Demographic and Clinical Risk Factors Contributing to Prolonged Mechanical Ventilation in ICU Patients at Tenwek Hospital
Abstract
Prolonged mechanical ventilation (PMV) remains a significant clinical challenge in intensive care units (ICUs). Approximately 30% of ventilated patients require PMV with attendant risk for higher morbidity, mortality, and healthcare expenditure. In spite of progress in critical care, little is known about the predictors and outcomes of PMV in low-resource settings. This study investigated the prevalence, demographic and clinical risk factors, and outcomes of prolonged mechanical ventilation in ICU patients at Tenwek Hospital. A retrospective cohort design was employed, reviewing medical records of adult ICU patients (≥18 years) who received invasive mechanical ventilation for more than seven consecutive days between January and December 2024. Patients were included if they had complete clinical documentation, ventilator parameters, and outcome data; those receiving only non-invasive ventilation or with missing critical records were excluded. Descriptive statistics and inferential analysis were used to analyse data. All associations were tested at p < 0.05. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were reported, with model stability ensured by maintaining a minimum of 10 events per predictor variable. Among 173 mechanically ventilated adults, 72.3% experienced prolonged mechanical ventilation. Multivariable logistic regression pinpointed acute respiratory distress syndrome (ARDS; adjusted OR = 5.25, 95% CI: 2.35-11.75) and chronic obstructive pulmonary disease (COPD; adjusted OR = 5.28, 95% CI: 2.38-11.73) as the strong predictors, followed by pneumonia (adjusted OR = 1.82, 95% CI: 0.80-4.14) and sepsis (adjusted OR = 1.56, 95% CI: 0.69-3.52). Daily sedation vacation reduced the odds of PMV by 81% (adjusted OR = 0.19, 95% CI: 0.08–0.46), while early mobility protocols diminished them by 37% (adjusted OR = 0.63, 95% CI: 0.28-1.42). These findings underscore the high burden of prolonged ventilation and recommend that simple, low-cost interventions such as structured sedation breaks and early mobilisation may significantly reduce the duration of ventilation and improve outcomes.
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Abate, S. M., Nega, S., Basu, B., Mesfin, R., & Tadesse, M. (2023). Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression. Pediatric Research, 94(2), 423-433.
Abdallat, M., Khalil, M., Al-Awwa, G., Kothuru, R., & La Punzina, C. (2020). Barotrauma in COVID-19 patients. Journal of Lung Health and Diseases, 4(2), 8-12.
Ainembabazi, P., Najjemba, L., Musaazi, J., Hönemann, M., Castelnuovo, B., & von Braun, A. (2024). Severe acute respiratory syndrome coronavirus-2 seroprevalence in non-vaccinated people living with HIV in Uganda during 2022. Frontiers in Virology, 4, 1429785.
Aiesh, B. M., Qashou, R., Shemmessian, G., Swaileh, M. W., Abutaha, S. A., Sabateen, A., ... & Zyoud, S. E. H. (2023). Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. BMC Infectious Diseases, 23(1), 1-8.
Al-Anazi, S., Al-Omari, A., Alanazi, S., Marar, A., Asad, M., Alawaji, F., & Alwateid, S. (2024). Artificial intelligence in respiratory care: Current scenario and future perspective. Annals of Thoracic Medicine, 19(2), 117-130.
Ali, J. M., & Abu-Omar, Y. (2020). Complications associated with mechanical circulatory support. Annals of Translational Medicine, 8(13), 1-11.
Amato, M. B., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L., Schoenfeld, D. A., ... & Brower, R. G. (2015). Driving pressure and survival in the acute respiratory distress syndrome. New England Journal of Medicine, 372(8), 747-755.
Amos, K. K. (2022). Acute Viral Respiratory Infections in Intensive Care Unit and Ventilator Support Patients in Moi Teaching and Referral Hospital, Uasin-Gishu County, Kenya (Doctoral dissertation, Kenyatta University).
Atchade, E., Boughaba, A., Dinh, A. T., Jean-Baptiste, S., Tanaka, S., Copelovici, L., ... & Montravers, P. (2023). Prolonged mechanical ventilation after lung transplantation: risk factors and consequences on recipient outcome. Frontiers in Medicine, 10, 1160621.
