A cute respiratory failure at the accident and emergency Department Kenyatta National and Referral Hospital Nairobi, Kenya.

Abstract

Background: Acute respiratory failure (ARP) is a common presentation at the Accident and Emergency (A&E) department. Delay or failure to identify ARP can result in significant morbidity and mortality. Advances in assisted respiratory support and oxygen therapy for patients in ARF have had a positive impact on overall prognosis. The burden of ARP at the Kenyatta National Hospital (KNH) Accident and Emergency (A&E) department is unknown. Outcome in both short and long-terms in and out of hospital is unknown, too. Objective: The main objective of this study was to determine the prevalence of acute respiratory failure, identify the causes and document the outcome up to two weeks in hospital in patients presenting with acute dyspnoea to the A&E department of KNH. Methods: In this prospective descriptive study, all patients aged 13years or more, presenting to the A&E department, KNH with acute dyspnoea were screened for clinical as well as laboratory evidence of ARF by pulse oximetry and baseline arterial blood gas analysis (ABG). A chest radiograph was taken in all patients. Other tests were done as clinically indicated and all findings documented. The primary clinical diagnosis associated with the ARF was determined and documented. Patients were followed up by alternate day ABG till death/recovery or till the fourteenth day of hospitalization, whichever came earlier. The outcome was documented. Outcome Measures: Outcome events were either full recovery from ARF, persisting respiratory failure (acute evolving into chronic) or death. The time duration to each outcome was documented. Results: Thirteen thousand and three patients age 2: 13 years were seen at the Accident and Emergency department during the study period. Two hundred and eighty six of them presented in acute dyspnoea, and 83 were in ARF. The period prevalence of ARF was 0.6% (95% Cl, 0.47-0.73), Xl with 29.02% (95% Cl, 28.2-29.8) of all acutely dyspnoeic patients in ARF. Majority of patients (65.1%) were male. M: F ~ 2: 1. Most patients were young, with peak age as 31-40 years of age. Most patients presented with symptoms of S 2 days in duration, which was significantly associated with an adverse outcome (OR 4.135, p-value 0.003). Acute trauma was the commonest cause of ARF. Central causes of ARF were significantly associated with an adverse outcome. 65.1% Of all patients in ARF died within eight days of presentation. Most deaths occurred in the A&E department while awaiting lCU admission. Conclusion: Acute respiratory failure is common among patients presenting in acute dyspnoea, affecting younger patients. Trauma is the commonest cause of ARF. ARF is associated with a high mortality rate. Patients presenting in ARF due to central disorders and those with symptoms of S 2 days in duration are at the highest risk of mortality.