The burden of respiratory failure among patients admitted in the medical wards at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Respiratory failure (RF) is a major problem globally with significant morbidity and mortality. It accounts for approximately 56% of all ICU admissions in Europe with at least 40% mortality. World Health Organization estimates the burden of RF in Sub- Saharan Africa (SSA) at 1.6 -2.4 M cases per year. The cost of RF to society is enormous in terms of lost productivity, shortened lives and cost of care since it requires ICU. In SSA, no specific studies have been published on epidemiology of RF and its burden in terms of cost & mortality. Most studies focus on etiologies of RF, making it difficult to anticipate and plan for the management of patients with RF since the extent of the problem is unknown. This study focuses on the gaps that exist in the epidemiology of RF and its burden in Moi Teaching and Referral Hospital (MTRH) and Kenya. Objectives: To determine the proportion, clinical characteristics and 30-day treatment outcomes of patients with respiratory failure in MTRH medical wards. Methods: A prospective study was done with a 30 day follow up. The study population was patients admitted in the MTRH medical wards between June and August 2018. Recruitment was done by consecutive sampling and patients followed up for 30 days to describe their clinical features and treatment outcomes. Data was collected using interviewer administered questionnaires. Continuous variables were summarized as means, medians, standard deviations & interquartile ranges while categorical variables were summarized as frequencies & percentages. Association between clinical characteristics and outcomes was tested using chi square and fisher’s exact test. Data was presented using tables, graphs & pie charts. Results: Pulse oxymetry was done on 1607 patients to identify those with hypoxemia (SPO2<92%) who were then subjected to arterial blood gas analysis to confirm the diagnosis of RF. A total of 217 patients with RF were enrolled. The proportion of RF among patients in MTRH medical wards was 13.5% (217), (95% CI 12.0, and 15.2). The mean age for the participants was 49.8 years. Hypoxemic RF accounted for 84.3% (183) while hypercapnic RF accounted for 15.7% (34). The commonest documented diagnosis was pneumonia at 24.4% (53) and the commonest comorbidity was renal disease at 13.4% (29). Parenchymal lung disease was the leading chest xray finding with consolidation being the commonest at 76% (165). Severity of illness was assessed by Simplified Acute Physiologic score where most patients had 15 – 35 points at 67.3% (149). Most patients received oxygenation in the general ward. Mortality was 23% (50) at 30 days and 54.8% (97) of those who survived had residual respiratory failure. Severity of illness was associated with mortality (p<0.0001). The median length of hospital stay was 11 days with an interquartile range of 7- 18 days. The median cost of treatment was USD 348 with an interquartile range of USD 229- 529. Conclusion: Respiratory failure is common in MTRH with a high morbidity and mortality. Recommendation: There is need to improve capacity to manage RF in MTRH by doing arterial blood gas analysis for patients with low oxygen saturations, performing severity of illness scores and establishing a medical ICU.