Outcomes of patients with severe infection in Uganda according to adherence to the World Health Organization's Integrated Management of Adolescent and Adult Illness fluid resuscitation guidelines
We determined outcomes in hospitalized patients in Uganda with World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI) defined septic shock (IMAI-shock) or severe respiratory distress without shock (IMAI-SRD) based on whether they received recommended fluid resuscitation according to IMAI guidelines.Materials and methods:
We performed a secondary analysis of a prospective cohort of adult septic patients in Uganda that included the volume of fluids patients received during the first 6 h of resuscitation. We used logistic regression to determine predictors of outcomes.Results:
We evaluated 122 patients with IMAI-shock and 32 patients with IMAI-SRD. For patients with IMAI-shock or IMAI-SRD, there was no difference in mortality between those that received IMAI recommended fluid volume and those that did not (30% vs 36%, p = 0.788; 22% vs 57%, p = 0.08). For patients with IMAI-shock, in-hospital mortality was associated with mid-upper arm circumference (adjusted odds ratio [aOR] 0.841, 95% confidence interval [CI] 0.722–0.979, p = 0.026) and ambulation (aOR 0.247, 95%CI 0.084–0.727, p = 0.011). We found no associations with in-hospital mortality for patients with IMAI-SRD.Conclusion:
IMAI recommended fluid resuscitation was not associated with better outcomes for patients with IMAI-shock or IMAI-SRD. Further studies are needed to optimize resuscitation for patients with severe infection in resource-limited settings such as Uganda.