SARS-CoV-2 Pneumonia in Critical Care at Three Altitude Levels in Latin America. Presentation and Clinical Outcome

Abstract

The different positions on the role of barometric hypoxia in the presentation and evolution of patients with COVID-19 motivate this paper, which includes patients with SARS-CoV-2 pneumonia admitted to Intensive 
Care Units at three altitude levels in Latin America: Bogotá (Colombia) at 2.650 masl, Huaraz (Peru) at 3.100 masl and El Alto (Bolivia) at 4.150 masl. A multicenter, retrospective, descriptive, and observational study was performed. A total of 120 patients were included, 40 in Bogota, 40 in Huaraz and 40 in El Alto. 67.5% were male. The median age was 57.6 years (interquartile range was 20.17 years). The most common comorbidity was chronic hypertension in 35%. Variability was presented in all 3 groups in terms of respiratory clinical characteristics, with a deeper level of desaturation parallel to the increase in altitude from Bogota, Huaraz, and El Alto (89% vs 80%
vs 76% p<0.001, respectively) as well as a progressive increase in respiratory rate (16 vs 20 vs 28 cycles per minute p<0.001, respectively). 93.4% of patients received mechanical ventilation. Overall mortality was 43.3% with significant variations among the city of Huaraz (17.5%), Bogotá and El Alto (55% and 57.5%, respectively). There was great variability in management, both ventilatory and pharmacological. The development of local guides, based on our own characteristics, is of vital importance facing the COVID-19 pandemic.