IntroductionCritical care is a serious global healthcare burden. Although a high number of surgical patients are being admitted to the surgical intensive care unit (SICU), the mortality remained high, particularly in low and middle-income countries. However, there is limited data in Ethiopia. Therefore, this study aimed to investigate the survival status and predictors of mortality in surgical patients admitted to the SICUs of Addis Ababa governmental hospitals, Ethiopia.MethodsA multicenter retrospective cohort study was conducted on 410 surgical patients admitted to the SICUs of three government hospitals in Addis Ababa selected using a simple random sampling from February 2017 to February 2020. The data were entered into Epidata version 4.6 and imported to STATA/MP version 16 for further analysis. Bi-variable and multivariable Cox regression models were fitted in the analysis to determine the predictor variables. A hazard ratio (HR) with a 95% confidence interval (CI) was computed, and variables with a p-value <0.05 were considered statistically significant.ResultsFrom a sample of 410 patients, 378 were included for final analysis and followed for a median follow-up of 5 days. The overall mortality among surgical patients in the SICU was 44.97% with an incidence rate of 5.9 cases per 100 person-day observation. Trauma (AHR = 1.83, 95% CI: 1.19–2.08), Glasgow coma score (GCS) <9 (AHR = 2.06, 95% CI: 1.28–3.31), readmission to the SICU (AHR = 3.52, 95% CI: 2.18–5.68), mechanical ventilation (AHR = 2.52, 95% CI: 1.23–5.15), and creatinine level (AHR = 1.09, 95% CI: 1.01–1.18) were found to be significantly associated with mortality in the SICU.ConclusionThe mortality of surgical patients in the SICU was high. Trauma, GCS <9 upon admission, readmission to the SICU, mechanical ventilation, and increased in the creatinine level on admission to the SICU were the identified predictors of mortality in the SICU.

Background : Body temperature is a vital sign and 37°C is the mean core body temperature of a healthy human. Core body temperature is normally tightly regulated and maintained within narrow range. Perioperative hypothermia is one of the major problems during surgery and anesthesia that can affect operated patients. Methods: Institutional based cross-sectional study was conducted. Patient interview, chart review and temperature measurement were employed for data collection. Temperature was measured using tympanic membrane thermometer. SPSS version 20 software was used for analysis. binary logistic regression was used to look at associations anda p-value of <0.05 was considered statistically significant. Result :The overall magnitude of preoperative, intra and post-operative hypothermia in this study was 16.2%, 53.2% and 31.3%, respectively. Age (AOR=7.15, 95% CI, 1.16, 43.99), coexisting illness (AOR, 3.32, 95% CI, 1.06; 10.36), preoperative hypothermia (AOR; 57; 95% CI; 7.1, 455.4), operation room temperature (AOR=1.91; 95 % CI, 1.04; 3.5) and crystalloid fluids administered (AOR; 2.3; 95% CI, 1.07, 4.9) were found to be factors associated with intraoperative hypothermia. Conclusion and recommendation: The magnitude of perioperative hypothermia remains high. Measures should focus on improving room temperature and warming up fluids. Susceptible patients like the aged and those with coexisting disease should be given extra attention.

Background Coronavirus disease 2019 (COVID-19) has resulted in severe acute respiratory failure, requiring intubation and an invasive mechanical ventilation. However, the time for initiation of intubation remains debatable. Therefore, this study aimed to compare early and late intubation on the outcome of COVID-19 patients admitted to the intensive care unit (ICU) of selected Addis Ababa COVID-19 treatment centers, Ethiopia. Methods A multicenter retrospective cohort study was conducted on 94 early and late intubated ICU-admitted COVID-19 patients from October 1, 2020, to October 31, 2021, in three selected COVID-19 treatment centers in Addis Ababa, Ethiopia. A simple random sampling technique was used to select study participants. An independent t-test, Mann Whitney U test and Fisher’s exact test were used for statistical analysis, as appropriate. A P value < 0.05 was used to declare a statistical significance. Results A total of 94 patients participated, for a response rate of 94.68%. There was a statistically insignificant difference in the rates of death between the early intubated (47.2%) and the late intubated (46.1%) groups (P = 0.678). There was no difference in the median length of stay on a mechanical ventilator (in days) between the groups (P = 0.11). However, the maximum length of stay in the ICU to discharge was significantly shorter in the early intubated (33.1 days) than late intubated groups (63.79 days) (P < 0.001). Conclusion Outcomes (death or survival) were similar whether early or late intubation was used. Early intubation did appear to improve length of ICU stay in ICU-admitted COVID-19 patients. Highlights

