Manuel Jibaja1, Guillermo Ortiz-Ruiz2, Fernanda García3, Manuel Garay-Fernández4, Felipe de Jesús Montelongo5, Jorge Martinez6, José Antonio Viruez7, Orville Baez-Pravia8, Santiago Salazar9, Francisco Villacorta-Cordova10, Freddy Morales11, Amilcar Tinoco-Solórzano12, Carlos Ibañez Guzmán13, Bruno Valle Pinheiro14, Felix Zubia-Olaskoaga15, Carmelo Dueñas16, Antonio Lara Garcia17, Pablo Cardinal-Fernández18. 1. Intensive Care Unit, Hospital Eugenio Espejo, Quito, Ecuador; Escuela de Medicina, Universidad Internacional del Ecuador, Quito, Ecuador. Electronic address: mjibaja79@gmail.com. 2. Universidad El Bosque, Bogotá, Colombia; Universidad de Barcelona, Spain. 3. Intensive Care Unit, Hospital Eugenio Espejo, Quito, Ecuador. 4. Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia; Universidad El Bosque, Bogotá, Colombia. 5. Intensive Care Unit, Hospital General de las Américas, Ecatepec, Mexico. 6. Intensive Care Unit, Hospital San Pedro, Pasto, Colombia. 7. Intensive Care Unit, Hospital Norte, El Alto, Bolivia. 8. Intensive Care Unit, Hospital Universitario HM Sanchinarro, Madrid, Spain. 9. Intensive Care Unit, Hospital Carlos Andrade Marín, Quito, Ecuador. 10. Intensive Care Unit, Hospital General Docente, Riobamba, Ecuador. 11. Intensive Care Unit, Hospital Oncológico Dr. Julio Villacreses Comont, Portoviejo, Ecuador; Intensive Care Unit, Clínica Santa Margarita, Portoviejo, Ecuador. 12. Intensive Care Unit, Hospital Ramiro Prialé Prialé EsSalud, Huancayo, Peru; Centro de Investigación de Medicina de la altura, Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru. 13. Intensive Care Unit, Hospital Obrero N° 1, La Paz, Bolivia. 14. Pulmonary Research Laboratory, Federal University of Juiz de Fora, Minas Gerais, Brazil; Intensive Care Unit, Hospital Universitário, Universidade Federal de Juiz de Fora, Minas Gerais, Brazil. 15. Intensive Care Department, Donostia University Hospital, San Sebastián, Spain; Departamento de Medicina, Universidad del País Vasco-Euskal Herriko Unibertsitatea, Spain. 16. Intensive Care Department, Gestión Salud, Cartagena, Colombia; Universidad de Cartagena, Cartagena, Colombia. 17. Universidad El Bosque, Bogotá, Colombia; Intensive Care Unit, Hospital Santa Clara Bogotá, Colombia. 18. Hospital Universitario HM Sanchinarro, Madrid, Spain; HM Research Foundation, Madrid, Spain.
