INTRODUCTION:
The unit dedicated to specialized care in the
hospital is the intensive care unit (ICU) or critical care unit (CCU) which
offers provision of care for patients that ill from critical conditions from
which they have potential for recovery.1,2 This entails closer
monitoring and better management than the care provided to patients in normal
admission wards and non-critically care units. 2 The goal of the ICU
is to prevent morbidity and mortality among patients who are at high risk
through the provision of critical care.1-5 The patients admitted in
the ICU are given more detailed observation, monitoring and treatment as
compared to other patients admitted to the standard lying-in wards.2,3
Researchers have observed that common
conditions managed at the ICU include severe neurological, cardiac and
respiratory diseases.2-4 In study conducted at the Enugu State
University Teaching Hospital out of the 179 patients admitted at the ICU over a
three-year period 49.9% were post-operative patients with 21.2% admitted from
the accident and emergency.1 There were 41.3% of medical cases,
43.3% were surgical cases and the rest were unspecified.1 out of the
surgical cases 19% were from general surgery, 18.4.% from obstetrics and
gynaecology and neurosurgery 16.8%.1 Cerebrovascular accidents and
traumatic brain injury were the most common specific diagnosis recorded in the
ICU admitted patients,1 The study revealed the mortality rate to be
34.1% which was related to patients age and type of illness.1
Similarly in a study conducted at the Benue University Teaching Hospital,
Nigeria reported post-laparotomy care 24.8% was the most frequent reason why patients
were admitted in the ICU followed by head injury 18.4% and burns 11.2%.1,3-4
Furthermore, in a study conducted in ICU at the University of Nigeria Teaching
Hospital, southeast was in agreement with previous study findings that
postoperative cases were the most common reason for ICU admission 49.3% and
traumatic brain injury was the leading cause of traumatic brain injury as
leading diagnosis 70.9%.5 In a research work by Eze et al in Abakaliki,
southeastern Nigeria in a review of ICU mortality revealed that acute abdomen
27.0%, traumatic/injury 24.7% and cerebrovascular accident 17.8% were the most
common reasons for admission.6
Scholars have shown that mortality
rates depend on myriad of factors which include patient demographic, population
characteristics, infrastructural availability, type of illness and quality of
ICU care plays a role in the clinical outcomes of patients.1,6 Researches
conducted in Africa reported mortality rates between 34-43%.5-8 When
compared to the developed countries are relatively higher than ICU mortalities
rates in USA (11.3%), France (18%), Australia and New Zealand (7%).9,10
There have been no studies on the
disease and mortality distribution in the ICU of the Rivers State University
(RSUTH), Nigeria. This study conducted to review disease distribution cases
admitted at the ICU of RSUTH. The goal of the study was to engage prospects of
patients’ management and reduce mortality.
Study design:
This was a one-year retrospective,
descriptive review of all patients admitted into the ICU of RSUTH, Port
Harcourt Nigeria from January 1, 2023 to December 31, 2023.
Study area:
This study was conducted in the general ICU
of RSUTH, Port Harcourt Nigeria Port Harcourt is capital of Rivers State
south-south Nigeria. The ICU is relatively built unit of the hospital.
The patients who are higher risk for
life-threatening conditions or organ failure are managed in the ICU for more
intensive care.
The ICU of RSUTH has a nine-beds
equipped with ventilators, suction machines, defibrillators, multi-parameter
monitors, infusion and syringe pumps The ICU of RSUTH is under the anaesthesia
department. Consultant anaesthetist as the Director, senior registrar from
anaesthesia department, 8 nurses and 12 interns monthly.
Data collection:
Data were retrieved from patients’ admission
and discharge registers including the age, sex, diagnosis, source of admission,
duration of admission and clinical outcome of all admissions between January 1,
2023 to December 31, 2023.
Data analysis:
Data were analysed using SPSS version 25.
Aim:
To determine the morbidities and mortalities
at ICU of the Rivers State University Teaching Hospital (RSUTH), Port Harcourt,
Nigeria.
RESULTS:
Ninety-seven subjects were evaluated for the
year under review. There were 38 (29.2%) males and 59 (60.8%) females. The age
range was 19 to 87 years with the modal age of 30 years. There were 44 (45.4%)
patients that had medically related conditions while 53 (54.6%) were surgically
related. The three most common cases managed at the ICU were cerebrovascular
disease 17 (17.5%), intestinal obstruction 10 (10.3%) and eclampsia 9 (9.3%).
