Prolonged mechanical ventilation and its associated factors among adult patients admitted to intensive care unit in the teaching hospitals of Southern Ethiopia In 2023: a multicenter prospective cohort study

Abstract

Prolonged mechanical ventilation (PMV) is defined as the ventilation of critically ill patients for ≥ 21 consecutive days for at least six hours per day. It has resulted in increased morbidity and mortality in patients admitted to the intensive care unit (ICU) in addition to huge hospital budget consumption. Identifying its risk factors may help to improve the intensive care unit outcomes and optimize resource allocation. Therefore, this study aimed to determine the incidence of prolonged mechanical ventilation and its associated factors among adult patients admitted to intensive care units in southern Ethiopia, 2023. A multicenter prospective cohort study was conducted at ICUs in the teaching hospitals of southern Ethiopia among 390 adult patients mechanically ventilated for more than 24 h from February 2023 to October 2023.Binary logistic regression analysis was conducted to identify the factors associated with PMV. Multivariable logistic regression was fitted to determine the factors independently associated with PMV. In the final model, Adjusted Odds Ratio (AOR) and 95% confidence intervals (CI) were used to assess the strength of association and presence of statistical significance with a p-value of less than 5%. Out of 390 patients included in this study, the incidence of PMV was 33.3% (CI 95%: 28.7–38.5). The odds of experiencing PMV were significantly lower among patients who underwent early tracheostomy compared with those who received late tracheostomy, with an adjusted odds ratio (AOR) of 0.08 (95% CI: 0.02–0.32; p = 0.001). The patients with anemia (AOR: 18.3 (95% CI: 3.54–60.27; p = 0.001)), at least one comorbidity (AOR: 39.9, 95% CI: 9.30-86.16; p = 0.0001), and parenteral nutrition (AOR: 9.8, 95% CI: 2.22–43.16; p = 0.003) were significantly associated with PMV. Overall, this study found a high incidence of prolonged mechanical ventilation (PMV). Anemia, early tracheostomy, the presence of at least one comorbidity, and parenteral nutrition were significantly associated with PMV which occurred more frequently among patients ventilated for respiratory causes. Therefore, optimization of overall ICU care, particularly hematologic management, and the application of targeted weaning strategies may help mitigate the burden and adverse outcomes of PMV.