Benites, M. H., Suarez-Sipmann, F., Kattan, E., Cruces, P., & Retamal, J. (2025). Ventilation-induced acute kidney injury in acute respiratory failure: Do PEEP levels matter? Critical Care, 29(1), 130.
Berhe, E., Gebrehiwet, T. G., Teka, H., Gebrehiwot, K. G., Abraha, H. E., & Tequare, M. H. (2022). Clinical characteristics and determinants of invasive mechanical ventilation outcome in adult intensive care unit in Northern Ethiopia: A resource-limited setting. Journal of the Pan African Thoracic Society, 4(1), 11-21.
Bissett, B., Gosselink, R., & Van Haren, F. M. (2020). Respiratory muscle rehabilitation in patients with prolonged mechanical ventilation: a targeted approach. Annual Update in Intensive Care and Emergency Medicine 2020, 595-609.
Bissett, B., Leditschke, I. A., Green, M., Marzano, V., Collins, S., & Van Haren, F. (2019). Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Australian Critical Care, 32(3), 249-255.
Böhmer, A. B., Just, K. S., Lefering, R., Paffrath, T., Bouillon, B., Joppich, R., ... & Gerbershagen, M. U. (2014). Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases. Critical Care, 18(4), R143.
Brodsky, M. B., Levy, M. J., Jedlanek, E., Pandian, V., Blackford, B., Price, C., Cole, G., Hillel, A. T., Best, S. R., & Akst, L. M. (2018). Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: a systematic review. Critical Care Medicine, 46(12), 2010-2017.
Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. Dimensions of Critical Care Nursing, 33(4), 246-253.
Cederwall, C. J., Naredi, S., Olausson, S., Rose, L., & Ringdal, M. (2021). Prevalence and intensive care bed use in subjects on prolonged mechanical ventilation in Swedish ICUs. Respiratory care, 66(2), 300-306.
Cheifetz, I. M. (2014). Cardiorespiratory interactions: the relationship between mechanical ventilation and hemodynamics. Respiratory Care, 59(12), 1937-1945.
Cook, D., Taneja, S., Krewulak, K., Zytaruk, N., Menon, K., Fowler, R., ... & Canadian Critical Care Trials Group. (2024). Barriers, solutions, and opportunities for adapting critical care clinical trials in the COVID-19 pandemic. JAMA Network Open, 7(7), e2420458-e2420458.
Emeriaud, G., López-Fernández, Y. M., Iyer, N. P., Bembea, M. M., Agulnik, A., Barbaro, R. P., ... & Khemani, R. G. (2023). Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PALICC-2). Pediatric Critical Care Medicine, 24(2), 143-168.
Engidaw, M. S., Tekeba, B., Amare, H. T., Belay, K. A., Ayana, Y., & Liyew, B. (2025). Incidence and predictors of extubation failure among adult intensive care unit patients in Northwest Amhara comprehensive specialised hospitals. Scientific Reports, 15(1), 20957.
Fan, E., Del Sorbo, L., Goligher, E. C., Hodgson, C. L., Munshi, L., Walkey, A. J., ... & Brochard, L. J. (2017). An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 195(9), 1253-1263.
Fanelli, A., Cescatti, A., Ciscar, J. C., Dubois, G., Ibarreta, D., Lowe, R., ... & Massaro, E. (2025). Assessing the risk of diseases with epidemic and pandemic potential in a changing world. Science Advances, 11(30), eadw6363.
Geri, G., Ferrer, L., Tran, N., Celi, L. A., Jamme, M., Lee, J., & Vieillard-Baron, A. (2021). Cardio-pulmonary-renal interactions in ICU patients. Role of mechanical ventilation, venous congestion and perfusion deficit on worsening renal function: insights from the MIMIC-III database. Journal of Critical Care, 64, 100-107.
Griggs, E. P., Mitchell, P. K., Lazariu, V., Gaglani, M., McEvoy, C., Klein, N. P., ... & Tenforde, M. W. (2024). Clinical epidemiology and risk factors for critical outcomes among vaccinated and unvaccinated adults hospitalised with COVID-19—VISION Network, 10 states, June 2021–March 2023. Clinical Infectious Diseases, 78(2), 338-348.
