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The diagnosis of acute respiratory distress syndrome (ARDS) includes the ratio of pressure arterial oxygen and inspired oxygen fraction (P/F) [less than or equal to] 300, which is often adjusted in locations more than 1,000 meters above sea level (masl) due to hypobaric hypoxemia. The main objective of this study was to develop a prediction model for in-hospital mortality among patients with ARDS due to coronavirus disease 2019 (COVID-19) (C-ARDS) at 2,600 masl with easily available variables at patient admission and to compare its discrimination capacity with a second model using the P/F adjusted for this high altitude. This study was an analysis of data from patients with C-ARDS treated between March 2020 and July 2021 in a university hospital located in the city of Bogotá, Colombia, at 2,600 masl. Demographic and laboratory data were extracted from electronic records. For the prediction model, univariate analyses were performed to screen variables with p <0.25. Then, these variables were automatically selected with a backward stepwise approach with a significance level of 0.1. The interaction terms and fractional polynomials were also examined in the final model. Multiple imputation procedures and bootstraps were used to obtain the coefficients with the best external validation. In addition, total adjustment of the model and logistic regression diagnostics were performed. The same methodology was used to develop a second model with the P/F adjusted for altitude. Finally, the areas under the curve (AUCs) of the receiver operating characteristic (ROC) curves of the two models were compared. A total of 2,210 subjects were included in the final analysis. The final model included 11 variables without interaction terms or nonlinear functions. The coefficients are presented excluding influential observations. The final equation for the model fit was g(x) = age(0.04819)+weight(0.00653)+height(-0.01856)+haemoglobin(-0.0916)+platelet count(-0.003614)+ creatinine(0.0958)+lactate dehydrogenase(0.001589)+sodium(-0.02298)+potassium(0.1574)+systolic pressure(-0.00308)+if moderate ARDS(0.628)+if severe ARDS(1.379), and the probability of in-hospital death was p (x) = e .sup.g (x) /(1+ e .sup.g (x)). The AUC of the ROC curve was 0.7601 (95% confidence interval (CI) 0.74-0, 78). The second model with the adjusted P/F presented an AUC of 0.754 (95% CI 0.73-0.77). No statistically significant difference was found between the AUC curves (p value = 0.6795). This study presents a prediction model for patients with C-ARDS at 2,600 masl with easily available admission variables for early stratification of in-hospital mortality risk. Adjusting the P/F for 2,600 masl did not improve the predictive capacity of the model. We do not recommend adjusting the P/F for altitude.

Background The role of cardiac surgery in octogenarians is debated, but limited data exist for patients aged 65–79. This study compared clinical characteristics, surgical procedures, and outcomes between patients ≥ 80 and those aged 65–79 years to evaluate whether age alone should influence surgical decisions. Methods We conducted a retrospective cohort study including all patients aged ≥ 65 who underwent cardiac surgery between January 2019 and December 2022. Patients were divided into two groups: 65–79 years ( n  = 217) and ≥ 80 years ( n  = 57). Demographic, clinical, and surgical data were collected and analyzed. EuroSCORE II and STS scores were evaluated as predictors of in-hospital mortality. Results Among 274 patients (median age 74 [IQR 69–79]), the overall in-hospital mortality rate was 11.6%, slightly higher in octogenarians, although the difference was not statistically significant (15.7% vs. 10.5%, p  = 0.39). Octogenarians had significantly higher EuroSCORE II values (4.31 vs. 2.81, p  < 0.005), longer cardiopulmonary bypass and aortic cross-clamp times, and a higher proportion of non-elective procedures. There were no statistically significant differences between groups in postoperative complications, including acute kidney injury, atrial fibrillation, or cardiogenic shock. EuroSCORE II demonstrated a trend toward better discriminative performance in octogenarians (AUC 0.831; 95% CI: 0.6964–0.9656) compared to patients aged 65–79 years (AUC 0.6432; 95% CI: 0.5825–0.8095), though this did not reach statistical significance (p = 0.06175). The STS score showed moderate and consistent predictive performance across age groups, with AUCs of 0.6981 in the overall cohort, 0.6971 in patients <80 years, and 0.6894 in patients ≥80 years. Conclusion Patients aged ≥80 years exhibited similar in-hospital mortality rates and no increase in postoperative complication rates compared to younger elderly patients. EuroSCORE II appears to outperform the STS score in predicting in-hospital mortality among octogenarians.

