The practice of mechanical ventilation in Kenyatta National Hospital intensive care unit

Abstract

This was a descriptive longitudinal study that was carried out in Kenyatta National Hospital intensive care unit between January and March 2007.The main objective of the study was to describe the pattern of ventilatory support to patients admitted in the ICU.Other objectives included the determination of diagnoses of mechanically ventilated patients ,the duration of ventilatory support, the weaning outcomes and micro organisms isolated from tracheal aspirates. The information obtained from the patients was filled in structured questionnaires by the principle investigator. Data analysis was done using the SPSS programme and standard statistical tests applied. The study revealed that most of the patients were males (64. 1%) with male to female ratio of 1.8:1.Head injuries accounted for almost a third (29.7%) of all patients admitted for mechanical ventilatory support.27.2% of the patients were referred from the District hospitals. Mechanical ventilatory support was delivered through translaryngel intubation in 80.5% of the patients. Half of the patients (50.6%) were successfully weaned from ventilatory support while 4.4% became ventilator dependent. Pseudomonas aeruginosa was the commonest micro organism isolated from tracheal aspirates and accounted for 19.8% of all tracheal aspirates that were done. The commonest complication was tube blockage/displacement (28.8%) while critical incidents were reported in almost a third of the patients (31. 1%) The study recommended that better utilization of Acute and Emergency department, intensive care rooms in medical and surgical wards and post anaesthetic care unit would reduce the number of referrals to the ICU.Clearly elaborated admission criteria for admission of patients for mechanical ventilation should be availed and a weaning protocol should be prepared and availed to all critical care teams.