PEEP can decrease pendelluft, but its effect can be counteracted by increased expiratory activity.

To review the current knowledge on mechanical ventilation after cardiac arrest, carefully balancing the protection of both the brain and the lungs. Although lung-protective ventilation (LPV) strategies are often considered in the general population and widely studied in acute respiratory distress syndrome (ARDS) patients, current knowledge focused on patients after cardiac arrest is unclear. Mechanical ventilation in this unique population should prevent potential brain injury while also avoiding ventilation-induced lung injury. This includes optimizing ventilation parameters, such as tidal volume ( VT ), positive end-expiratory pressure (PEEP), and gas exchange targets, while also considering the impact on cerebral perfusion and intracranial pressure. The role of LPV in patients without ARDS and after cardiac arrest is still uncertain. In this review, we updated the strategy to optimize mechanical ventilation after cardiac arrest with the primary aim of protecting the lungs and brain, improving the patients' outcomes.

An e-survey study on the practice of recruitment manoeuvres in dogs among board-certified veterinary anaesthesia and analgesia specialists.

Traumatic pneumothoraces occur in 25% of patients sustaining traumatic chest injury. Tube thoracostomy carries a risk of major complications leading to the necessity of tube thoracostomy insertion for traumatic pneumothoraces to be challenged. This meta-analysis analyses current evidence relating to the management of traumatic pneumothorax and synthesises the evidence to determine whether clinicians can safely omit tube thoracostomy in patients with traumatic pneumothorax presenting to the Emergency Department (ED). This meta-analysis was performed by searching electronic databases. Papers were included for analysis if they used patients sustaining blunt trauma and compared tube thoracostomy to conservative management. Comparisons were made for those undergoing tube thoracostomy and those undergoing conservative management. Fourteen studies comprising 1550 patients were included. There is a non-significant combined pneumothorax progression rate of 12% for those observed, and 7.6% for those with a tube thoracostomy (p = 0.8447) with an odds ratio of 1.33. There was an 11.9% rate for tube thoracostomy insertion among patients observed, and a 10.4% requirement for further tube thoracostomy placement in those already with a tube thoracostomy (p = 0.3436) with an odds ratio of 0.553. For patients receiving positive pressure ventilation, the rates were 18% in observed patients compared to 9% of those with a tube thoracostomy (p = 0.2848) with an odds ratio of 4.123. Conservative management of traumatic pneumothorax without positive pressure ventilation is a reasonable initial safe approach in the ED. Only ~12% of these patients will eventually require a tube thoracostomy.

Self-selected movement patterns during lateral locomotion with body weight support.

Electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration may optimize ventilation and reduce ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). We compared EIT-guided PEEP with low PEEP/FiO₂ strategy in patients with moderate-to-severe ARDS. In this randomized controlled trial, 108 patients with PaO₂/FiO₂ below 200mmHg were allocated to EIT-guided PEEP after a recruitment maneuver (n = 56) or low PEEP/FiO₂ strategy (n = 52). Patients in the EIT group underwent PEEP titration guided by the intersection point between alveolar overdistension and collapse during a decremental PEEP trial. Primary outcomes were oxygenation (PaO₂/FiO₂) and static compliance. Secondary outcomes included mortality, ventilator-free days, ICU stay, barotrauma, rescue therapies, and sequential organ failure assessment (SOFA) score changes. On day 1, oxygenation was higher with EIT (mean PaO₂/FiO₂ 180 vs. 159mmHg; p = 0.036). Static compliance was greater at both day 1 (26 vs. 23mL/cmH₂O; p = 0.016) and day 2 (27 vs. 24mL/cmH₂O; p = 0.029). Driving pressure was lower with EIT at day 1 (16 vs. 17 cmH₂O; p < 0.001) and day 2 (15 vs. 17 cmH₂O; p = 0.005). SOFA scores improved more in the EIT group (day 1: - 1 vs. 0, p = 0.013; day 2: - 1 vs. - 0.5, p = 0.015). Twenty-eight-day mortality was lower with EIT (29 vs. 44%), although not statistically significant (p = 0.090). ICU stay, ventilation duration, barotrauma, ECMO use, and rescue therapies were similar. Benefits were most pronounced in patients with severe ARDS. EIT-guided PEEP improved oxygenation, lung mechanics, and reduced organ dysfunction in moderate-to-severe ARDS, particularly in severe cases. It showed a trend toward reduced mortality and may serve as a practical bedside tool for lung-protective ventilation. Larger multicenter trials are needed to confirm its clinical benefits.Trial registration: ClinicalTrials, NCT06733168. Registered on 13/12/2024, https://clinicaltrials.gov/study/NCT06733168.

