Clinical Outcome of Patients Admitted to Critical Care Unit in Karnali Province

Abstract

Background: Life-threatening illnesses are rising globally, disproportionately affecting patients from developing countries. The outcome of such illness depends on the critical care services provided to the patients. Constrained resources may impact the quality and outcome of critical care. This study aims to assess the outcomes of critically ill patients admitted to the Intensive Care Unit (ICU) of a hospital in remote Karnali Province of Nepal
Methods: This retrospective observational study reviewed data of ICU patients admitted from July 2021 to July 2022 in Province Hospital, Karnali, Nepal. Analysis included data on socio-demographic information, clinical diagnosis, duration of stay in ICU, use of mechanical ventilator, and outcomes of patient admitted to the ICU.
Results: A total of 745 patients were admitted within the specified time period. The most common diagnoses were chronic obstructive pulmonary disease (COPD), poisoning, and acute coronary syndrome(ACS). Non-communicable diseases accounted for 60% of admissions. Overall, 17% of patients received support via mechanical ventilation. 50% of patients admitted in the ICU were recovered. The ICU mortality rate was 22 %, whereas 23% left the ICU against the medical advice. Age (p<0.001), ventilator use (p<0.001), and source of admission(p<0.001) were significantly associated with death in the ICU. Though the mortality rate varied significantly across diagnoses, septic shock and COPD attributed to the highest mortality.
Conclusions: Non-communicable diseases were the most common cause of admission to the ICU of the hospital. Half of the ICU patients had poor outcomes, with one out of four succumbing to death. Factors like suboptimal speciality services and equipments, poor infrastructure development, and poor human resources might have contributed to poor outcomes in such settings.
Keywords: Critical care; intensive care; mortality; prognosis; pulmonary disease chronic obstructive.