The phenomenon of hypoxic brain damage at Kenyatta National Hospital intensive care and high dependancy units
Information relating to twelve patients admitted into the Kenyatta National Hospital Intensive Care and High Dependency Units with a primary diagnosis of Hypoxic Brain Damage, was analyzed. The range of ages was from one-day-olds to adults and the length of stay within the units varied from one to nine days with an average stay of three days. Eight (66.7%) of the patients were admitted from operating theatres within or outside of Kenyatta National Hospital, while the remaining four (33.3%) were from the casualty. All twelve patients were resuscitated prior to admission either as a result of cardiac arrest (33.3%) or respiratory arrest or failure (66.7%). The duration of resuscitation was only indicated in one (8.3%) of the cases with the duration of resuscitation being five minutes. On admission to the units, three (27.3%) of the patients were hypotensive, one patient (8.3%) was bradycardic and six patients (50.5%) were hypothermic. Investigations done on the patients while in the units included arterial blood gases on all cases; random blood sugar in eleven cases (91.7%), hemoglobin levels in five cases (41.7%), serum sodium and potassium levels in ten (83.3%) and eleven (91.7%) cases respectively.Computer Tomography Scans of the brain were not done on any of the patients. Neurological assessments were done on all the twelve patients on admission. Ten (83.3%) of the patients had a Glasgow Coma Scale of 3 out of 15, one (8.3%) had a scale of 4 out of 15, one patient was not assessed as the patient was paralyzed and sedated with a neuromuscular blocking agent and a benzodiazepine 10 respectively. Pupillary light reflex assessment on admission revealed three patients (25%) had response to light while nine (75%) patients had no response to light. Of the latter, five (41.7%) had mid-dilated pupils and four (33.3%) fully dilated pupils. Management of patients included antibiotic therapy and mechanical ventilation in eleven cases (91.7%), ionotropic support in one case (8.3%) and steroid therapy in four cases (33.3%).Eleven (91.7%) of the patients died while in the unit while one (8.3%) was transferred to the wards. An assessment for brain death was made in only four (33.3%) of the patients.