Hospital Mortality and Effect of Adjusting PaO/FiO According to Altitude Above the Sea Level in Acclimatized Patients Undergoing Invasive Mechanical Ventilation. A Multicenter Study.

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 PaO/FiO 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. PaO/FiO ratio was adjusted by the AASL according to: PaO/FiO*(barometric pressure/760). Categorical variables were compared with χ 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 PaO/FiO were correlated with several respiratory and non respiratory variables. None discordances between non adjusted and adjusted PaO/FiO 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 PaO/FiO according the elevation above the sea level seems to be inaccurate and the altitude above the sea level does not affect the mortality risk.