Pattern and outcome of elderly admissions into the Intensive Care Unit (ICU) of a low resource tertiary hospital

Background: Globally, the population of the elderly is increasing and the greatest increase is occurring in the developing and middle income countries because of falling death rate and high birth rate. The ageing of the population in developing countries may result in increasing requirement for health care facilities including ICU care for the elderly. This study was aimed at assessing the pattern and outcome of elderly patients’ admissions into the ICU of our hospital and identifies the determinants of outcome.Method: This was a retrospective study covering a 5 year period (January1st 2010 to 31st December 2014) in the ICU of a sub-Saharan tertiary hospital. Data was obtained from the review of ICU admission records over this period. We included as elderly patients aged 65years and above.Results: During the period under review, 90 cases were identified but only 62 cases were available for review (68.9%). There were 40 males and 22 females with ages ranging between 65 and 92years. Surgical admissions accounted for 75.8% of admissions while medical admissions were 24.2%.  The overall ICU mortality in the elderly was 58.1%.The major predictors of mortality were: need for endotracheal intubation (p=0.001), mechanical ventilation (p=0.001), vasopressor (p=0.001), electrolyte derangement (p=0.001), sepsis on admission (p=0.001), shock on admission (p=0.001).Conclusion: Elderly patients admitted into the ICU are a population with an increased risk of mortality. The predictors of high risk of death are sepsis on admission, septic shock, need for vasopressor, endotracheal intubation and or mechanical ventilation and the presence of electrolyte derangement. The outcome of this study calls for a need to pay more attention to this rapidly expanding group of the population.Keywords: Elderly, Admission, ICU, low resource hospita

Is there a need for extra-length spinal needles for obstetric spinal anaesthesia in obese parturients? A multi-centre study

Background: Neuraxial blocks are often the preferred anaesthetic techniques in obese mothers for caesarean section because of  increased risk of difficult intubation in them. However, these techniques may be challenging possibly because of poor landmark of spinal space and poor selection of spinal needles in them. Objective: To investigate if there is need for extra-length spinal needles in obese parturients during caesarean section. Design: A prospective observational study Setting: Four University Teaching Hospitals in South-Western Nigeria. Subjects: Parturients scheduled for caesarean section under spinal anaesthesia Results: The mean age, weight, body mass index and skin to subarachnoid space depth (SSD) were 31.49 ± 5.12 years, 75.21 ± 14.14 kg, 27.68 ± 5.45 kg/m2 and 6.08 ± 0.98 cm respectively. Of the 485 parturients, 156 (32.2%) were obese. Majority of the obese patients were greater than 30 years of age when compared with those that were under 30 years and this was statistically significant (p= 0.007). Only one obese parturient needed an extra-length spinal needle for skin to sub-arachnoid space depth (SSD) of 10 cm. There was a more positive linear correlation between depth of spinal needle and weight (0.455) than BMI (0.229) Conclusion: Although about one-third of parturients in our study were obese, only one required an extra-length spinal needle. Extra-length spinal needle is rarely needed in our populatio