Hospital Mortality and Effect of Adjusting PaO2/FiO2 According to Altitude Above the Sea Level in Acclimatized Patients Undergoing Invasive Mechanical Ventilation. A Multicenter Study

Jibaja, Manuel; Ortiz, Guillermo; García, Fernanda; Garay-Fernández, Manuel; Montelongo, Felipe de Jesús; Martínez, J. Ladape; Viruez, José Antonio; Baez-Pravia, Orville; Salazar, Santiago; Villacorta-Cordova, Francisco; Morales, Freddy; Tinoco-Solórzano, Amilcar; Guzmán, Carlos Ibañez; Pinheiro, Bruno Valle; Zubia-Olaskoaga, Félix; Dueñas, Carmelo; García, Antonio Lara; Cardinal-Fernández, Pablo

doi:10.1016/j.arbr.2019.06.020

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…15,16 Hovewer, we did not follow this recommendation because in a multicenter study we found that in acclimatized patients (which is our case) undergoing invasive mechanical ventilation, the traditional equation for adjusting PaO 2 /F I O 2 according the elevation seems to be inaccurate. 17 In the bivariate analysis we considered the following covariates: APACHE II score, PaO 2 /F I O 2 , invasive mechanical ventilation parameters (plateau pressure, driving pressure, and compliance), duration of mechanical ventilation, and ICU length of stay (LOS). For the Cox regression model we used the following independent variables: age (a binary variable dichotomized by 62); presence of diabetes mellitus and hypertension; hemoglobin concentrations; creatine concentrations ( ≥ 2 vs. <2 mg/dl); APACHE II score, and capillary refill time.…”

Section: Methodsmentioning

confidence: 99%

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study

Jibaja

Roldan-Vasquez

Rello

et al. 2022

J Intensive Care Med

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Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.

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Section: Methodsmentioning

confidence: 99%

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study

Jibaja

Roldan-Vasquez

Rello

et al. 2022

J Intensive Care Med

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“…Jibaba et al already showed that adjusting the PaO 2 /FiO 2 in patients with mechanical ventilation acclimatized to altitude did not improve the evaluation of respiratory variables. 12 Hypobaric hypoxia at high altitudes may be a potential physiological cause, suggesting perhaps the need to adjust these indexes to lower cutoff points, 25,26 although this possibility could not be assessed in this study. Our calculation of the Youden index, with an IROX > 3.3 at 12 h, was not superior to the RR > 30 breaths per minute at 12 h.…”

Section: Discussionmentioning

confidence: 91%

“…Additionally, SpO 2 /FiO 2 was also adjusted for barometric pressure using the formula: sea level barometric pressure/city barometric pressure * SpO 2 /FiO 2 (patient): ROX altitude. 12 Significant clinical outcomes, such as intensive care mortality and ICU length of stay, were examined.…”

Section: Variablesmentioning

confidence: 99%

Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?

Molano-Franco

Mario

Beltran

et al. 2021

J Intensive Care Med

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Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Methods: Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. Results: One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). Conclusions: High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.

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“…However, results are con icting and may be explained by differences in population density, underreporting of cases and barriers of access to healthcare among populations (23)(24)(25). Although altitude does not affect the mortality rate in general patients undergoing invasive mechanical ventilation, speci c features of subgroups of patients with acute respiratory distress syndrome in COVID-19 may in uence the need of ventilatory support at high-altitude (26). We theorize that high-altitude hypoxemia could have impacted in severity and course of acute respiratory failure in our COVID-19 population.…”

Section: Resultsmentioning

confidence: 99%

Characteristics and Clinical Course of Adult in-Patients With SARS-CoV-2 Pneumonia in Bogotá, Colombia.

Galindo¹,

Lutz²,

Izquierdo³

et al. 2021

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Background: SARS-CoV-2 virus has spread worldwide causing a crisis in healthcare systems. We aimed to describe the clinical characteristics and to explore risk factors of death, critical care admission and use of invasive mechanical ventilation in hospitalized patients with SARS-CoV-2 pneumonia in Bogotá, Colombia.Methods: We conducted a cross-sectional study of adult patients with laboratory-confirmed SARS-CoV-2 pneumonia. Demographic and clinical data were extracted from electronic records. Univariate and multivariable methods were performed to investigate the relationship between each variable and clinical outcomes at 28 days of follow-up.Results: Between March 20 and June 30, 2020, 377 adults (56.8% male) were included in the study, of whom 85 (22.6%) died. Non-survivors were older on average than survivors (mean age, 56.7 years [SD 15.8] vs. 70.1 years [SD 13.9]) and more likely male (28 [32.9%] vs. 57 [67.1%]). Most patients had at least one underlying disease (333 [88.3%]), including arterial hypertension (149 [39.5%]), overweight (145 [38.5%]) and obesity (114 [30.2%]). Critical care admission (158 [41.9%]) and invasive mechanical ventilation (123 [32.6%]) was high. Age over 65 years (OR 9.26, 95% CI 3.29-26.01; p=0.00), ICU admission (OR 12.37, 95% CI 6.08-25.18; p=0.00), and arterial pH higher than 7.47 (OR 0.25, 95% CI 0.08-0.74; p=0.01) were associated with in-hospital mortality.Conclusions: In this study of in-hospital patients with SARS-CoV-2 pneumonia frequency of death was similar to what has been reported. ICU admission and use of invasive mechanical ventilation was high. Risk factors as older age, ICU admission, and arterial pH were associated with mortality.

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Hospital Mortality and Effect of Adjusting PaO2/FiO2 According to Altitude Above the Sea Level in Acclimatized Patients Undergoing Invasive Mechanical Ventilation. A Multicenter Study

Cited by 5 publications

References 21 publications

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study

Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study

Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?

Characteristics and Clinical Course of Adult in-Patients With SARS-CoV-2 Pneumonia in Bogotá, Colombia.

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