Huang, H. Y., Huang, C. Y., & Li, L. F. (2022). Prolonged mechanical ventilation: outcomes and management. Journal of Clinical Medicine, 11(9), 1-15.
Huang, D., Zhao, W., Chen, Y., Shen, B., Wang, Y., Guan, H., & Luo, W. (2021). Effect of mechanical ventilation and pulmonary rehabilitation in patients with ICU-acquired weakness: a systematic review and meta-analysis. Annals of Palliative Medicine, 10(9), 9594606-9599606.
Kallet, R. H. (2021). 2020 year in review: mechanical ventilation during the first year of the COVID-19 pandemic. Respiratory Care, 66(8), 1341-1362.
Kenyatta National Hospital (2021). KNH ICU Audit Report 2021. Nairobi: KNH.
Kunga, B. M. (2023). Implementation of High-flow Nasal Canula Ventilation in Kenyatta National Hospital Paediatric Intensive Care Unit (Doctoral dissertation, University of Nairobi).
Liaqat, A., Mason, M., Foster, B. J., Kulkarni, S., Barlas, A., Farooq, A. M., ... & Pau, D. (2022). Evidence-based mechanical ventilatory strategies in ARDS. Journal of Clinical Medicine, 11(2), 319.
Lone, N. I., Masterson, J. A., & Tripathy, S. (2025). Understanding the scale of critical illness in Africa and the need for universal access to emergency and critical care. The Lancet, 405(10480), 674-675.
MacIntyre, C. R., Chughtai, A. A., Rahman, B., Peng, Y., Zhang, Y., Seale, H., ... & Wang, Q. (2017). The efficacy of medical masks and respirators against respiratory infection in healthcare workers. Influenza and other Respiratory Viruses, 11(6), 511-517.
Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., ... & Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care, 25(1), 25.
Martínez-Martínez, M., Plata-Menchaca, E. P., Nuvials, F. X., Roca, O., & Ferrer, R. (2021). Risk factors and outcomes of ventilator-associated pneumonia in COVID-19 patients: a propensity score matched analysis. Critical Care, 25(1), 235.
Masilela, C., Adeniyi, O. V., & Benjeddou, M. (2022). Prevalence, patterns and determinants of dyslipidaemia among South African adults with comorbidities. Scientific Reports, 12(1), 337.
Merali, N. M. (2021). Prevalence and incidence of infections and Sepsis in critical care units at two tertiary referral hospitals in Kenya (Doctoral dissertation, Uon).
Micallef, A., Buttigieg, S. C., Tomaselli, G., & Garg, L. (2020). Defining delayed discharges of inpatients and their impact on acute hospital care: a scoping review. International Journal of Health Policy and Management, 11(2), 103.
Nagiah, S. (2024). An Analysis of Nosocomial Infections and Risk Factors of ICU Patients Admitted at a Private Hospital in Johannesburg. University of Johannesburg (South Africa).
Neto, A. S., Simonis, F. D., Barbas, C. S., Biehl, M., Determann, R. M., Elmer, J., ... & Protective Ventilation Network Investigators. (2015). Lung-protective ventilation with low tidal volumes and the occurrence of pulmonary complications in patients without acute respiratory distress syndrome: a systematic review and individual patient data analysis. Critical Care Medicine, 43(10), 2155-2163.
Ochieng, J. (2021). Intensive Care Survivors’ Experiences During Acute Hospitalization in Critical Care Unit Kenyatta National Hospital (Doctoral dissertation, University of Nairobi).
Parker, R. K., Mwachiro, E. B., Mwachiro, M. M., Pletcher, J., Parker, A. S., & Many, H. R. (2019). Mortality prediction in rural Kenya: a cohort study of mechanical ventilation in critically ill patients. Critical Care Explorations, 1(12), e0067.
Pathan, U. A. (2021). Estimation of Direct Medical Expenditures and Health-Related Quality of Life (HRQoL) among Type-2 Diabetes (T2DM) Patients with Depression Using 2016–2018 Medical Expenditure Panel Survey (MEPS) Data. St. John's University (New York).