Background Apneic oxygenation using a nasal cannula is used to deliver oxygen continuously during the apneic period of endotracheal intubation to prevent desaturation. Pre-oxygenation using face mask alone technique may be insufficient to provide a safe apnea period in pediatric patients who are at high risk for rapid desaturation compared to added apneic oxygenation. This study compared the efficacy of apneic oxygenation with a face mask (AO) versus a face mask alone (FMA) pre-oxygenation to prevent desaturation during endotracheal intubation in elective pediatric surgical patients. Methods A prospective cohort study was conducted on two equal groups of elective pediatric patients observed in either use of apneic oxygenation with a face mask (AO) or face mask alone(FMA) pre-oxygenation during endotracheal intubation at the study hospital from early December 2021 to late March 2022. The data were collected using a structured questionnaire. The primary outcome variable was the desaturation SpO2 (<94%) observed during endotracheal intubation. The categorical data were analyzed using a χ2-test. Parametric data were analyzed using an independent t-test or one-way ANOVA as appropriate with a 95% CI and a p-value of < 0.05 was considered statistically significant. The Bonferroni post hoc analysis was employed to test the significance of means between the groups. Results The mean desaturation level was (SpO2 = 95.74 ± 2.99) in apneic oxygenation with face-mask group and (SpO2 = 93.96 ± 3.74) in the face-mask alone group(p = 0.006) with medium effect size (Cohan’s d = 0.06). A one-way ANOVA showed a statistically significant difference in the mean (±SD) of desaturation level with the number of attempts at endotracheal intubation within the groups (P = 0.005). The Bonferroni pairwise comparison within groups, showed that the mean (±SD) desaturation level during endotracheal intubation for the participant with >2 attempts is significantly lower than for participants with only 1 attempt (p-value = 0.004). Conclusion and recommendation A continuous administration of apneic oxygenation (5-l/min) by nasal cannula during endotracheal intubation significantly reduced desaturation in pediatrics. We recommend the use of apneic oxygenation (AO) in pediatrics during intubation time. Highlights

Background Propofol is the most commonly used general anesthesia induction agent. It has injection pain and hemodynamic changes as a major drawback. These side effects are clinically undesirable because they can cause agitation and hinder the smooth induction of anesthesia. Determining the best method to reduce this effect is paramount important. This study aimed to compare the effectiveness of low dose ketamine versus lignocaine pre-treatment to prevent propofol injection pain and hemodynamic changes among study participants. Methods An institutional prospective cohort study was conducted on 82 (n1 = n2 = 41) adult elective surgical patients who took general anesthesia induction by propofol at our hospital from 01-Jan-2022 to30 Mar-2022. A systematic random sampling technique was used to select study participants. The pain was scored using a verbal rating scale and mean arterial pressure, heart rate and oxygen saturation was recorded during induction using a questionnaire. An independent samples t-test or chi-square test were used as appropriate. A P-value of < 0.05 was considered as statistically significant. Results Two groups of 41 (LDK = low dose ketamine = Ld = Lignocaine = 41) patients were studied and the incidence of pain after pre-treatment with Low-dose ketamine (4.9%) group was significantly lower than lignocaine (22%) group (p = 0.023). The mean pain score after pre-treatment with low-dose ketamine group was significantly lower than the lignocaine group (p = 0.024). However, there was no statistically significant difference in heart rate, mean arterial pressure, and oxygen saturation (SpO2) between the groups. Conclusion and recommendation Pre-treatment with a low dose of ketamine significantly reduces the incidence of propofol injection pain. We recommend its routine use before propofol injection, and a multi-center more controlled study. Highlights