This facility based retrospective follow-up study was mainly focused on time to recovery and its predictors among critically ill patients on mechanical ventilation. The study revealed that the median recovery time of critically ill patients on mechanical ventilation was 15 days with an interquartile range (IQR) of (6–30 days). This result is supported by findings from Saudi Arabia, India, Germany, Brazil, Nigeria, and Ethiopia [1, 3, 25, 26, 28, 29]. However, the finding is lower than studies from US & UK ICUs [30], Kenya [31], Nigeria [32], and University of Jimma, Ethiopia [33]. This might be because of difference in level of ICU organization and ICU supplies as well as it might be due to presence of long term acute care facilities and palliative care/hospice facilities in US & UK ICUs. This implies the need for refining quality ICU organization and related conditions in the study area. Therefore, it is recommended that the Federal Ministry of Health (FMOH) in collaboration with health facility and other supportive organizations should give its time to invest on ways to enhance ICU organization and essential ICU supplies in order for improving recovery rate of critically ill patients on mechanical ventilation.
This paper found that, in cox proportional hazard regression, predictors such as diagnosis category at time of receiving mechanical ventilation, oxygen saturation, presence of comorbidities, Glasgow coma scale, and use of tracheostomy were statistically significant.
At any particular time, non-traumatic critically ill patients had a 69.0% faster rate of recovery proportional to traumatic patients on mechanical ventilation at ICU {AHR: 1.690; 95% CI: (1.150- 2.485)}. This is supported by research results conducted in Sub-Saharan Africa [12]. The possible justification for this probably would be because of severe, accidental violence and road traffic injuries in the study area. In addition, it might be due to most of the time head involvement in these types of severe accidental injuries that end up with severe traumatic injuries (TBI). This implies that road traffic accidents, violence and other forms of injury look prevalent in the study area.
The recovery time of critically ill patients with free of comorbidities faced a 77.4% greater recovery as proportionally to those having comorbidities {AHR: 1.774; 95% CI: (1.250- 2.519)}. This study finding was supported by findings from Pakistan, Germany, Brazil, and Ethiopian studies [3, 4, 11, 25, 34].
At any time, those patients having 90% and above oxygen saturation had a 60% greater recovery than its counterparts {AHR: 1.600; 95% CI: (1.157- 2.211)}. Similarly, at any particular time, patients with GCS scale of 9–12 had 99.3% faster recovery rate relative to patients with GCS scale of 8 or below {AHR: 1.993; 95% CI: (1.358- 2.924)} and critically ill patients with GCS scale of 13–15 had two times more recovery time than patients with GCS of 8 or below {AHR: 2.451; 95% CI: (1.483- 4.051)}. These findings were supported by research output from Pakistan, the southern part of Ethiopia [4, 25].
On the other hand, critically ill patients on mechanical ventilation receiving a tracheostomy had a 72.3% lower rate of recovery than its counter parts {AHR: 0.277; 95% CI: (0.181–0.423)}. This research finding is comparable to finding in Sub Saharan Africa [12]. But it has a discrepancy with findings from tertiary hospitals of Nigeria [29] in which those gaining tracheostomy recovered better. This might be due to a difference in time of initiation of tracheostomy after intubation for mechanical ventilation.
This study also depicted that 42.29% critically ill patients were recovered with the overall recovery rate of critically ill patients on mechanical ventilation as 4.49 per 100 person- days. This finding is similar to that of studies from different areas of study. For instance in Southern Brazil Nigeria, Kenya, Jimma University Specialized Hospital, and also from a systematic review of 39 countries [3, 29, 31, 33, 35]. But, the finding was lower from other different parts of the world. For instance, finding from Saudi Arabia, Germany, India, Uganda, Egypt, South Western Kenya, Gondar Hospital, and Southern part of Ethiopia recovery [1, 12, 16, 17, 25,26,27, 36]. The possible explanation for ending up with lower finding could possibly be due to differences in the level of quality of ICU set-up and availability of intensive care equipment and due to the presence of long term acute care facilities and palliative care/hospice facilities in some countries. Even, for instance, some are studied from specialized weaning ICU centers. Plus, studies from Saudi Arabia and Germany mainly focused on tertiary care centers and specialized weaning ICU centers and also study from Kenya; it includes pediatric population unlike this study area. This indicates the importance of upgrading ICU, medical equipment, supplies and staffing. The hospital is better able to enhance its level of ICU quality, its staffing and ICU equipment. ICU health staff should give attention, frequent monitoring and expand their knowledge on handling of critical ill victims, those on mechanical ventilation.
The paper also demonstrated main causes of admission to the ICU for the purpose of mechanical ventilation were traumatic injuries (45.2%), abdominal (10.6%), respiratory (10.4%), and cardiac (9.8%) causes. This study finding is almost similar to studies conducted in Sub Saharan Africa, Nigeria, Uganda, South Western Kenya and Jimma University Specialized Hospital [12, 16, 32, 33] in which traumatic injuries were number one causes. However, finding from Sothern Brazil, India & Southern Ethiopia [3, 25, 37] ended up with malignancy, sepsis and cardiovascular & respiratory causes respectively were mainly explained reasons for admission to ICU for mechanical ventilation. The possible justification for trauma causes that made study participants visit an ICU for the purpose of mechanical ventilation was because of major occurrence of traumatic injuries and violence in the developing world. This signifies that road traffic accidents, violence and other trauma are the major events which adversely affected the lives of the population in the study area. It is advised that transport office should take serious measures be taken in order for preventing and controlling occurrence of traumatic injuries because almost half of critically ill victims on mechanical ventilation as per this research were accidental injuries and also it’s statistically significant.
Finally, since as per the knowledge of the researcher, there are no enough studies conducted on time to recovery among critically ill victims on mechanical ventilation and its predictors in Ethiopian context, so it’s advised for interested researchers to invest their time on this issue mainly by using prospective research approaches.
Limitations of the study
This study was not without limitations; for instance, it’s using of time of admission, and discharge of critically ill victims, those on mechanical ventilation as time of observation interval due to lack of adequate record keeping. This was done because, as per the study area, only mandatory critically ill patients needing mechanical ventilation were admitted to ICU.
In addition, ventilator modes, and blood chemistry tests were not studied due to issues in record keeping, so that the effect of these conditions on recovery of the studied population were not determined.