Browsing by Author "García, Fernanda"
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- PublicationClinical characteristics, systemic complications, and in-hospital outcomes for patients with COVID-19 in Latin America. LIVEN-Covid-19 study: A prospective, multicenter, multinational, cohort study(2022) Reyes, Luis F; Bastidas, Alirio; Narváez, Paula O; Parra-Tanoux, Daniela; Fuentes, Yuli V; Serrano-Mayorga, Cristian C; Ortíz, Valentina; Caceres, Eder L; Ospina-Tascon, Gustavo; Díaz, Ana M; Jibaja, Manuel; Vera, Magdalena; Silva, Edwin; Gorordo-Delsol, Luis Antonio; Maraschin, Francesca; Varón-Vega, Fabio; Buitrago, Ricardo; Poveda, Marcela; Saucedo, Lina M; Estenssoro, Elisa; Ortíz, Guillermo; Nin, Nicolás; Calderón, Luis E; Montaño, Gina S; Chaar, Aldair J; García, Fernanda; Ramírez, Vanessa; Picoita, Fabricio; Peláez, Cristian; Unigarro, Luis; Friedman, Gilberto; Cucunubo, Laura; Bruhn, Alejandro; Hernández, Glenn; Martin-Loeches, IgnacioPurpose: The COVID-19 pandemic has spread worldwide, and almost 396 million people have been infected around the globe. Latin American countries have been deeply affected, and there is a lack of data in this regard. This study aims to identify the clinical characteristics, in-hospital outcomes, and factors associated with ICU admission due to COVID-19. Furthermore, to describe the functional status of patients at hospital discharge after the acute episode of COVID-19. Material and methods: This was a prospective, multicenter, multinational observational cohort study of subjects admitted to 22 hospitals within Latin America. Data were collected prospectively. Descriptive statistics were used to characterize patients, and multivariate regression was carried out to identify factors associated with severe COVID-19. Results: A total of 3008 patients were included in the study. A total of 64.3% of patients had severe COVID-19 and were admitted to the ICU. Patients admitted to the ICU had a higher mean (SD) 4C score (10 [3] vs. 7 [3)], p<0.001). The risk factors independently associated with progression to ICU admission were age, shortness of breath, and obesity. In-hospital mortality was 24.1%, whereas the ICU mortality rate was 35.1%. Most patients had equal self-care ability at discharge 43.8%; however, ICU patients had worse self-care ability at hospital discharge (25.7% [497/1934] vs. 3.7% [40/1074], p<0.001). Conclusions: This study confirms that patients with SARS CoV-2 in the Latin American population had a lower mortality rate than previously reported. Systemic complications are frequent in patients admitted to the ICU due to COVID-19, as previously described in high-income countries.
- PublicationEffect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study(2022) Jibaja, Manuel; Roldan-Vasquez, Estefania; Rello, Jordi; Shen, Hua; Maldonado, Nelson; Grunauer, Michelle; Díaz, Ana María; García, Fernanda; Ramírez, Vanessa; Sánchez, Hernán; Barberán, José Luis; Paredes, Juan Pablo; Cevallos, Mónica; Montenegro, Francisco; Puertas, Soraya; Briones, Killen; Martínez, Marlon; Vélez-Páez, Jorge; Montalvo-Villagómez, Mario; Herrera, Luis; Garrido, Santiago; Sisa, IvanPurpose: 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. Keywords: COVID-19; ICU; SARS-CoV-2; high altitude; sea level; survival.
- PublicationHospital Mortality and Effect of Adjusting PaO2/FiO2 According to Altitude Above the Sea Level in Acclimatized Patients Undergoing Invasive Mechanical Ventilation. A Multicenter Study(2019) Jibaja, Manuel; Ortiz-Ruiz, Guillermo; García, Fernanda; Garay-Fernández, Manuel; Montelongo, Felipe de Jesús; Martinez, Jorge; Viruez, José Antonio; Baez-Pravia, Orville; Salazar, Santiago; Villacorta-Cordova, Francisco; Morales, Freddy; Tinoco-Solórzano, Amilcar; Ibañez Guzmán, Carlos; Valle Pinheiro, Bruno; Zubia-Olaskoaga, Felix; Dueñas, Carmelo; Lara Garcia, Antonio; Cardinal-Fernández, PabloObjective: (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. Keywords: Altitud; Altitud elevada; Altitude; Fallo respiratorio; High altitude; Mechanical ventilation; Mortalidad; Mortality; Respiratory failure; Ventilación mecánica.
- PublicationRisk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU A retrospective cohort multicentric study(2024) Fuenmayor-González, Luis; Vera-Ormaza, Jair; Shen, Hua; Corella-Ortega, Belén; Fajardo-Loaiza, Thalía; Borja-Pérez, Cristina; Ochoa-Godoy, Nancy; Vásquez-Barzallo, Sebastián; Díaz-Rodríguez, Juan; María Díaz, Ana; García, Fernanda; Ramírez, Vanessa; Sánchez, Hernán; Barberán, José Luis; Paredes, Juan Pablo; Cevallos, Mónica; Montenegro, Francisco; Puertas, Soraya; Briones, Killen; Martínez, Marlon; Vélez-Páez, Jorge; Montalvo-Villagómez, Mario; Herrera, Luis; Garrido, Santiago; Sisa, Ivan; Jibaja, Manuel