Priya, V., Sen, J., & Ninave, S. (2024). A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions. Cureus, 16(3), e57247-e57247.
Rose, L., & Messer, B. (2024). Prolonged mechanical ventilation, weaning, and the role of tracheostomy. Critical Care Clinics, 40(2), 409-427.
Russotto, V., Rahmani, L. S., Parotto, M., Bellani, G., & Laffey, J. G. (2022). Tracheal intubation in the critically ill patient. European Journal of Anaesthesiology, 39(5), 463-472.
Saber, H., Palla, M., Kazemlou, S., Navi, B. B., Yoo, A. J., Simonsen, C. Z., ... & Sheth, S. A. (2021). Prevalence, predictors, and outcomes of prolonged mechanical ventilation after endovascular stroke therapy. Neurocritical Care, 34(3), 1009-1016.
Schjørring, O. L., Jensen, A. K., Nielsen, C. G., Ciubotariu, A., Perner, A., Wetterslev, J., ... & Rasmussen, B. S. (2020). Arterial oxygen tensions in mechanically ventilated ICU patients and mortality: a retrospective, multicentre, observational cohort study. British Journal of Anesthesia, 124(4), 420-429.
Simmons, J. S. C., Bourgault, A. M., Sole, M. L., & Peach, B. C. (2024). A review of chlorhexidine oral care in patients receiving mechanical ventilation. Critical Care Nurse, 44(3), 45-53.
Sterling, J., Policastro, C., Elyaguov, J., Simhan, J., & Nikolavsky, D. (2023). How and why tobacco use affects reconstructive surgical practice: a contemporary narrative review. Translational Andrology and Urology, 12(1), 1-16.
Sulani, I., Onofrey, L. A., Trevisi, L., Beane, A., Brotherton, B. J., Condo, J., ... & Riviello, E. (2025). The epidemiology and impact of hypoxemia in sub-Saharan Africa: prevalence, practices, and outcomes. Annals of the American Thoracic Society, 22(6), 905-914.
Telias, I., Brochard, L. J., Gattarello, S., Wunsch, H., Junhasavasdikul, D., Bosma, K. J., ... & Gattinoni, L. (2022). The physiological underpinnings of lifesaving respiratory support. Intensive Care Medicine, 48(10), 1274-1286.
Tobi, K. U., & Ogunbiyi, O. A. (2024). Critical care in sub-Saharan Africa, where are we? A review. Journal of West African College of Surgeons, 14(1), 1-4.
Trudzinski, F. C., Michels-Zetsche, J. D., Neetz, B., Meis, J., Müller, M., Kempa, A., ... & Frerk, T. (2024). Risk factors for long-term invasive mechanical ventilation: a longitudinal study using German health claims data. Respiratory research, 25(1), 1-11.
Udegbunam, I. C. (2024). Risk Factors Associated With COVID-19 Severity Amongst Adults With Pre-existing Medical Conditions In The United States (Doctoral dissertation, Hochschule für Angewandte Wissenschaften Hamburg).
Vali, M., Paydar, S., Seif, M., Sabetian, G., Abujaber, A., & Ghaem, H. (2023). Prediction of prolonged mechanical ventilation in trauma patients of the intensive care unit according to initial medical factors: a machine learning approach. Scientific Reports, 13(1), 5925.
Wachira, B. W., & Mwai, M. (2021). A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients. African Journal of Emergency Medicine, 11(2), 213-217.
Wang, Q., Tao, Y., Zhang, X., Xu, S., Peng, Y., Lin, L., ... & Lin, Y. (2024). The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Reviews in Cardiovascular Medicine, 25(11), 1-18.
Yaglowski, J. (2020). All-inclusive central line dressing kits: a lean approach. Critical Care Nursing Quarterly, 43(1), 99-106.
Zaidi, I., Vardha, J., Anjum, S., Chaudhary, S., Bakshi, A., Gill, J. K., & Gurav, J. (2023). Tuberculosis and pulmonary co-infections: Clinical profiles and management strategies. Medical Research Archives, 11(12), 1-24.
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