Nakuru

Acute hypoxemia is a serious condition that commonly occurs in adults in resource-limited settings and can be deadly. This trial investigates whether high flow oxygen therapy leads to better survival outcomes compared to standard flow oxygen in adults with low blood oxygen levels treated in five hospitals in low or lower middle income countries. The study also aims to understand what helps or hinders the use of high flow oxygen in these settings and to measure how much oxygen each method uses. Participants will be randomly assigned to receive either high flow oxygen delivered through a large nasal cannula at up to 60 liters per minute, or standard flow oxygen delivered by nasal cannula, face mask, or non-rebreather mask at flows up to 15 liters per minute. Both treatment groups aim to maintain blood oxygen saturation between 90% and 94%. The study will compare outcomes between these two oxygen delivery methods throughout the hospital stay. During the study, participants will be monitored for survival in the hospital up to day 90, as well as functional status, need for mechanical ventilation, days requiring oxygen, and length of hospital and ICU stay. Researchers will also track the time until escalation to more intensive respiratory support if needed. The study will examine oxygen use and barriers to implementing high flow oxygen therapy. Participants involvement will include regular assessments and follow-up during hospitalization and up to 90 days after admission.

The ICU-related Out-of-Pocket Expenses ICOPE study is a multinational, prospective observational study conducted in African and Asian countries to understand the financial impact of ICU care on patients and their families. The study focuses on measuring out-of-pocket expenses and the occurrence of catastrophic health expenditure among patients who stay in the ICU for more than 24 hours, including those who receive mechanical ventilation and those who do not. The study addresses the rising cost burden related to ICU care in low- and middle-income countries LMICs and aims to identify factors contributing to financial hardship. Participants include all patients admitted to participating ICUs during a 14-day recruitment period, with a planned sample size of at least 354 patients. The study compares groups of patients receiving invasive mechanical ventilation with those who do not, tracking their ICU-related expenses. The follow-up period extends from ICU admission to discharge, with additional assessments at 30 days and 6 months, spanning a total study duration of 18 months. During the study, researchers will collect detailed information about direct and indirect costs associated with ICU care, including medical and non-medical expenses. They will also examine how families cope with these costs and identify risk factors for catastrophic health expenditure. The primary outcomes include out-of-pocket cost per patient episode and the relative risk of catastrophic health expenditure by ICU discharge. Secondary outcomes include risk factors for catastrophic expenditure and the frequency of various coping strategies used by families.