Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 322
Insight
Ward Mechanical Ventilation (WMV) Audit
Sulaiman Khadadah 1 , Maryam Al-Ali 1 , Mohamed Bahzad 2
1
Department of Medicine, Mubarak Hospital, Ministry of Health, Kuwait
2
Department of Anesthesia and Intensive care, Mubarak Hospital, Ministry of Health, Kuwait
ABSTRACT
Kuwait Medical Journal 2012; 44 (4): 322 - 325
Objective: To look at the characteristics and mortality of
mechanically ventilated patients on a general medical ward.
The purpose of this audit is to evaluate this practice and
also help clarify the need for “do not resuscitate” orders in
Kuwait.
Design: Prospective, observational audit
Setting: Mubarak Al-Kabeer Hospital, Ministry of Health,
Kuwait
Subjects: Mechanically ventilated patients on medical wards
in Mubarak Al-Kabeer Hospital over a six-month period
Intervention: Mechanical ventilation
Main Outcome Measures: Primary outcome was death and
secondary outcome was extubation
Results: Eighty-one patients met the inclusion criteria. Most
patients had over three medical problems with a high number
of patients having brain dysfunction, cancer and end-stage
diseases. The mortality rate was 95%.
Conclusion: There is great need to further look into this
practice which appears to be highly fatal. There is evidence
for the need to introduce a “do not resuscitate” policy in
Kuwait, which is an ethical necessity in the practice of
medicine.
KEY WORDS: mechanical ventilation, medical ward, resuscitation
INTRODUCTION
Ever since the creation of the first positive pressure
mechanical ventilator in the 19 th century there has been
a constant demand for it in hospitals around the world.
The number of patients requiring such devices has also
grown exponentially since that time. The outcome of
patients on mechanical ventilation even in specialized
centers, like the Intensive Care Unit (ICU) has been
inconsistent due to a variety of causes [1] .
Due to limited resources and the increasing demand
for ICU beds with no “do not resuscitate (DNR)” policy,
for the past 10 years in Kuwait, we have selectively
placed some patients on mechanical ventilators in
the general medical wards. Most of these patients
are usually those on medical grounds “should not
have been resuscitated or intubated” due to predicted
poor prognosis. The aim of this audit was to look at
the mortality of these patients who are mechanically
ventilated in the medical wards in Mubarak Al-Kabeer
Hospital, Kuwait (MKH).
MKH is a secondary referral hospital servicing
approximately one third of the population of Kuwait
(1 million inhabitants). It has a total of 450 beds of
which 186 are allocated to adult medical patients. To
the best of our knowledge, there are very few countries
in the world that do not have a DNR policy and
selectively place poor prognosis patients on invasive
mechanical ventilation in the general medical ward.
This is the first time in Kuwait that the mortality and
characteristics of such patients has been reviewed
systematically.
SUBJECTS AND METHODS
We collected data from the general medical wards
in MKH over a six-month period starting from 1 st May
to 31 st October, 2010. The need for written consent
and ethical approval was waived by the local hospital
administration due to the observational nature of the
study. Mechanical ventilation (MV) was either through
a tracheostomy or an endotracheal tube.
We included all patients that were placed on
mechanical ventilation in the medical wards that
survived at least two hours from onset of MV. Since all
patients unselectively receive CPR and are intubated
during the process, we chose two hours as the minimal
survival time post MV. This is to ensure that we are
measuring the mortality of patients on MV in the ward
rather than the mortality of cardiac arrest patients
in the hospital, who are usually intubated during
resuscitation.
Address correspondence to:
Sulaiman Khadadah, MB Bch, BAO, Department of Medicine, Mubarak Al-Kabeer Hospital, Kuwait. P O Box 15081 Al-Daeyah, Kuwait.
Tel: +1 514 880 7484, E-mail: Khadadas@tcd.ie