Paredes, Daniel

Arts & Sciences

BS/BA

Peru

Peru - Long-term outcomes of patients requiring mechanical ventilation in Peruvian intensive care units.

Mechanical ventilation is a life sustaining measure used in intensive care units to compensate for patients who have acute respiratory failure. It is commonly used in patients with sepsis, acute respiratory distress syndrome (ARDS), trauma, pneumonia, pancreatitis, and inhalational injury, as well as in other chronic respiratory and cardiovascular conditions. We seek to characterize the general health and pulmonary function of patients who survived at least six months after receiving mechanical ventilation in the intensive care units (ICUs) of two large city hospitals in Lima, Peru. To optimize care of critically-ill patients in low- and middle-income countries, it is critical to understand which clinician practices lead to the best long term outcomes. These results at follow-up will be compared to similar data in the United States, which may allow us to improve both ICU-related and post discharge management and consequently future morbidity and mortality in patients requiring mechanical ventilation in the ICUs under study. The aims of this study are: 1) Estimate the 6 month and 1-, 2-, 3-, 4-, 5-year mortality in critically-ill patients that require mechanical ventilation in 2 intensive care units in Lima, Peru, 2) Characterize pulmonary function of critically-ill patients that required mechanical ventilation in 2 intensive care units in Lima, Peru, at 6 months and 1, 2, 3, 4, 5 years after their hospital stay, 3) Assess 6-minute walk, hand grip strength, and ability to return to work as markers of general physical function at 6 months and 1, 2, 3, 4, 5 years after their hospital stay, 4) Characterize cognitive function and activities of daily living at 6 months and 1, 2, 3, 4, 5 years after their hospital stay, and 5) Calculate medical care expenditure and correlate it with the above long-term outcomes.

Global Health Mentor: William Checkley, MD
Medical Director, Johns Hopkins Medicine International

Working in Peru as part of Dr. William Checkley’s research study was one of the most illuminating experiences that allowed me to witness the complex and intricate dynamics of the Peruvian health system and the country’s vivid and diverse population. During my time in Lima, I worked on a project that explored the long-term health outcomes of patients that required mechanical ventilation for at least 24 hours during their time at one of five different Peruvian intensive care units.

One of the most rewarding tasks that I carried out during my time in Lima was arranging and conducting interviews with the ICU patients as well as with community controls from the San Juan de Miraflores area. These interviews consisted mainly of surveys that measured the participants’ general health and pulmonary function, their anxiety and depression levels, cognitive ability, quality of sleep, and their ability to go about their daily lives independently. This experience allowed me to learn empirically about the data-collection process and about some of the tools and methodologies that are used in global health research projects. Conducting the interviews, I was also able to develop a good sense of what life is like for many participants and some of the complexities that are inherent to public health research in an environment such as Lima’s. Also, by participating in and having to administer the tests myself, I was able to see the significance of using well-constructed, targeted-yet-versatile instruments when dealing with diverse, multi-ethnic populations with varying educational, economic and social backgrounds. Contributing to the organization and completion of the study’s data set, I also travelled between different hospitals in Lima obtaining missing information from the health records of current and past study participants. These hospitals, funded by the Peruvian national social service provider, offer care for a majority of the population in the greater Lima metropolitan area and the surrounding provinces. Working at these hospitals, I got a chance to interact with the record-keeping infrastructure in many of these health institutions and also developed a sense of the research culture in a Latin American metropolis.

Having lived most of my life in different cities in Colombia and the United States, my culturally dynamic experiences have fundamentally shaped my identity and my outlook on the systems that I have pertained to and engaged with. Being passionate about the Latin American population and its historical memory, my time in Peru allowed me to juxtapose my experiences to further develop a more well-founded, empirical consideration of each of these countries’ vibrant environments and explore how these affect the health condition of their respective populations. Shortsighted policies in Latin America have failed to address the tangible needs of the population and the need for responsible, community-oriented interventions is crucial. As my perspective changes and I become increasingly more familiar with the circumstances and condition of many across Latin America, my restlessness grows and I feel increasingly more determined to continue exploring the data-driven analysis and execution of radical structural projects that might lessen the increasing and dehumanizing burden that many of these populations face. 

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...
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July 2018

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