Capnography access and use in Kenya and Ethiopia.

Autor: Nourian MM; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA. maziarnourian@gmail.com., Alshibli A; Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA., Kamau J; African Mission Healthcare, ImPACT Africa-Tanzania, Nairobi, Kenya., Nabulindo S; Department of Anesthesiology, University of Nairobi, Nairobi, Kenya., Amollo DA; African Population and Health Research Center, Nairobi, Kenya., Connell J; Vanderbilt University School of Medicine, Nashville, TN, USA., Eden SK; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Seyoum R; Department of Anesthesiology, Bahir Dar University, Bahir Dar, Ethiopia., Teklehaimanot MG; Department of Anesthesiology, Mekelle University, Mekelle, Ethiopia., Tegu GA; Department of Anesthesiology, Bahir Dar University, Bahir Dar, Ethiopia., Desta HB; Department of Anesthesiology, Mekelle University, Mekelle, Ethiopia., Newton M; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., Sileshi B; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2024 Jan; Vol. 71 (1), pp. 95-106. Date of Electronic Publication: 2023 Nov 01.
DOI: 10.1007/s12630-023-02607-y
Abstrakt: Purpose: Lack of access to safe and affordable anesthesia and monitoring equipment may contribute to higher rates of morbidity and mortality in low- and middle-income countries (LMICs). While capnography is standard in high-income countries, use in LMICs is not well studied. We evaluated the association of capnography use with patient and procedure-related characteristics, as well as the association of capnography use and mortality in a cohort of patients from Kenya and Ethiopia.
Methods: For this retrospective observational study, we used historical cohort data from Kenya and Ethiopia from 2014 to 2020. Logistic regression was used to study the association of capnography use (primary outcome) with patient/procedure factors, and the adjusted association of intraoperative, 24-hr, and seven-day mortality (secondary outcomes) with capnography use.
Results: A total of 61,792 anesthetic cases were included in this study. Tertiary or secondary hospital type (compared with primary) was strongly associated with use of capnography (odds ratio [OR], 6.27; 95% confidence interval [CI], 5.67 to 6.93 and OR, 6.88; 95% CI, 6.40 to 7.40, respectively), as was general (vs regional) anesthesia (OR, 4.83; 95% CI, 4.41 to 5.28). Capnography use was significantly associated with lower odds of intraoperative mortality in patients who underwent general anesthesia (OR, 0.31; 95% CI, 0.17 to 0.48). Nevertheless, fully-adjusted models for 24-hr and seven-day mortality showed no evidence of association with capnography.
Conclusion: Capnography use in LMICs is substantially lower compared with other standard anesthesia monitors. Capnography was used at higher rates in tertiary centres and with patients undergoing general anesthesia. While this study revealed decreased odds of intraoperative mortality with capnography use, further studies need to confirm these findings.
(© 2023. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
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