Browsing by Autor "Daniel Molano-Franco"

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Altitude-specific neurocritical care: A case study in the management of traumatic brain injury
(Elsevier BV, 2025) Fausto Maldonado-Coronel; Catty Castillo-Caicedo; Antonio Viruez‐Soto; Roger Huanca-Payehuanca; Amílcar Tinoco-Solórzano; Daniel Molano-Franco; Christian Arias‐Reyes; Jorge Soliz
This case illustrates a unique challenge in neurocritical care at high altitude, where sea-level ventilation protocols can be detrimental. It adds novel clinical evidence by showing the pathophysiological consequences and therapeutic reversal of hypercapnia-induced cerebral hyperemia in a high-altitude native with traumatic brain injury (TBI). A 25-year-old man, lifelong resident at 3600 m above sea level (m.a.s.l.), presented with moderate-to-severe TBI following a motor vehicle accident. He exhibited cerebral edema and hemorrhagic contusions on CT, with transcranial Doppler indicating cerebral hyperemia. Initial ventilation based on sea-level PaCO₂ norms led to iatrogenic hypercapnia and cerebral hyperemia. Upon adjusting the ventilatory targets to an altitude-appropriate PaCO₂ range (26–28 mmHg), cerebral blood flow normalized, as confirmed by Doppler. The patient rapidly recovered and was discharged neurologically intact. In high-altitude settings, standard ventilation protocols may provoke secondary cerebral complications. This case highlights the critical importance of individualized, altitude-specific neurocritical strategies, with transcranial Doppler serving as a valuable bedside guide to optimize outcomes in altitude-acclimatized TBI patients. • Sealevel TBI ventilation may cause hypercapnia and cerebral hyperemia in altitud-acclimatized patients. • Setting PaCO 2 to 26-28 mmHg restored cerebral perfusion and improved neurological recovery at altitude. • Highlights the need for altitude-specific neurocritical care to improve TBI outcomes in high-altitude settings.
Analgosedation and delirium practices in critically ill patients in the Pan-American and Iberian setting, and factors associated with oversedation after the COVID-19 pandemic: Results from the PANDEMIC study
(Elsevier BV, 2025) Carola Giménez-Esparza Vich; Felipe Martínez; Daniela Olmos Kutscherauer; Daniel Molano-Franco; M. Gallardo; Enrique M. Olivares-Durán; Jesús Pérez Caballero; Rosa Reina; M. García Sánchez; Federico Carini
Definiciones y recomendaciones de consenso sobre la medicina crítica en la altitud del Comité de Expertos de Medicina Crítica en la altitud de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva
(Elsevier BV, 2025) Amílcar Tinoco-Solórzano; Adrián Ávila-Hilari; Manuel Luis Avellanas-Chavala; Felipe de Jesús Montelongo; Jorge Luís Vélez-Páez; Vanina Estrada; Antonio Viruez Soto; Daniel Molano-Franco; Eduardo Enrique Daguer Tamayo; Ignacio Granda Luna
Impact of High-Flow Nasal Cannula Use in Subjects With COVID-19 ARDS at High Altitudes: Clinical Presentation and Prognostic Factors
(American Association for Respiratory Care, 2023) Daniel Molano-Franco; Antonio Viruez‐Soto; Mario Gómez; Edgar Beltrán; Mario Villabon; Ángela Sosa; Leidy Ortiz; Estefania Orozco; Alejandra Hurtado; Lida Sanchez
High-altitude subjects treated with HFNC for COVID-19 showed a high risk of respiratory failure and progressive hypoxemia when FIO2 requirements were > 0.8 after 24 h of treatment. In these subjects, personalized management should include continuous monitoring of individual clinical conditions (such as oxygenation indices, with cutoffs adapted to those corresponding to high-altitude cities).
Inflammation severity, rather than respiratory failure, is strongly associated with mortality of ARDS patients in high-altitude ICUs
(Frontiers Media, 2025) Daniel Molano-Franco; Joan Ramón Masclans Enviz; Antonio Viruez‐Soto; Mario Gómez; Hugo Rojas; Edgar Beltrán; Víctor Manuel García Nieto; Fernanda Aliaga‐Raduán; Pablo Iturri; Christian Arias‐Reyes
The study concludes that, in high-altitude settings, ARDS patient survival in ICUs is more closely associated with managing inflammatory responses than with focusing solely on respiratory parameters. Further large-scale studies are recommended to validate the impact of inflammatory marker monitoring on survival outcomes in high-altitude ICUs.
