TY - JOUR
T1 - The Epidemiology and Impact of Hypoxemia in Sub-Saharan Africa: Prevalence, Practices, and Outcomes
AU - Sulani, Innocent
AU - Onofrey, Lauren A.
AU - Trevisi, Letizia
AU - Beane, Abi
AU - Brotherton, B. Jason
AU - Condo, Jeanine
AU - Dula, Dingase
AU - Ely, E. Wes
AU - Goel, Swati
AU - Gordon, Stephen B
AU - Haniffa, Rashan
AU - Hedt-Gauthier, Bethany
AU - Medline, Alexandra
AU - Njoki, Carolyne
AU - Oduor, Peter
AU - Otieno, George
AU - Rylance, Jamie
AU - Twagirumugabe, Theogene
AU - Umutoni, Nathalie
AU - Uwamahoro, Doris
AU - Vanderburg, Sky
AU - Waweru-Siika, Wangari
AU - Riviello, Elisabeth
PY - 2025/2/27
Y1 - 2025/2/27
N2 - Rationale: The epidemiology of hypoxemia in Sub-Saharan Africa is largely unknown.Objectives: Determine the prevalence, clinical care, and outcomes for hospitalized hypoxemic adults in Sub-Saharan Africa.Methods: We prospectively screened all adults admitted to five hospitals in Kenya, Malawi, and Rwanda over four months; identified those with hypoxemia (defined as SpO2<90% or receipt of oxygen therapy); and followed hypoxemic patients to discharge.Measurements and Main Results: Of the 24,724 adult patients admitted, 1,739 (7%) were hypoxemic on admission. Median imputed PaO2/FiO2 was 168. Of all patients screened, 4,546 (18%) had complete oxygenation domains (SpO2, device, and quantity) documented in their charts on admission. Among hypoxemic patients, 44% of in-hospital days (6,890/15,553) had chart documentation of all three oxygenation domains. Of 1,508 unique hypoxemic patients, 770 (51%) had at least one day with subtherapeutic oxygen (SpO2<90%). Of patient-days with patients on oxygen therapy, 84% indicated supratherapeutic oxygen therapy (SpO2>94%). Of all hypoxemic adults, 35% died in-hospital. Sixteen percent of patients were mechanically ventilated during their stay, and in-hospital mortality in this subgroup was 49%.Conclusions: Hypoxemia is common and associated with high mortality in five referral hospitals in three countries in Sub-Saharan Africa. Monitoring and titration practices for oxygen therapy are inconsistent. Subtherapeutic and supratherapeutic oxygen therapy are common. Mortality is high among the few patients who receive mechanical ventilation. These findings suggest the urgent need to study interventions to improve survival for hypoxemic patients in Sub-Saharan Africa. Prioritized investigations include the development and implementation of oxygen monitoring and titration protocols, as well as studies of advanced oxygen therapies other than mechanical ventilation.
AB - Rationale: The epidemiology of hypoxemia in Sub-Saharan Africa is largely unknown.Objectives: Determine the prevalence, clinical care, and outcomes for hospitalized hypoxemic adults in Sub-Saharan Africa.Methods: We prospectively screened all adults admitted to five hospitals in Kenya, Malawi, and Rwanda over four months; identified those with hypoxemia (defined as SpO2<90% or receipt of oxygen therapy); and followed hypoxemic patients to discharge.Measurements and Main Results: Of the 24,724 adult patients admitted, 1,739 (7%) were hypoxemic on admission. Median imputed PaO2/FiO2 was 168. Of all patients screened, 4,546 (18%) had complete oxygenation domains (SpO2, device, and quantity) documented in their charts on admission. Among hypoxemic patients, 44% of in-hospital days (6,890/15,553) had chart documentation of all three oxygenation domains. Of 1,508 unique hypoxemic patients, 770 (51%) had at least one day with subtherapeutic oxygen (SpO2<90%). Of patient-days with patients on oxygen therapy, 84% indicated supratherapeutic oxygen therapy (SpO2>94%). Of all hypoxemic adults, 35% died in-hospital. Sixteen percent of patients were mechanically ventilated during their stay, and in-hospital mortality in this subgroup was 49%.Conclusions: Hypoxemia is common and associated with high mortality in five referral hospitals in three countries in Sub-Saharan Africa. Monitoring and titration practices for oxygen therapy are inconsistent. Subtherapeutic and supratherapeutic oxygen therapy are common. Mortality is high among the few patients who receive mechanical ventilation. These findings suggest the urgent need to study interventions to improve survival for hypoxemic patients in Sub-Saharan Africa. Prioritized investigations include the development and implementation of oxygen monitoring and titration protocols, as well as studies of advanced oxygen therapies other than mechanical ventilation.
KW - Africa
KW - clinical care
KW - epidemiology
KW - hypoxemia
KW - outcomes
U2 - 10.1513/annalsats.202410-1092oc
DO - 10.1513/annalsats.202410-1092oc
M3 - Article
SN - 2325-6621
VL - 22
SP - 905
EP - 914
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 6
ER -