Induction of general anaesthesia is often accompanied by hypotension. Standard haemodynamic monitoring during anaesthesia relies on intermittent blood pressure and heart rate. Continuous monitoring systemic blood pressure requires invasive or advanced modalities creating a barrier for obtaining important information of the circulation. The Peripheral Perfusion Index (PPI) is obtained non-invasively and continuously by standard photoplethysmography. We hypothesized that different patterns of changes in systemic haemodynamics during induction of general anaesthesia would be reflected in the PPI. Continuous values of PPI, stroke volume (SV), cardiac output (CO), and mean arterial pressure (MAP) were evaluated in 107 patients by either minimally invasive or non-invasive means in a mixed population of surgical patients. 2 min after induction of general anaesthesia relative changes of SV, CO, and MAP was compared to the relative changes of PPI. After induction total cohort mean(± st.dev.) MAP, SV, and CO decreased to 65(± 16)%, 74(± 18)%, and 63(± 16)% of baseline values. In the 38 patients where PPI decreased MAP was 57(± 14)%, SV was 63(± 18)%, and CO was 55(± 18)% of baseline values 2 min after induction. In the 69 patients where PPI increased the corresponding values were MAP 70(± 15)%, SV 80(± 16)%, and CO 68(± 17)% (all differences: p < 0,001). During induction of general anaesthesia changes in PPI discriminated between the degrees of reduction in blood pressure and algorithm derived cardiac stroke volume and -output. As such, the PPI has potential to be a simple and non-invasive indicator of the degree of post-induction haemodynamic changes.

Background During the COVID-19 pandemic, a great number of patients required Mechanical Ventilation (MV). Tracheostomy is the preferred procedure when difficult weaning is presented. Surgical techniques available for performing tracheostomy are open and percutaneous, with contradictory reports on the right choice. This paper aims to describe the clinical results after performing a tracheostomy in patients with COVID-19, regarding both surgical techniques. Methods An observational, analytical study of a retrospective cohort was designed. All patients admitted to the Hospital Universitario Mayor Méderi, between March 2020 and April 2021 who presented COVID-19 requiring MV and who underwent tracheostomy were reviewed. Open versus percutaneous tracheostomy groups were compared and the primary outcome evaluated was in-hospital mortality. Results A total of 113 patients were included in the final analysis. The median age was 66.0 (IQR: 57.2 – 72.0) years old and 77 (68.14%) were male. Open tracheostomy was performed in 64.6% ( n  = 73) of the patients and percutaneous tracheostomy in 35.4% ( n  = 40) with an in-hospital mortality of 65.7% ( n  = 48) and 25% ( n  = 10), respectively ( p  < 0.001). In a multivariate analysis, open tracheostomy technique [OR 9.45 (95% CI 3.20–27.92)], older age [OR 1.05 (95% CI 1.01–1.09)] and APACHE II score [OR 1.10 (95% CI 1.02–1.19)] were identified as independent risk factors for in-hospital mortality. Late tracheostomy (after 14 days) [OR 0.31 (95% CI 0.09–1.02)] and tracheostomy day PaO 2 /FiO 2 [OR 1.10 (95% CI 1.02–1.19)] were not associated to in-hospital mortality. Conclusions Percutaneous tracheostomy was independently associated with lower in-hospital mortality and should be considered the first option to perform this type of surgery in patients with COVID-19 in extended MV or difficulty weaning.

Background Advancing age is associated with an increase in mortality among patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed to determine risk factors for in-hospital mortality in patients over 60 years old with COVID-19-related ARDS (C-ARDS). Methods This was an observational, analytical, retrospective study conducted on a cohort that included all patients aged 60 years or older diagnosed with COVID-ARDSwho were admitted to a high-complexity hospital in Bogotá, Colombia, between March 2020 and July 2021. Results A total of 1563 patients were included in the analysis, with a median age of 73 years (interquartile range [IQR]: 67–80) and 811 deaths (51.8%). Independent risk factors for in-hospital mortality were identified as follows: patients aged 71–80 [OR 1.87 (95% CI 1.33–2.64)], age > 80 [OR 8.74 (95% CI 5.34–14.31)], lactate dehydrogenase (LDH) [OR 1.009 (95% CI 1.003–1.0015)], severe C-ARDS [OR 2.16 (95% CI 1.50–3.11)], use of invasive mechanical ventilation (IMV) [OR 12.94 (95% CI 9.52–17.60)], and use of steroids [OR 1.49 (95% CI 1.09–2.03)]. In patients over 80 years of age ( n  = 388), the primary risk factor associated with in-hospital mortality was the use of IMV ( n  = 76) [OR 6.26 (95% CI 2.67–14.69)], resulting in an in-hospital mortality rate of 89.4% ( n  = 68) when this therapy was implemented. Conclusions The primary risk factors for in-hospital mortality in patients older than 60 years were age, the use of IMV, the severity of C-ARDS, use of steroids and elevated LDH values. Among patients older than 80 years, the main risk factor for in-hospital mortality was the use of IMV. In cases of C-ARDS in older patients, the decision to initiate IMV should always be individualized; therefore, the use of alternative oxygen delivery systems as the first-line approach can be considered.

