Factors Predisposing to Organ (s) Dysfunction among Critically Ill Adult Patients at a Selected University Hospital in Egypt

Abstract

Multiple organs dysfunction is one of the most challenging clinical problems in the intensive care units. It is one of the leading causes of morbidity and the main cause of mortality in critically ill patients. Therefore, requires efforts of of the health care team especially critical care nurses who are the healthcare providers and most closely involved in the daily care of critically ill patients. They have the opportunity to early detect and identify patients at risk for the development organs dysfunction. Aim of the study: to identify factors predisposing to organ(s) dysfunction among critically ill adult patients at a selected university hospital. Research questions: Q1-What is the frequency of organ dysfunction among critically ill adult patients at a selected university hospital, in Egypt? Q2-What are diffrent predisposing factors to organ dysfunction among critically ill adult patients at a selected university hospital, in Egypt?. Research design: A descriptive/exploratory research design was utilized. Sample: A sample of convince consisting of 110 adult male and female critically ill patients admitted to to different intensive care units over a period of six months was included. Tools of data collection: Four tools were utilized for data collection: Sociodemographic and Medical data Sheet; Predisposing Factors to Organ (s) Dysfunction Assessment Sheet; Physical Assessment Sheet; and The Sequential Organ Failure Assessment score (SOFA). Results: The current study revealed that: more than half (55.5%) of the studied sample had two organs dysfunction, of these (n=33/54.1%) were in age group from 58 - < 68, with no significant statistical relationship between the age and frequency of organs dysfunction (?2/P = 20.24/0.20). Infection, heart failure, hypertension, and diabetes were the common predisposing factors to organ(s) dysfunction in percentages of 63.6%, 30.2%, & 22% respectively. Mild degree of organs dysfunction were most frequently noticed on admission, after 24 and 96 hours of admission to the ICU with mean SOFA scores of 5.08 ± 1.601, 4.87± 1.86, & 5.00 ± 1.87 respectively. The mean total and subtotal SOFA scores didn’t differ significantly in different assessment times (F / P= 1.29/0.35, 3.63/0.10, 2.69/0.72). The fate of the studied sample differed significantly in relation to the total mean SOFA scores (?²= 54.96, p= 0.000). Conclusion: multi-organ(s) dysfunction was evident among critically ill patients. The most common predisposing factors were comorbidity diseases, infection on admission, after 48 and 96 hours of admission, having different types of shock, and trauma. So, identification and management of these predisposing factors may decrease the complication and improve patients' outcomes. Recommendations: Based on findings of the present study the following are recommended: strict application of universal precautions / infection control measures; prevention, and early detection of shock, sepsis, and so organ dysfunction; designing continuous practical educational programs about the application of the strict aseptic technique, the universal precautions and infection control for critical care nurses; Designing booklets and posters about early manifestation, predisposing factors, and importance of prevention of sepsis and organ dysfunction for critical care nurses; and utilization of SOFA scores in the management of patient with sepsis and organ dysfunction.

Key words: Predisposing factors, Organ(s) Dysfunction, Critically Ill Patients, Sepsis, SOFA scores.