ABSTRACT This paper provides the net wind pressures on a series of curved open canopy (i.e. free) roofs. Net wind pressures acting across the roof were obtained by testing two 1/50 scale model configurations in a boundary layer wind tunnel. Design data for such structures are not readily available in codes and standards. The paper determines net pressure coefficients across taps on the top and bottom surfaces of the roofs. Large net negative (outward) and positive (inward) pressures were measured at the leading edges. Net aerodynamic shape factors C shp,n are given in a form appropriate for the Australian/New Zealand wind loading standard, AS/NZS 1170.2:2021 to obtain loads for the design of cladding and the supporting structure.

Rare-earth orthotantalate, DyTaO4is a technologically important material having unique combination of optical transparency, high dielectric constant and thermal robustness. In this study, we report the synthesis and ambient structural characterization of bothM- andM'-type monoclinic phases of DyTaO4. The high pressure (HP) behaviour ofM-type (fergusonite) phase was investigated using synchrotron-based x-ray diffraction (XRD) and Raman spectroscopy up to ∼28 GPa and 38 GPa respectively. Signature of pressure-induced structural phase transition was observed near 24 GPa, marked by changes in both diffraction patterns and vibrational spectra. First-principles density functional theory calculations predict a transition to a tetragonal structure (space group (SG)P4/nbm) near 15 GPa from ambient pressure monoclinic structure (SGI2/a). The XRD data and theoretical simulations for low pressure (LP) phase shows anisotropic lattice compression being largest forbaxis followed byaandcaxis as has been reported for other isostructural compounds in the series. We also present the experimental and simulated values of bulk modulus forMphase. The positive pressure coefficient for all the Raman modes in LP phase indicates the dynamical stability of the compound up to 24 GPa. Additionally, Grüneisen parameters are reported for several Raman-active modes to understand the vibrational response of the material under pressure. These results provide new insights into the HP structural evolution of DyTaO4and contribute to the broader understanding of pressure-induced phenomena in rare-earth orthotantalates.

Resonant Breathwork is proposed as a layered, measurable intervention that modulates vagal activity and interoceptive processing through acoustic vocalization, respiratory mechanics, and biofeedback. This review synthesizes human empirical studies from 2022–2025 across five domains: (1) noninvasive transcutaneous auricular vagus nerve stimulation and acoustic or vocal vagal engagement; (2) interoception targets modulated by breathing; (3) respiratory rehabilitation tools, including oscillatory positive expiratory pressure and inspiratory muscle training; (4) virtual or augmented reality breath biofeedback; and (5) neuroimaging of high ventilation breathwork with music. Evidence shows taVNS can acutely increase vagal indices, with effects contingent on frequency and pulse width, while paced humming or singing near 0.1 Hz enhances respiratory sinus arrhythmia and positive affect. Breathing phase shapes perception and neural excitability; exhalation weighting and slow pacing amplify heartbeat evoked potentials and attention to internal signals. OPEP improves airway clearance and symptoms, and inspiratory training increases inspiratory strength with shifts toward parasympathetic balance, suggesting autonomic co benefits beyond pulmonary gains. XR delivery yields physiologic outcomes comparable to non XR biofeedback but improves engagement and transfer in stress laden contexts. Neuroimaging during high ventilation plus music reveals reduced perfusion in interoceptive cortex and increased perfusion in limbic regions alongside sympathetic activation and post session emotional relief. Findings align with a testable framework in which acoustic resonance, mechanical load, and feedback guided timing jointly modulate vagal efference and interoceptive circuitry, with translational potential for neurodivergent and post viral dysautonomia.

