Variability in Assisted Ventilation in Neonatal Intensive Care Units in Latin America. Influence of High Altitude

Objective: To examine the variability in the duration and use of assisted ventilation among Neonatal Intensive Care Units (NICUs) in Latin America, with particular focus on the influence of high-altitude settings.

Study Design: This multicenter observational study analyzed data from the EpicLatino database (2015–2022), encompassing 32 NICUs across Latin America and the Caribbean. The study population included preterm infants born at ≤32 weeks of gestation. Assisted ventilation was defined as the use of invasive mechanical ventilation, high-frequency oscillatory ventilation, continuous positive airway pressure, or high-flow nasal cannula. A competing risks regression model was applied to assess the association between total ventilation duration and clinical, altitude, and temporal factors, accounting for length of stay and in-hospital mortality.

Results: Of the total cohort, approximately 40% of infants were managed in NICUs located at altitudes above 2,000 meters. Use of assisted ventilation increased significantly in the post-pandemic period (2020–2022) with a subhazard ratio (SHR) of 1.2 (95% CI: 1.1–1.3). High-altitude units showed significant variability in ventilation duration compared to the reference unit; however, no consistent pattern distinguished high-altitude from sea-level units. Altitude could not be analyzed independently due to collinearity with unit of origin.

Conclusions: Significant inter-unit variability in the duration of assisted ventilation was observed among Latin American NICUs, with no uniform trend attributable to high altitude. These findings underscore the importance of unit-specific practices and highlight the potential for standardizing ventilatory strategies through quality improvement initiatives, particularly in high-altitude settings.