Recomendaciones de la Academia Nacional de Medicina de Colombia para enfrentar los conflictos éticos secundarios a la crisis de COVID-19 en el inicio y mantenimiento de medidas de soporte vital avanzado

Yepes, Ramón Abel Castaño; Nieto, Gloria Arias; Gaona, OOswaldo A. Borráez; Murcia, Alejandro Nino Murcia Alejandro Nino; Támara-Patiño, Liliana Marcela; Molina, Julieta Moreno

doi:10.30944/20117582.725

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Similar deficiencies and practices were observed in other low-and middle-income countries globally. [36][37][38]…”

Section: Implications Of the Findingsmentioning

confidence: 99%

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study

Fuenmayor-González,

Vera-Ormaza,

Shen

et al. 2024

Medicine

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Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ± 13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723–0.964), diabetes mellitus (HR = 0.80 95% CI 0.696–0.938), older than 62 years (HR = 0.86 95% CI 0.790–0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697–0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937–0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786–0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614–0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

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“…Similar deficiencies and practices were observed in other low-and middle-income countries globally. [36][37][38]…”

Section: Implications Of the Findingsmentioning

confidence: 99%

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study

Fuenmayor-González,

Vera-Ormaza,

Shen

et al. 2024

Medicine

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Principio de proporcionalidad terapéutica en la decisión de intubación orotraqueal y ventilación mecánica invasiva en paciente COVID-19 grave

Rubio

2022

Acta Colombiana de Cuidado Intensivo

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El derecho a la salud en tiempos de pandemia en Colombia: entre la inequidad endémica y el estado de emergencia

García-Echeverry

Moreno-Amézquita²,

Bustamante³

et al. 2020

Rev. Col. Bioet.

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Propósito/Contexto. La pandemia por COVID-19 y la emergencia sanitaria desencadenada permite analizar, desde la bioética y el bioderecho, los problemas relativos al principio de justicia distributiva, en el contexto estructural de la inequidad endémica en Colombia.Metodología/Enfoque. Este artículo realiza un análisis de los ajustes normativos en Colombia en relación con la garantía del derecho a la salud, en el contexto de la atención a la pandemia por SARS-CoV-2. Resultados/Hallazgos. A pesar de los ajustes normativos y la declaración del estado de emergencia sanitaria en Colombia, la persistencia de la inequidad social y económica en distintas regiones, la no intervención sobre determinantes sociales, las irregulares condiciones laborales de los trabajadores de la salud y las dificultades para materializar el principio de reciprocidad constituyen barreras para mitigar los efectos negativos de la pandemia sobre las poblaciones más vulnerables.Discusión/Conclusiones/Contribuciones. Ningún sistema de salud en el mundo estaba preparado para los retos que genera la pandemia y aun cuando se emitió normatividad de contingencia, siguen siendo críticas las profundas brechas de justicia distributiva e inequidad regional en Colombia, así como el incumplimiento de principios enunciados en la ley estatutaria de salud.

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Recomendaciones de la Academia Nacional de Medicina de Colombia para enfrentar los conflictos éticos secundarios a la crisis de COVID-19 en el inicio y mantenimiento de medidas de soporte vital avanzado

Cited by 3 publications

References 9 publications

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study

Principio de proporcionalidad terapéutica en la decisión de intubación orotraqueal y ventilación mecánica invasiva en paciente COVID-19 grave

El derecho a la salud en tiempos de pandemia en Colombia: entre la inequidad endémica y el estado de emergencia

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