BackgroundMechanical ventilation in bariatric surgery presents unique challenges, requiring strategies that minimize intraoperative atelectasis, maintain adequate oxygenation, and lower the risk of postoperative pulmonary complications. The present study compared driving pressure–guided ventilation with conventional lung-protective ventilation in morbidly obese patients undergoing laparoscopic bariatric surgery.MethodsSixty patients with a body mass index (BMI) of 40–50 kg/m², scheduled for laparoscopic bariatric surgery, were randomized according to intraoperative ventilation strategy into two groups: Group I (n = 30) received the conventional lung-protective strategy, and Group II (n = 30) received the driving pressure–guided ventilation strategy. After induction of pneumoperitoneum, a standardized lung recruitment maneuver was performed, after which ventilation strategies were applied according to group allocation: in Group I, positive end-expiratory pressure (PEEP) was maintained at 5 cmH₂O throughout surgery, whereas in Group II, PEEP was individualized to achieve the lowest driving pressure (DP).ResultsThe PaO₂/FiO₂ ratio showed significant improvement after the recruitment maneuver in both groups compared with baseline values. However, measurements obtained before the end of surgery and after extubation were significantly higher in Group II than in Group I (P < 0.001). Lung mechanics were also significantly better in Group II, with higher compliance, lower driving pressure, and reduced plateau pressure (Pplat). Intraoperative hypoxia requiring rescue therapy occurred in 10 patients (33.3%) in Group I compared with 2 patients (6.7%) in Group II, while postoperative hypoxia requiring supplementary oxygen was observed in 7 patients (23.3%) in Group I and in none of the patients in Group II.ConclusionThe adoption of driving pressure–based ventilation in laparoscopic bariatric surgery for morbidly obese patients was associated with improved oxygenation, optimized lung mechanics, and a lower risk of postoperative hypoxemia.Trial registrationThe trial was registered prior to patient enrolment at ClinicalTrials.gov (NCT04861168, Date of registration: 27/4/2021).

Effect of High Positive End-Expiratory Pressure on Perioperative Atelectasis in Neonates and Small Infants (0-6 months) with Healthy Lungs: A Randomized Controlled Trial.

Small animal experiments are essential in biomedical research, particularly for preclinical investigations. These experiments frequently require mechanical ventilation, but the market offers expensive and functionally limited ventilators. To address this, we developed a cost-effective multi-mode ventilator using commercially available components. Our ventilator utilizes a microcontroller as the primary processing unit, receiving settings from a computer interface. The microcontroller synchronizes five valves to control inspiration and expiration of breathing cycles while managing airflow via piston pumps to generate the required tidal volume. This ensures precise breath regulation in terms of controlling the desired pressure-volume schematic in small animal respiratory systems. Positive end-expiratory pressure is manually adjustable. The system emulates conventional profiles like Volume Control Ventilation and Pressure Control Ventilation, while offering customizable inspiration and expiration patterns (sinusoidal, linear, and exponential). Operating specifications include tidal volumes of 1-15 ml and respiratory rates up to 120 breaths per minute. This versatile system provides customizable ventilation profiles with precise inspiration-expiration cycle synchronization, enabling tailored experimental conditions. Its cost-effectiveness makes it accessible to a broader range of researchers. This system marks a significant advancement in small animal research by offering precise and flexible ventilation strategies that enhance experimental accuracy and contribute to improved research outcomes.

Impact of pneumothorax on clinical course of patients with amyotrophic lateral sclerosis on long-term ventilation.

This study analyzes post-suppression ventilation strategies in a simulated 70 m 2 residential unit within a firefighter training environment, utilizing training fuels. It compares five tactical approaches: ventilation-controlled, ventilation by using thermal buoyancy, positive pressure ventilation (PPV), and hydraulic ventilation with single and dual openings. Results demonstrate that tactical ventilation significantly outperformed ventilation-controlled strategies. While positive pressure ventilation achieved superior temperature reduction (25.49% at 1.7 m height), it caused temporary CO increases and visibility loss due to turbulence. Hydraulic ventilation with dual openings proved most effective overall, delivering the highest visibility category and 44.71% CO reduction while maintaining clear smoke extraction. These findings offer evidence-based guidance for fire services to refine their post-suppression protocols, ultimately enhancing firefighter safety and improving survival outcomes in residential fires.

