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.