The optimal role of invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (C-ARDS) remains uncertain. During the pandemic, many patients with ARDS were managed without IMV, creating a unique opportunity to examine whether IMV is an independent risk factor for mortality rather than a marker of disease severity alone. This study aimed to estimate the adjusted association between IMV and in-hospital mortality in patients with C-ARDS. We performed a secondary analysis of a previously published prospective cohort of adults hospitalized with confirmed C-ARDS at a tertiary center located at high altitude (2,640 m, Bogotá, Colombia). Covariate balancing propensity scores (CBPS) were used to derive inverse probability of treatment weights (IPTW). Weighted logistic regression was then applied to estimate the average treatment effect (ATE) of IMV on in-hospital mortality. As a secondary objective, respiratory mechanics during the first 5 days of IMV were described to evaluate adherence to lung-protective ventilation. A total of 1,724 patients with complete data were included; median age was 68 years, 65.9% were male, and overall mortality was 44.8%. Of these, 897 patients (52.0%) required IMV. Mortality differed markedly between groups: 65% in ventilated patients vs. 22% in non-ventilated patients. After IPTW adjustment, IMV remained independently associated with higher mortality (ATE-adjusted OR 7.67; 95% CI 6.20-9.48; p < 0.001). Respiratory mechanics were available for 838 (93.4%) ventilated patients. Median tidal volume, plateau pressure, and driving pressure were initially within protective ventilation targets; however, non-survivors showed small progressive increases in plateau and driving pressures over time. In this propensity score-weighted cohort of patients with COVID-19-related ARDS, IMV was strongly associated with in-hospital mortality after adjustment for measured confounders. Ventilatory parameters were generally within protective ranges during the early course of ventilation, although non-survivors showed less favorable longitudinal pressure trajectories. These findings support careful patient selection, optimization of non-invasive support when feasible, and strict adherence to lung-protective ventilation strategies. Residual confounding cannot be excluded.

Background Oral health is closely linked to well-being at work; however, evidence in hospital personnel remains limited. Methods Cross-sectional study in a Level II-1 hospital (n = 72). Oral-health–related quality of life (OHRQoL) was measured with OHIP-14 and perceived oral health (POH) with a modified HU-DBI. Bivariate associations were estimated with Spearman’s ρ and 95% confidence intervals; domain-level relationships were examined with proportional-odds ordinal logistic regression (Nagelkerke’s pseudo-R 2 ). Results OHRQoL was distributed as 38.9% Excellent, 26.4% Fair and 34.7% Poor; POH concentrated in the Low level (52.8%), followed by Excellent (29.2%) and Fair (18.1%). POH correlated positively with OHRQoL (ρ = 0.391; 95% CI 0.18–0.57; p = 0.001). Domain-level analyses showed the strongest links for psychological discomfort (ρ = 0.421; p < 0.001; pseudo-R 2 = 0.111; p = 0.027) and physical disability (ρ = 0.319; p = 0.006; pseudo-R 2 = 0.167; p = 0.004); social disability (ρ = 0.242; p = 0.040; pseudo-R 2 = 0.124; p = 0.017) and handicap (ρ = 0.298; p = 0.011; pseudo-R 2 = 0.131; p = 0.013) were smaller but significant, whereas functional limitation was non-significant (ρ = 0.096; p = 0.424; pseudo-R 2 = 0.014; p = 0.6). Conclusions Better perceived oral health is significantly associated with higher oral-health-related quality of life among hospital staff. Consequently, targeted workplace strategies, including education for self-care, pain management, and functional support, could enhance oral well-being. Moreover, open instruments and pilot reliability outputs are available to ensure transparency and reproducibility.