Differences in mechanical ventilation strategies between patients with and without acute brain injury (ABI) remain incompletely characterized. We aimed to compare ventilation approaches in patients with and without ABI over a 10-year period and to investigate impacts of practice changes on Pao2 and Paco2. Retrospective registry-based cohort study involving prospectively collected data from nine ICUs across Toronto, Ontario, Canada. Adult patients (≥ 18 yr) receiving invasive ventilation for at least 48 hours from 2014 to 2023 were included. Patients were classified as having ABI (exposure) or non-ABI (comparator) conditions. Between-group differences in tidal volume (Vt), positive end-expiratory pressure (PEEP), Paco2, and Pao2 were summarized using adjusted linear mixed-effects regression. Six additional ventilation and gas exchange variables were evaluated in unadjusted analyses. None. Thirteen thousand nine hundred twenty-five patients were included. Mean age (sd) was 59.1 years (17.5 yr), 38.1% of patients (n = 5305) were female, and 25.2% had ABI (n = 3503). Over the first 7 ventilation days, Vt was comparable between groups, with a daily median close to 6 mL/kg (interquartile range, 6-7 mL/kg) predicted body weight. PEEP was significantly lower in patients with ABI (median 5 vs. 8 cm H2O in non-ABI patients; p < 0.001). Among patients with hypoxemic respiratory failure, PEEP remained significantly lower in the ABI subset. From 2014 to 2023, Vt decreased slightly in both groups, while PEEP remained unchanged. Paco2 was largely maintained within 35-45 mm Hg in ABI patients and Pao2 remained largely within 80-120 mm Hg. Differences in six additional ventilation parameters between groups were minimal. Both ABI and non-ABI patients received comparable Vt that trended downwards over time. Paco2 and Pao2 remained largely within guideline-recommended ranges. However, PEEP was significantly lower in ABI patients, including among those with hypoxemic respiratory failure, highlighting potential opportunities to improve PEEP application in relevant subsets.

The effect of flow-controlled ventilation (FCV) as compared with volume-controlled ventilation (VCV) on oxygenation and respiratory system mechanics in patients undergoing one-lung ventilation (OLV) is unknown. To test the hypothesis that FCV would improve oxygenation and respiratory system mechanics compared with VCV during OLV. Two-centre, two-arm, randomised controlled clinical trial. University hospital and speciality hospital for pulmonary diseases in Germany. A total of 78 thoracic surgery patients undergoing OLV for more than 30 min. Patients were randomly assigned to OLV with FCV (n = 39), or VCV (n = 39). In both groups, OLV was conducted with tidal volume of 5 ml kg-1, positive end-expiratory pressure of 5 cmH2O, respiratory rate to normocapnia, and inspiratory oxygen fraction of 1.0. The primary outcome was the arterial partial pressure of oxygen (PaO2) 20 min after initiation of OLV. The secondary outcomes included respiratory system mechanics, the need for rescue due to hypoxaemia, and clinical outcome variables. The partial pressure of arterial oxygen did not differ between FCV and VCV at 20 min after starting OLV (PaO2: 24.8 ± 14.8 kPa vs. 26.1 ± 15.9 kPa, mean difference -1.2 (95% confidence interval -8.2 to 5.7), P = 0.721), while mechanical power was lower during FCV compared with VCV. Other variables did not differ at any time thereafter, except for the compliance of the respiratory system at end of surgery. The need for rescue manoeuvres due to hypoxemia or hypercapnia during OLV did not differ between the groups. The incidence of postoperative pulmonary and extrapulmonary complications, as well as the number of hospital-free days at day 30 after surgery, did not differ between FCV and VCV. Compared with VCV in thoracic surgery patients, FCV did not improve oxygenation or respiratory system mechanics during OLV, nor was it associated with improved outcomes.

We aimed to assess the prognostic performance of different indexes of oxygenation, respiratory mechanics and ventilation intensity in predicting 90-day mortality, and to estimate their independent associations, in a "real world" observational cohort of acute respiratory distress syndrome (ARDS) patients on ICU mortality. This is a secondary analysis of the "Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure" (LUNG SAFE), an international prospective cohort study of patients with severe respiratory failure involving 459 Intensive Care Units (ICUs) from 50 countries. We evaluated prognostic performance of oxygenation (PaO2/FiO2), respiratory mechanics (normalized elastance) and ventilation intensity (plateau pressure, driving pressure (DP); 4DP+RR and mechanical power (MP)) measured on day 1 of controlled mechanical ventilation in ARDS patients, with respect to ICU mortality within 90 days of admission. For each parameter, associations with mortality were assessed using logistic regression models, estimating effect sizes (odds ratios, OR with 95% confidence interval, CI), model discrimination (area under the ROC curve), calibration, and overall predictive accuracy. Among 2813 early ARDS patients, 516 (18.3%) met inclusion criteria: mean age 60 years (±16), 61% male. Normalized elastance, plateau, DP and 4DP+RR were significantly associated with mortality, with adjusted ORs ranging from 1.02 (95%CI 1.01-1.03) for 4DP+RR to 1.48 (95%CI 1.15-1.95) for normalized elastance. These parameters showed higher predictive accuracy for mortality compared to PaO2/FiO2 and MP. MP showed a U-shaped relationship with mortality abut it was not significantly associated with it. Its predictive accuracy decreased after accounting for positive end-expiratory pressure (PEEP) and dynamic resistance, with PEEP also demonstrating a U-shaped association with mortality. Normalized elastance, DP and 4DP+RR-measured at day1 of ARDS-were best predictors of ICU mortality, and outperformed oxygenation and MP. DP showed the best balance between predictive accuracy and clinical simplicity. These results reinforce the importance of focusing on DP and 4DP+RR as key metrics to guide lung-protective strategies and ARDS severity classification.