Low serum erythropoietin levels are associated with fatal COVID-19 cases at 4,150 meters above sea level
(Elsevier BV, 2021) Antonio Viruez-Soto; Mónica Marlene López-Dávalos; Gabriel Rada-Barrera; Alfredo Merino‐Luna; Daniel Molano-Franco; Amílcar Tinoco-Solorozano; Natalia Zubieta-DeUrioste; Gustavo Zubieta‐Calleja; Christian Arias‐Reyes; Jorge Soliz
Oxygen therapy limiting peripheral oxygen saturation to 89-93% is associated with a better survival prognosis for critically ill COVID-19 patients at high altitudes
(Elsevier BV, 2022) Antonio Viruez‐Soto; Samuel Arias; Ronnie Casas‐Mamani; Gabriel Rada-Barrera; Alfredo Merino‐Luna; Daniel Molano-Franco; Amílcar Tinoco-Solórzano; Danuzia A. Marques; Natalia Zubieta-DeUrioste; Gustavo Zubieta‐Calleja
Prácticas de analgosedación y delirium en pacientes críticos de la región Panamericana e Ibérica y factores asociados a la sobresedación tras la pandemia COVID-19: resultados del estudio PANDEMIC
(Elsevier BV, 2025) Carola Giménez-Esparza Vich; Felipe Martínez; Daniela Olmos Kutscherauer; Daniel Molano-Franco; M. Gallardo; Enrique M. Olivares-Durán; Jesús Pérez Caballero; Rosa Reina; M. García Sánchez; Federico Carini
La sobresedación tiene consecuencias negativas en pacientes críticos. Desde el Comité de Analgosedación y Delirium de la Federación Panamericana e Ibérica de Medicina Crítica y Terapia Intensiva (FEPIMCTI) diseñamos un estudio transversal mediante encuesta dirigida a médicos/as de UCI: PANDEMIC (estudio Panamericano e Ibérico sobre manejo de ANalgosedación y DEliriuM en Cuidados Críticos [fepImCti]). Hipótesis Empeoramiento de dichas prácticas durante la pandemia que persistieron tras ella, con mayor sobresedación. Percepción de prácticas de analgosedación y delirium en las UCI de las regiones Panamericana e Ibérica antes, durante y después de la pandemia COVID-19 y factores asociados a persistencia de la sobresedación pospandemia. De los 1.008 encuestados, el 25% informaron percepción de sobresedación tras la pandemia (IC 95%: 22,4%-27,8%), mayor en Sudamérica (35,8%; p < 0,001). Principal factor riesgo: hábito adquirido durante la pandemia (OR ajustado [aOR]: 3,16; IC 95%: 2,24-4,45; p < 0,001). Principal factor protector: monitorización delirium (aOR: 0,70; IC 95%: 0,50-0,98; p = 0,038) previo a la pandemia. Estos factores identificados en el estudio ofrecen una base para dirigir intervenciones futuras. Oversedation has adverse effects on critically ill patients. The Analgosedation and Delirium Committee of the FEPIMCTI (Pan-American and Iberian Federation of Critical Care Medicine and Intensive Care) conducted a cross-sectional study through a survey addressed to ICU physicians: PANDEMIC (Pan-American and Iberian Study on the Management of Analgosedation and Delirium in Critical Care [fepImCti]). Hypothesis Worsening of these practices in the course of the pandemic and that continued afterwards, with further oversedation. Perception of analgosedation and delirium practices in Pan-American and Iberian ICUs before, during and after the COVID-19 pandemic, and factors associated with persistent oversedation after the pandemic. Of the 1008 respondents, 25% perceived oversedation after the pandemic (95% CI: 22.4-27.8). This perception was higher in South America (35.8%; P < .001). Main risk factor: habit acquired during the pandemic (adjusted OR [aOR]: 3.16; 95% CI: 2.24-4.45; P < .001). Main protective factor: delirium monitoring before the pandemic (aOR: 0.70; 95% CI: 0.50-0.98; P = .038). The factors identified in this study provide a basis for targeting future interventions.
Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?
(SAGE Publishing, 2021) Daniel Molano-Franco; Gómez Duque Mario; Edgar Beltrán; Mario Villabón; Hurtado Alejandra; Gómez Nicolas; Pablo Vásquez‐Hoyos; Nieto Victor; Valencia Albert; Garzón Diego
Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Methods: Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. Results: One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). Conclusions: High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.