Prospective one year mortality rate and the factors associated with mortality in the general intensive care unit at Mulago national referral hospital.
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Introduction Intensive care units usually admit critically ill patients for advanced organ supports. Admissions aim at achieving better outcomes than they would if patients were in lesser acuity areas of the hospital. This however comes at a huge cost to the hospital, and more importantly to the relatives of the patients. Despite the advances in care mortality in intensive care unit (ICU) remains high. This is due to a number of factors which include; severity of the patients’ illness, human resource constraints, lack of equipment and substandard care. These issues are magnified in the low income countries and probably worse in sub-Saharan Africa. This may explain why ICU mortality in low income countries is high. Methodology Upon institutional ethical approval and waiver of consent, we conducted a one year prospective study in the general ICU at Mulago national referral hospital. We sought to determine the one year mortality rate, determine the association of the admission vital signs (GCS, BP, and SPO2), trauma, surgery, mechanical ventilation, and length of stay in the ICU with mortality and to document the most common indications for admission. During the study period, all patients admitted to the unit were recruited into the study using consecutive sampling method. Patients’ files and charts were reviewed; information was extracted and filled into the study tool on admission and discharge from ICU. Data entry was done using EpiData 3.1. Univariate and bivariate data analysis was performed using STATA 12. Results Over one year, 240 patients were recruited. 131(54.6%) were aged 15 to 45 years, 73>45 year and 36< 15 years. 131(54.6%) were males and 109 females. 171(71.3%) were surgical and 69 medical. Of the surgical patients 68 (39.8%) were trauma, the rest non trauma. 115 (67.3%) were postoperative patients. 119(49.6%) were admitted for respiratory support and 88 (36.7%) for post operative high care. The overall mortality was 43.7%. Most deaths occurred in the evening (p=0.001), at night (p=0.001) and on weekends (p=0.001). High mortality was found among patients with diabetes mellitus, HIV, anaemia, sepsis, renal failure, CVA, head injury in that order, GCS <8 (p=0.001), and diastolic blood pressures < 60mmHg (p=0.001). Medical and mechanically ventilated patients had a high mortality (p=0.001), while the use of tracheotomy was associated with low mortality (p=0.001). Conclusion Mortality is high, especially among patients with HIV, anaemia, sepsis, renal failure, head injury and those mechanically ventilated. Most patients are admitted for respiratory support and post operative high care. Majority of the patients die in the evening, at night and on weekends. The unit is understaffed with only three specialists. The patient to nurse ratio of 3:1 is inadequate. The hospital needs to revise the ICU staffing, invest in human resource, develop and implement protocols for admission and management of critically ill patients and provide adequate and appropriate respiratory support equipment.