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

• Autores: Jibaja, Manuel, Ortiz-Ruiz, Guillermo, García, Fernanda, Montelongo, Felipe de Jesús, Martinez, Jorge, Viruez, José Antonio, Salazar, Santiago, Villacorta-Cordova, Francisco, Morales, Freddy, Tinoco Solórzano, Amilcar, Baez-Pravia, Orville, Garay-Fernández, Manuel
• Formato: artículo
• Fecha de Publicación: 2020
• Institución: Seguro Social de Salud
• Repositorio: ESSALUD-Institucional
• Lenguaje: inglés
• OAI Identifier: oai:repositorio.essalud.gob.pe:20.500.12959/870
• Enlace del recurso: https://hdl.handle.net/20.500.12959/870; https://doi.org/10.1016/j.arbres.2019.06.024
• Nivel de acceso: acceso abierto
• Materia: Altitud; Altitud elevada; Mortalidad; Fallo respiratorio; Ventilación mecánica; Altitude; High altitude; Mortality; Respiratory failure; Mechanical ventilation; https://purl.org/pe-repo/ocde/ford#3.02.08; https://purl.org/pe-repo/ocde/ford#3.02.07

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 12 h. 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 2 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 (1500 m. 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.