Clinical Profile and Outcomes of Patients Requiring Invasive Mechanical Ventilation in a Medical ICU: A Prospective Observational Study from Central India

Abstract

Background: Invasive mechanical ventilation (IMV) is a cornerstone of critical care, yet data from medical ICUs in resource-limited settings in central India remain sparse. We aimed to characterise the clinical profile, complications, and outcomes of patients requiring IMV in a tertiary care medical ICU.

Methods: A prospective observational study was conducted in the Medical ICU (MICU) of C.R. Gardi Hospital, Ujjain, from 2023–2026. Adults (>12 years) requiring IMV for ≥24 hours were enrolled consecutively (n=143). Demographics, comorbidities, primary diagnosis, SOFA score, GCS, ABG parameters, ventilator settings, complications, and ICU outcomes were systematically recorded. Statistical analysis used the chi-square test, independent t-test, Mann–Whitney U test, and Kaplan–Meier survival analysis.

Results: Mean age was 55.92±17.06 years; 69.9% were male and 62.9% from rural areas. Leading diagnoses were COPD/asthma exacerbation (16.1%), pneumonia (15.4%), and stroke (15.4%). Mean SOFA score was 8.8±3.1 and mean GCS 8.6±4.5. Airway protection was the primary indication for IMV in 53.1% of cases. Lung-protective ventilation (tidal volume 6.0±0.2 mL/kg PBW) was applied in 97.9%. Overall ICU mortality was 58.0%. Mortality ranged from 0% in seizures to 91.7% in meningoencephalitis. Higher SOFA score was a significant predictor of mortality in sepsis (p=0.020), ACS/cardiogenic shock (p=0.040), stroke (p=0.030), and uremic encephalopathy (p=0.010). Ventilator-associated pneumonia (VAP) occurred in 10.5% overall and was markedly higher in non-survivors (16.9% vs 1.7%). Admission SOFA score, serum lactate, and VAP were independent predictors of ICU mortality.

Conclusions: IMV carries high mortality in this Indian MICU, particularly in neurological emergencies and sepsis. SOFA score, serum lactate, and VAP are key prognostic determinants. Consistent lung-protective ventilation and VAP prevention are feasible and critical in resource-limited Indian settings. These data provide locally relevant benchmarks for clinical practice and quality improvement.