Pautas éticas para la asignación de recursos sanitarios escasos en el marco de la pandemia por COVID-19 en Colombia

Barrera, Eduardo Alfonso Rueda; Duque, Andrea Caballero; Camargo, Diana Rocío Bernal; Torregrosa, Lilián; Castro, Edilma Marlén Suárez; Rueda, Fritz Eduardo Gempeler; Badoui, Nora

doi:10.30944/20117582.653

Cited by 10 publications

(7 citation statements)

References 8 publications

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“…The shift of priorities towards tackling the COVID-19 pandemic, as also observed in our study, has disrupted health care systems and in particular PHC services [ 28 ]. In Colombia, PHCCs were almost entirely suspended for several months and providers were asked to manage COVID-19 cases regardless of their specialisation [ 29 , 30 ]. In contrast, PHC facilities remained open in Mexico and they played a key role to mitigate the pandemic [ 31 ], however, the number of consulting patients also declined here.…”

Section: Discussionmentioning

confidence: 99%

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

et al. 2022

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Background During the COVID-19 pandemic, an increase of heavy alcohol use has been reported in several high-income countries. We examined changes in alcohol use during the pandemic among primary health care (PHC) patients in two middle income countries, Colombia and Mexico. Methods Data were collected during routine consultations in 34 PHC centres as part of a large-scale implementation study. Providers measured patients’ alcohol consumption with the three item ‘Alcohol Use Disorders Identification Test’ (AUDIT-C). Generalized linear mixed models were performed to examine changes in two dependent variables over time (pre-pandemic and during pandemic): 1) the AUDIT-C score and 2) the proportion of heavy drinking patients (8+ on AUDIT-C). Results Over a period of more than 600 days, data from N = 17 273 patients were collected. During the pandemic, the number of patients with their alcohol consumption measured decreased in Colombia and Mexico. Each month into the pandemic was associated with a 1.5% and 1.9% reduction in the mean AUDIT-C score in Colombia and Mexico, respectively. The proportion of heavy drinking patients declined during the pandemic in Colombia (pre-pandemic: 5.4%, 95% confidence interval (CI) = 4.8% to 6.0%; during the pandemic: 0.8%, 95% CI = 0.6% to 1.1%) but did not change in Mexico. Conclusions Average consumption levels declined and the prevalence of heavy drinking patterns did not increase. In addition to reduced opportunities for social drinking during the pandemic, changes in the population seeking PHC and restrictions in alcohol availability and affordability are likely drivers for lower levels of alcohol use by patients in this study.

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Section: Discussionmentioning

confidence: 99%

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

et al. 2022

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“…Then, they reviewed the electronic clinical records in the institutional platform SAHI ® to verify inclusion and exclusion criteria. A standard form was used to collect data that included age, sex, weight, height, comorbidities, vaccination state, Charlson comorbidity index [ 24 ], and Pittsburgh priority score in COVID-19 [ 25 ]. The study also collected information on the disease’s clinical presentation: time with symptoms at initial consultation, laboratory results at hospital admission, and the Sequential Organ Failure Assessment (SOFA) index at ICU admission [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2

et al. 2023

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In a high proportion of patients, infection by COVID-19 progresses to acute respiratory distress syndrome (ARDS), requiring invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). Other devices, such as a high-flow nasal cannula (HFNC), have been alternatives to IMV in settings with limited resources. This study evaluates whether HFNC exposure time prior to IMV is associated with mortality. This observational, analytical study was conducted on a historical cohort of adults with ARDS due to SARS-CoV-2 who were exposed to HFNC and subsequently underwent IMV. Univariate and multivariate logistic regression was used to analyze the impact of HFNC exposure time on mortality, controlling for multiple potential confounders. Of 325 patients with ARDS, 41 received treatment with HFNC for more than 48 h before IMV initiation. These patients had a higher mortality rate (43.9% vs. 27.1%, p: 0.027) than those using HFNC < 48 h. Univariate analysis evidenced an association between mortality and HFNC ≥ 48 h (OR 2.16. 95% CI 1.087–4.287. p: 0.028). Such an association persisted in the multivariable analysis (OR 2.21. 95% CI 1.013–4.808. p: 0.046) after controlling for age, sex, comorbidities, basal severity of infection, and complications. This study also identified a significant increase in mortality after 36 h in HFNC (46.3%, p: 0.003). In patients with ARDS due to COVID-19, HFNC exposure ≥ 48 h prior to IMV is a factor associated with mortality after controlling multiple confounders. Physiological mechanisms for such an association are need to be defined.

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“…Cuando los recursos son limitados este principio implica priorizar a quienes los recibirán considerando el mayor potencial de beneficio clínico a corto y largo plazo y la equidad de oportunidades entre los ciudadanos para vivir un ciclo de vida completo. En el contexto que nos ocupa, este principio justifica limitar la reanimación cardiopulmonar cuando de su práctica se derive la demanda de recursos escasos, como camas en las unidades de cuidados intensivos, respiradores, etc., que deberían ser asignados a otras personas según los mencionados principios (11).…”

Section: Principio De Justiciaunclassified

“…Cuando haya escasez de respiradores no deben realizarse maniobras de reanimación cardiopulmonar en aquellos pacientes que no hayan sido priorizados con base en las reglas de asignación éticamente justificadas, pues eventualmente requerirían de respiradores que pueden no estar disponibles (11). A los pacientes que no tengan prioridad se les deben garantizar todas las medidas de cuidado paliativo y confort físico, emocional y espiritual que requieran durante el final de su vida (6).…”

Section: A No Actuar De Forma Injustaunclassified

Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia

et al. 2020

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La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos.Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar.

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Pautas éticas para la asignación de recursos sanitarios escasos en el marco de la pandemia por COVID-19 en Colombia

Cited by 10 publications

References 8 publications

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

Reduced alcohol consumption during the COVID-19 pandemic: Analyses of 17 000 patients seeking primary health care in Colombia and Mexico

Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2

Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia

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