Profile of cases and factors associated with poor outcomes among patients admitted to the intensive care unit at a regional referral hospital in Bhutan: an observational study

INTRODUCTION: Timely admission and treatment of critically ill patients to Intensive Care Units (ICU) is shown to reduce premature mortality. However, low- and middle-income countries face many challenges in providing ICU services. This study describes the profile of patients admitted to ICU and their outcomes at the Central Regional Referral Hospital in Bhutan. METHOD: This was an observational study with a review of records of patients from 2021 to 2023. The data were extracted into a pro forma, entered into EpiData Entry 3.1, and analysed in STATA 18. RESULTS: There were 287 patients admitted to the ICU. The mean age was 56.53 (SD ± 19.18) years). The highest number of cases were admitted from the Emergency Department (117, 40.77%) and Medicine Department (50, 17.42%). The common indications for admissions were pulmonary disease (91, 31.70%), sepsis/infection (61, 21.25%), cardiovascular diseases (48, 16.72%), and cerebrovascular diseases (38, 13.24%). There were 140 (48.78%) patients who received mechanical ventilation, 27 (9.41%) required positive pressure airway support, 36 patients (12.54%) had central venous access insertion, and 19 patients (6.62%) had haemodialysis line insertion. The mortality rate was 51.22% (147/287 patients); the most common causes of mortality were septic shock (22, 14.97%), stroke (16, 10.88%), and pneumonia (14, 9.52%). Patients with chronic liver disease (adjusted OR 4.32, 95% CI 1.84-10.09, p = 0.001), and those receiving Ceftriaxone (adjusted OR 2.57, 95% CI 1.31-5.03, p = 0.006), Piperacillin-Tazobactam (adjusted OR 2.63, 95% CI 1.02-6.77, p = 0.045), and Cefazolin (adjusted OR 7.57, 95% CI 1.26-44.16, p = 0.026) had higher odds of mortality. Patients receiving Doxycycline (adjusted OR 0.49, 05% CI 0.25-0.96, p = 0.036) had lower odds of mortality. CONCLUSION: About half of patients admitted to the ICU ended in mortality and the most common cause was septic shock. This study provides a baseline understanding of critical care service delivery in a resource-limited setting.