BackgroundMuslim immigrants and their direct descendants are a large ethnoreligious minority in many regions, yet their access to palliative care remains under-researched and poorly theorised for practice. Existing evidence points to structural, communicative and cultural constraints, while mechanisms at the threshold of access remain unclear.AimWe explored access to palliative care among this population, developed an explanatory model of access dynamics and reconstructed culturally and religiously framed narrative resources.DesignWe conducted a qualitative, multicentre, four-group study using constructivist Grounded theory with complementary Narrative inquiry. Loosely structured interviews followed Kaufmann’s ‘L’entretien compréhensif’ between August 2021 and December 2022.Setting/participantsThis study involved six centres in North Rhine-Westphalia, Germany. Participants were 53 adults from 14 countries in four groups (patients receiving palliative care vs not, relatives, interface stakeholders).ResultsThe Grounded theory SAME SAME BUT DIFFERENT conceptualises a paradox between formal equality and lived constraint at the threshold of access. Six analytical categories operated cyclically and mutually reinforced delayed access: (I) Othering/Belonging, (II) Information/Representation, (III) Role of the family, (IV) Palliative stigma, (V) ‘Language barrier’ as a multidimensional challenge and (VI) Dealing with life crisis, illness and death.Participants identified leverage points within the access dynamics, including native-language information and contact persons, openness to cultural-religious concerns, culture- and religion-sensitive training, Muslim support services and spiritual care and non-denominational environments.Narrative inquiry reconstructed four culturally and religiously framed narrative resources that shaped access decisions.ConclusionsIntersecting structural, communicative and meaning-making dynamics affect access to palliative care. Culturally adaptive, multilingual and community-engaged approaches require evaluation and should be supported by improved routine sociodemographic data.

Background/Objectives: Anemia is common in critically ill patients, yet red blood cell (RBC) transfusion without active bleeding does not consistently improve outcomes and carries risks such as pulmonary injury, fluid overload, and increased costs. Optimal transfusion thresholds remain debated, with some guidelines recommending a restrictive target of 7 g/dL instead of a more liberal target of 9 g/dL. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, EMBASE, and LILACS from January 1995 to October 2024. Thirteen randomized controlled trials involving 13,705 critically ill adults were included, with 6855 assigned to liberal and 6850 to restrictive transfusion strategies. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2, and the pooled effect sizes were estimated with a random-effects model. We registered the protocol in PROSPERO International Prospective Register of Systematic Reviews (CDR42024589225). Results: No statistically significant difference was observed in 30-day mortality between restrictive and liberal strategies (odds ratio [OR] 1.02; 95% confidence interval [CI], 0.83–1.25; I2 = 49%). Similarly, no significant differences emerged for the 90-day or 180-day mortality, hospital or intensive care unit (ICU) length of stay, dialysis requirement, or incidence of acute respiratory distress syndrome (ARDS). However, patients in the restrictive group received significantly fewer RBC units. The trial sequential analysis (TSA) indicated that the evidence accrued was insufficient to definitively confirm or exclude an effect on the 30-day mortality, as the required sample size was not reached. Conclusions: In conclusion, while our meta-analysis found no statistically significant difference in the short-term mortality between restrictive and liberal transfusion strategies, larger trials are needed to fully determine whether any clinically meaningful difference exists in critically ill populations.

BackgroundThere are few data on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) in cities over 1000 m above sea level (masl).ObjectivesTo describe the clinical characteristics and mortality of patients with COVID-19 treated at a high complexity hospital in Bogotá, Colombia, at 2640 masl.MethodsThis was an observational study of a cohort including 5161 patients with confirmed COVID-19 infection from 19 March 2020 to 30 April 2021. Demographic data, laboratory values, comorbidities, oxygenation indices, and clinical outcomes were collected. Data were compared between survivors and nonsurvivors. An independent predictive model was performed for mortality and invasive mechanical ventilation (IMV) using classification and regression trees (CART).ResultsThe median cohort age was 66 years (interquartile range (IQR) 53–77), with 1305 patients dying (25%) and 3856 surviving (75%). The intensive care unit (ICU) received 1223 patients (24%). Of 898 patients who received IMV, 613 (68%) of them perished. The ratio of partial pressure arterial oxygen (PaO2) to fraction inspired oxygen (FiO2), or the P/F ratio, upon ICU admission was 105 (IQR 77–146) and 137 (IQR 91–199) in the deceased and survivors, respectively. The CART model showed that the need for IMV, age greater than 79 years, ratio of oxygen saturation (SaO2) to FiO2, or the S/F ratio, less than 259, and lactate dehydrogenase (LDH) greater than 617 U/L at admission were associated with a greater probability of death.ConclusionAmong more than 5000 patients with COVID-19 treated in our hospital, mortality at hospital discharge was 25%. Older age, low S/F ratio, and high LDH at admission were predictors of mortality.