Objective Carbon monoxide (CO) poisoning impairs oxygen transport by forming carboxyhemoglobin (COHb). Normobaric oxygen (NBO) is standard therapy, but its COHb elimination rate is slow. This study compared the effectiveness of NBO, NIMV, and EzPAP in reducing COHb levels in acute CO poisoning. Materials and methods This prospective cohort study included patients with acute CO poisoning in an emergency department. Participants received one of three treatment modalities: standard NBO therapy, NIMV with positive pressure support, or the EzPAP system. COHb levels were recorded at baseline, 30 min, and 60 min after initiation of therapy. The primary outcome was the change in COHb concentration over time. Results and discussion A total of 66 patients were included in the study (NIMV: n = 29, EzPAP: n = 18, and NBO: n = 19). Significant differences were observed in symptom distribution, with headache more frequent in the EzPAP and NBO groups and dyspnea more common in NIMV and EzPAP groups (p < 0.001). Baseline COHb levels did not differ between groups (p = 0.849). At 30 and 60 min, NIMV achieved significantly greater COHb reduction compared to NBO (p < 0.001), while EzPAP showed superiority over NBO at 60 min (p = 0.031). Pairwise analyses indicated NIMV was also superior to EzPAP at 60 min (p = 0.003). Conclusions While NBO remains the standard therapy, this study suggests NIMV – and to a lesser extent, EzPAP – may serve as effective adjuncts in the management of CO poisoning. These findings provide a rationale for further randomized controlled trials.

IntroductionTimely admission and treatment of critically ill patients to Intensive Care Units (ICU) is shown to reduce premature mortality. However, low- and middle-income countries face many challenges in providing ICU services. This study describes the profile of patients admitted to ICU and their outcomes at the Central Regional Referral Hospital in Bhutan.MethodThis was an observational study with a review of records of patients from 2021 to 2023. The data were extracted into a pro forma, entered into EpiData Entry 3.1, and analysed in STATA 18.ResultsThere were 287 patients admitted to the ICU. The mean age was 56.53 (SD ± 19.18) years). The highest number of cases were admitted from the Emergency Department (117, 40.77%) and Medicine Department (50, 17.42%). The common indications for admissions were pulmonary disease (91, 31.70%), sepsis/infection (61, 21.25%), cardiovascular diseases (48, 16.72%), and cerebrovascular diseases (38, 13.24%). There were 140 (48.78%) patients who received mechanical ventilation, 27 (9.41%) required positive pressure airway support, 36 patients (12.54%) had central venous access insertion, and 19 patients (6.62%) had haemodialysis line insertion. The mortality rate was 51.22% (147/287 patients); the most common causes of mortality were septic shock (22, 14.97%), stroke (16, 10.88%), and pneumonia (14, 9.52%). Patients with chronic liver disease (adjusted OR 4.32, 95% CI 1.84–10.09, p = 0.001), and those receiving Ceftriaxone (adjusted OR 2.57, 95% CI 1.31–5.03, p = 0.006), Piperacillin-Tazobactam (adjusted OR 2.63, 95% CI 1.02–6.77, p = 0.045), and Cefazolin (adjusted OR 7.57, 95% CI 1.26–44.16, p = 0.026) had higher odds of mortality. Patients receiving Doxycycline (adjusted OR 0.49, 05% CI 0.25–0.96, p = 0.036) had lower odds of mortality.ConclusionAbout half of patients admitted to the ICU ended in mortality and the most common cause was septic shock. This study provides a baseline understanding of critical care service delivery in a resource-limited setting.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13637-1.