Critical care in a resource-limited setting: a 10-year retrospective analysis of factors associated with mortality in intensive care at Alotau Provincial Hospital, Papua New Guinea

Introduction The characteristics of patients admitted to intensive care units in Papua New Guinea (PNG) are essential to identifying areas that need improvement. In PNG, there is no published data on the characteristics of patients admitted to any intensive care unit. This study aimed to describe the epidemiological and clinical characteristics of patients admitted to the Alotau Provincial Hospital ICU and to describe the factors associated with mortality. Methodology A retrospective observational cohort study was conducted in the Alotau Provincial Hospital ICU from January 2014 to December 2024. Epidemiological and clinical characteristics were described, and factors associated with mortality were assessed using univariate logistic regression to identify odds ratios (OR) and 95% confidence intervals (CI). A P-value of < 0.05 was considered significant. Results Over the 10 year period, 1,584 patients were analysed, of whom 59% were males. The mean age was 36.3 ± 19.2 years; the age range was 2 days to 88 years for males, and 1 day to 90 years for females. Almost half (47.6%) were surgical patients. The Emergency Department admitted 51.7% of patients directly to ICU, and 8% of all ICU admissions had at least one comorbidity, with diabetes and hypertension being the common comorbidities. Postoperative management (18.7%), sepsis (17%), and cardiovascular disease (13.2%) were the commonest diagnoses. Mechanical ventilation rate was 33.8%, with an average length of ventilation of 1.4 ± 4.3 days. Tracheostomy rate was 3.9%. The average length of ICU stay was 4.5 ± 5.3 days, and the overall ICU mortality rate was 19% (95% CI 17.10–20.96%). Factors associated with mortality included direct admission from the Emergency Department (OR 1.44, 95% CI 1.12–1.87%), the presence of a comorbidity (OR 1.64, 95% CI 1.08–2.48%), being mechanically ventilated (OR 8.14, 95% CI 6.12–10.81%), having a tracheostomy (OR 3.05, 95% CI 1.81–5.17%), and having sepsis (OR 3.58, 95% CI 2.69–4.76%). Having surgery performed was associated with a decreased risk of ICU mortality (OR 0.59, 95% CI 0.45–0.77%). Conclusion This is the first paper to report on the characteristics and outcomes of ICU patients in PNG. In this study, admission from the Emergency Department, comorbidity, mechanical ventilation, tracheostomy, and sepsis were all factors associated with increased mortality. Patients who underwent surgery during ICU admission had a decreased risk of mortality. Prospective, multi-centre studies are required to better understand the characteristics and outcomes of ICU in resource-limited settings.