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[Should mechanical ventilation be used in ICU patients in developing countries?].
P Durasnel1, P Gallet de Santerre, D Merzouki
1Faculté de Médecine de Strasbourg. philippe@durasnel.com
Medecine Tropicale : Revue Du Corps De Sante Colonial
|March 25, 2006
Summary
Mechanical ventilation (MV) in intensive care units (ICUs) in developing countries shows high in-hospital mortality but favorable long-term survival. Early diagnosis and risk assessment are crucial for effective MV management.
Area of Science:
- Critical Care Medicine
- Public Health
- Developing Country Health
Context:
- Monocentric prospective cohort study conducted in a 10-bed polyvalent ICU in the Comoros Islands.
- 106 patients requiring mechanical ventilation (MV) out of 633 ICU admissions over 10 months were analyzed.
- Assessed mortality and factors influencing outcomes in mechanically ventilated patients in a resource-limited setting.
Purpose:
- To evaluate mortality rates in intensive care unit (ICU) patients requiring mechanical ventilation (MV) for over 6 hours in a developing country.
- To identify factors associated with mortality in this patient population.
- To compare outcomes with those reported in developed countries.
Summary:
- In-hospital mortality was 59%, with higher rates linked to elevated Simplified Acute Physiology Score version 2 (SAPS II) and myorelaxant use.
- No correlation found between age, gender, admission reason, urgency, sedation, complications, or MV duration and mortality.
- Favorable prognosis associated with severe malaria, meningitis, eclampsia, and poisoning; all ICU survivors were alive at one year.
Impact:
- Mechanical ventilation is feasible and effective in developing countries, though it demands expertise and adaptability.
- Mortality rates for MV in developing countries are comparable to developed nations, potentially due to younger patients and reversible conditions.
- Emphasizes the importance of accurate diagnosis and risk stratification for initiating and discontinuing MV.