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Fang AP, Edmond MC, Marsh RH, Normil M, Poola N, Michel Payant SJ, Luc PR, Strokes N, Calixte M, Rimpel L, Rouhani SA. Outcomes of Invasive and Noninvasive Ventilation in a Haitian Emergency Department. Ann Glob Health 2023; 89:72. [PMID: 37868710 PMCID: PMC10588490 DOI: 10.5334/aogh.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/17/2023] [Indexed: 10/24/2023] Open
Abstract
Background Limited data exist on the outcomes of patients requiring invasive ventilation or noninvasive positive pressure ventilation (NIPPV) in low-income countries. To our knowledge, no study has investigated this topic in Haiti. Objectives We describe the clinical epidemiology, treatment, and outcomes of patients requiring NIPPV or intubation in an emergency department (ED) in rural Haiti. Methods This is an observational study utilizing a convenience sample of adult and pediatric patients requiring NIPPV or intubation in the ED at an academic hospital in central Haiti from January 2019-February 2021. Patients were prospectively identified at the time of clinical care. Data on demographics, clinical presentation, management, and ED disposition were extracted from patient charts using a standardized form and analyzed in SAS v9.4. The primary outcome was survival to discharge. Findings Of 46 patients, 27 (58.7%) were female, mean age was 31 years, and 14 (30.4%) were pediatric (age <18 years). Common diagnoses were cardiogenic pulmonary edema, pneumonia/pulmonary sepsis, and severe asthma. Twenty-three (50.0%) patients were initially treated with NIPPV, with 4 requiring intubation; a total of 27 (58.7%) patients were intubated. Among those for whom intubation success was documented, first-pass success was 57.7% and overall success was 100% (one record missing data); intubation was associated with few immediate complications. Twenty-two (47.8%) patients died in the ED. Of the 24 patients who survived, 4 were discharged, 19 (intubation: 12; NIPPV: 9) were admitted to the intensive care unit or general ward, and 1 was transferred. Survival to discharge was 34.8% (intubation: 22.2%; NIPPV: 52.2%); 1 patient left against medical advice following admission. Conclusions Patients with acute respiratory failure in this Haitian ED were successfully treated with both NIPPV and intubation. While overall survival to discharge remains relatively low, this study supports developing capacity for advanced respiratory interventions in low-resource settings.
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Affiliation(s)
- Anna P. Fang
- Boston Medical Center, Department of Emergency Medicine, One Boston Medical Center Place, Boston, MA, USA
| | - Marie Cassandre Edmond
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Regan H. Marsh
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Manouchka Normil
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, GHESKIO Centers, Port-au-Prince, Haiti
| | - Nivedita Poola
- Department of Emergency Medicine, SUNY Downstate/King’s County Hospital, Brooklyn, NY, USA
| | - Sherley Jean Michel Payant
- Zanmi Lasante, Port-au-Prince, Haiti
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Pierre Ricot Luc
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Natalie Strokes
- Family Medicine, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Manise Calixte
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Linda Rimpel
- Emergency Department, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
- Zanmi Lasante, Port-au-Prince, Haiti
| | - Shada A. Rouhani
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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