Abstract
OBJECTIVE: (i) Analyze the effect of altitude above the sea level on the mortality rate in patients undergoing invasive mechanical ventilation. (ii) Validate the traditional equation for adjusting PaO2/FiO2 according to the altitude. DESIGN: A prospective, observational, multicenter and international study conducted during August 2016. PATIENTS: Inclusion criteria: (i) age between 18 and 90 years old, (ii) admitted to intensive care unit (ICU) situated at the same altitude above the sea level (AASL) in which the patients has stayed, at least, during the previous 40 days and (iii) received invasive MV for at least 12h. MATERIAL AND METHODS: All variables were registered the day of intubation (day 0). Patients were followed until death, ICU discharge or day 28. PaO2/FiO2 ratio was adjusted by the AASL according to: PaO2/FiO2*(barometric pressure/760). Categorical variables were compared with χ2 and Cochran-Mantel-Haenszel test. Continuous variables with Mann-Whitney. Correlation between continuous variables was analyzed graphically and analytically. Logistic regression model was constructed to identify factors associated to mortality. Kapplan-Meier method was used to estimate the probability of survival according to the altitude. A 2-side p value <0.05 was consider significant. RESULTS: 249 patients (<1500m n=55; 1500 to <2500m n=20; 2500 to <3500m n=155 and ≥3500m n=19) were included. Adjusted and non-adjusted PaO2/FiO2 were correlated with several respiratory and non respiratory variables. None discordances between non adjusted and adjusted PaO2/FiO2 were identified. However, several correlations were appreciated only in patients situated <1500m or in >1500m. Seventy-nine patients died during the ICU stayed (32%). The mortality curve was not affected by the altitude above the sea level. Variables independently associated to mortality are: PEEP, age, systolic arterial blood pressure, and platelet count. AUROC: 0.72. CONCLUSION: In acclimatized patients undergoing invasive mechanical ventilation, the traditional equation for adjusting PaO2/FiO2 according the elevation above the sea level seems to be inaccurate and the altitude above the sea level does not affect the mortality risk.
OBJECTIVE: (i) Analyze the effect of altitude above the sea level on the mortality rate in patients undergoing invasive mechanical ventilation. (ii) Validate the traditional equation for adjusting PaO2/FiO2 according to the altitude. DESIGN: A prospective, observational, multicenter and international study conducted during August 2016. PATIENTS: Inclusion criteria: (i) age between 18 and 90 years old, (ii) admitted to intensive care unit (ICU) situated at the same altitude above the sea level (AASL) in which the patients has stayed, at least, during the previous 40 days and (iii) received invasive MV for at least 12h. MATERIAL AND METHODS: All variables were registered the day of intubation (day 0). Patients were followed until death, ICU discharge or day 28. PaO2/FiO2 ratio was adjusted by the AASL according to: PaO2/FiO2*(barometric pressure/760). Categorical variables were compared with χ2 and Cochran-Mantel-Haenszel test. Continuous variables with Mann-Whitney. Correlation between continuous variables was analyzed graphically and analytically. Logistic regression model was constructed to identify factors associated to mortality. Kapplan-Meier method was used to estimate the probability of survival according to the altitude. A 2-side p value <0.05 was consider significant. RESULTS: 249 patients (<1500m n=55; 1500 to <2500m n=20; 2500 to <3500m n=155 and ≥3500m n=19) were included. Adjusted and non-adjusted PaO2/FiO2 were correlated with several respiratory and non respiratory variables. None discordances between non adjusted and adjusted PaO2/FiO2 were identified. However, several correlations were appreciated only in patients situated <1500m or in >1500m. Seventy-nine patients died during the ICU stayed (32%). The mortality curve was not affected by the altitude above the sea level. Variables independently associated to mortality are: PEEP, age, systolic arterial blood pressure, and platelet count. AUROC: 0.72. CONCLUSION: In acclimatized patients undergoing invasive mechanical ventilation, the traditional equation for adjusting PaO2/FiO2 according the elevation above the sea level seems to be inaccurate and the altitude above the sea level does not affect the mortality risk.
Authors: Manuel Jibaja; Estefania Roldan-Vasquez; Jordi Rello; Hua Shen; Nelson Maldonado; Michelle Grunauer; Ana María Díaz; Fernanda García; Vanessa Ramírez; Hernán Sánchez; José Luis Barberán; Juan Pablo Paredes; Mónica Cevallos; Francisco Montenegro; Soraya Puertas; Killen Briones; Marlon Martínez; Jorge Vélez-Páez; Mario Montalvo-Villagómez; Luis Herrera; Santiago Garrido; Ivan Sisa Journal: J Intensive Care Med Date: 2022-05-09 Impact factor: 2.889
Authors: Javier Leonardo Galindo; Juan Ricardo Lutz; María Alejandra Izquierdo; Katherine Parra; Lina María Prieto; Jorge Alberto Carrillo Journal: Can Respir J Date: 2021-06-08 Impact factor: 2.409