There were 31 (31.9%) deaths, the commonest cause of death was cerebrovascular
disease 6 (6.2%).
Table 1:
Summary of results
|
Number Subjects
|
97
|
|
Males
|
38
|
|
Females
|
59
|
|
Age Range (years)
|
19 to 87
|
|
Modal age
|
30
|
|
Medically related conditions
|
44
|
|
Surgically related conditions
|
53
|
|
Mortality Rate
|
31.9
|
Table 2:
Sex Distributions
|
Sex
|
Number (n)
|
Percentage (%)
|
|
Male
|
38
|
29.2
|
|
Female
|
59
|
60.8
|
|
Total
|
97
|
100
|
Table 3:
Distribution of Patients into Medical or Surgical conditions
|
Distribution of Patients
|
Number (n)
|
Percentage (%)
|
|
Medical
|
44
|
45.4
|
|
Surgical
|
53
|
54.6
|
|
Total
|
97
|
100
|
Table 4:
Sex Distribution of Anaemia
|
Anaemia
|
Number (n)
|
Percentage (%)
|
|
Male Sex
|
7
|
7.2
|
|
Female
|
21
|
21.6
|
|
|
28
|
28.8
|
Table 5: Three most common morbidities
managed at ICU
|
Morbidity
|
Number (n)
|
Percentage (%)
|
|
cerebrovascular
disease
|
17
|
17.5
|
|
intestinal
obstruction
|
10
|
10.3
|
|
Eclampsia
|
9
|
9.9
|
Conflict
of interest:
Authors have
declared that there was no conflict of interest.
Acknowledgement:
Associate Professor
Eli Sukarime Executive Director research arm Mother, Baby and Adolescent Care
Global Foundation
Ethics:
Guidelines in line
with Helsinki’s declaration (revised 13th edition).
DISCUSSION
This study revealed the three commonest cases
managed at the ICU of RSUTH as cerebrovascular disease (17.5%) and a mortality
rate of 31.3% (tables 1and 5). This was in agreement with a study conducted at
the Enugu State University Teaching Hospital which showed that out of the 179
patients admitted at the ICU over a three-year period cerebrovascular accidents
and traumatic brain injury were the most common specific diagnosis recorded in
the ICU.1 The study revealed the mortality rate to be 34.1% which
was higher than the one in our study which was 31.3%.1
Contrarily to our study, in a research
work conducted at the Benue University Teaching Hospital, Nigeria reported
post-laparotomy care 24.8% as the most frequent reason why patients were
admitted in the ICU followed by head injury 18.4% and burns 11.2%.1,5
In a study conducted in ICU at the
University of Nigeria Teaching Hospital, southeast was not in agreement with
our study findings that postoperative cases were the most common reason for ICU
admission 49.3% and traumatic brain injury was the leading cause of traumatic
head injury.4 Traumatic brain injury accounted for approximately 70%
of ICU specific injuries.4
In a research work by Eze et al in
Abakaliki, southeastern Nigeria in a review of ICU mortality showed that cerebrovascular
accident 17.8% was the third most common reasons for admission.3 This
was also not in agreement with findings in our study.6
Researchers have revealed that
mortality rate at the ICU depends on myriad of factors such as
demographic, population
characteristics, infrastructural availability, type of illness and quality of
ICU care plays a role in the clinical outcomes of patients.1-4 In
the developing countries inclusive of African countries the mortality rates in
ICU ranges between 34-43%.5-8 This higher than that from our study
of 31.3%. However, for the developed countries the mortality rates are lower.5-7
ICU mortalities rates in USA (11.3%), France (18%), Australia and New Zealand
(7%).8-10
Our study revealed that out of the 97
cases managed at the ICU of RSUTH 54.6% were surgical while 45.4% were
medically related (table 3). This was in agreement with the study conducted at
the Enugu State University Teaching Hospital out of the 179 patients admitted
at the ICU over a three-year period there were 41.3% of medical cases, 43.3%
were surgical cases.1,7-10 The findings show that the proportion of
surgical cases were higher than the medical admissions at the ICU which
reflected same findings with ours,1-5
CONCLUSION:
This study revealed the three commonest
morbidities managed at the ICU of RSUTH were cerebrovascular disease,
intestinal obstruction and eclampsia. The mortalities at the ICU was 31.9%,
with majority from cerebrovascular disease. Early presentation and brainstorming
on critical care will reduce mortality.
This study will help review patients
prospects at the ICU of RSUTH and improve on future management.
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