Functional characteristics of intensive care units in Uganda and their 28 day patient mortality- a multicenter prospective cohort study (#nct03511742).

Abstract

Background; Despite advances in critical care, the ICU mortality in Uganda remains high, with sepsis and trauma as the major contributors. There is paucity of literature regarding ICUs characteristics, disease burden and patient characteristics, which could be contributing to the high mortality. Our study aimed to describe the functional characteristics of the ICUs in Uganda and their 28-day mortality. Methods; We carried out a three months prospective cohort study in 12 ICUs in Uganda. We recruited all new patients admitted and followed them up for death/ discharge or up to a maximum of 28 days in the ICU. Data was collected onto two separate questionnaires, one for patient characteristics and the second for ICU functional characteristics. Results; Of the 12 ICUs studied, 50% were private, 25%PNFPS and the rest public. Majority of study ICUs were located in the urban area (83. 7%).We found a total of 75 ICU beds with only 55(73.3%) able to provide mechanical ventilation; these comprised 2.06% of the hospital beds. Closed and transitional models were the commonest operation models used at 41.7% and 33.3% respectively. Organ support and monitoring capabilities varied in the different ICUs, RRT (58.3%), blood gas analysis (66.7%) and capnography (58.3%), neonatal mechanical ventilation (50%). Overall mortality was 25.6% with a median length of stay of 3 days. Multivariate analysis using cox regression model demonstrated that mechanical ventilation HR 3.34 (95 CI, 1.48-7.52), sedation/paralysis HR 2.68 (95 CI, 1.39- 5.16), inotropes HR 3.17 (95 CI, 1.89 -5.29), HIV status HR 2.28 (95 CI, 1.14-4.56) and GCS HR 1.56 (95 CI, 0.90-2.71) were independently associated with ICU mortality. Increased LOS in ICU was protective for mortality HR 0.97(95 CI, 0.96-0.99). Conclusion; This study highlights the dire need for critical care services in the country and more so in the rural areas. Our overall mortality was 25.6% and mechanical ventilation, HIV, use of Inotropes and sedatives are statistically significant risk factors for mortality.