Time to recovery and its predictors among critically ill patients on mechanical ventilation from intensive care unit in Ethiopia: a retrospective follow up study

Abstract

Introduction: For critically ill patients, mechanical ventilation is considered a pillar of respiratory life support. The mortality of victims in intensive care units is high in resource-constrained Sub-Saharan African countries. The recovery and prognosis of mechanically ventilated victims are unknown, according to evidence. The goal of the study was to see how long critically ill patients on mechanical ventilation survived.

Methods: A retrospective follow-up study was conducted. A total of 376 study medical charts were reviewed. Data was collected through reviewing medical charts. Data was entered into Epi-data manager version 4.6.0.4 and analyzed through Stata version 16. Descriptive analysis was performed. Kaplan- Meier survival estimates and log rank tests were performed. Cox proportional hazard model was undertaken.

Results: Median recovery time was 15 days (IQR: 6-30) with a total recovery rate of 4.49 per 100 person-days. In cox proportional hazard regression, diagnosis category {AHR: 1.690, 95% CI: (1.150- 2.485)}, oxygen saturation {AHR: 1.600, 95% CI: (1.157- 2.211)}, presence of comorbidities {AHR: 1.774, 95% CI: (1.250-2.519)}, Glasgow coma scale {AHR: 2.451, 95% CI: (1.483- 4.051)}, and use of tracheostomy {AHR: 0.276, 95% CI: (0.180-0.422)} were statistically significant predictors.

Discussion: Based on the outcomes of this study, discussions with suggested possible reasons and its implications were provided.

Conclusion and recommendations: Duration and recovery rate of patients on mechanical ventilation is less than expected of world health organization standard. Diagnosis category, oxygen saturation, comorbidities, Glasgow coma scale and use of tracheostomy were statistically significant predictors. Mechanical ventilation durations should be adjusted for chronic comorbidities, trauma, and use of tracheostomy.

Keywords: Artificial respiration; Intensive care unit; Mechanical ventilation; Predictor; Recovery; Time.

Fig. 1

STROBE flow chart of critically ill patients on mechanical ventilation from intensive care unit at Dessie Comprehensive specialized, Ethiopia. (n = 376). actual subjects from identification till analysis stage Yellow shaded area on left: indicates stages of flow of chart. Unshaded area on right side: shows actual subjects from identification till analysis stage

Fig. 2

Kaplan–Meier survival estimate of recovery time of critically ill patients on mechanical ventilation from intensive care unit at Dessie Comprehensive specialized, Ethiopia, 2021. (n = 376). Horizontal axis (X): shows time of analysis in (days). Vertical axis (Y): indicates cumulative survival. Middle line (down ward) Survival function

Fig. 3

A. Kaplan–Meier survival estimate by oxygen saturation of study participants from intensive care unit at Dessie Comprehensive specialized, Ethiopia, 2021. (n = 376). B. Kaplan–Meier survival estimate by comorbidity of study participants from intensive care unit at Dessie Comprehensive specialized, Ethiopia, 2021. (n = 376). Horizontal axis (X): shows time of analysis in (days). Vertical axis (Y): indicates cumulative survival. Middle-blue line (down ward) Survival of oxygen saturation >  = 90%. Middle-red line (down ward) Survival of oxygen saturation < 90%. Middle-blue line (down ward): Survival of those having comorbidities. Middle-red line (down ward) Survival of those not having comorbidities

Fig. 4

Cumulative hazard of Cox-Snell residuals of study participants from intensive care unit at Dessie Comprehensive specialized, Ethiopia, 2021. (n = 376). Horizontal axis (X): shows Cox Snell residual. Vertical axis (Y): indicates Nelson Aalen cumulative hazard. Middle-blue line (Jagged) indicates Nelson Aalen cumulative hazard. Middle-red line (45o) Cox Snell residual