Browsing by Author "Ramírez, Vanessa"
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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.
- PublicationEarly rise in central venous pressure during a spontaneous breathing trial: A promising test to identify patients at high risk of weaning failure?(2019) Dubo, Sebastián; Valenzuela, Emilio Daniel; Aquevedo, Andrés; Jibaja, Manuel; Berrutti, Dolores; Labra, Christian; Lagos, Rossana; García, María Fernanda; Ramírez, Vanessa; Tobar, Milton; Picoita, Fabricio; Peláez, Cristian; Carpio, David; Alegría, Leyla; Hidalgo, Carolina; Godoy, Karen; Bruhn, Alejandro; Hernández, Glenn; Bakker, Jan; Castro, RicardoBackground The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure. Methods Two-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT. Results One-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001). Conclusions An early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.
- 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.
- 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