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Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation
(2017)
Pablo Cruces
;
Sebastián González-Dambrauskas
;
Julio Quilodrán
;
Jorge Valenzuela
;
Javier Martínez
Scopus© Citations 27 2
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Sífilis congénita: presentación como shock séptico después del período neonatal
(2012)
Daniela Arriagada
;
Alejandro Donoso
;
Pablo Cruces
;
Franco Díaz
6Scopus© Citations 6
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Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study
(2012)
Pablo Cruces
;
Alejandro Donoso
;
Jorge Valenzuela
;
Franco Díaz
BackgroundLittle is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. MethodsWe enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (C-dyn) and gas exchange 1, 12, and 24hr after the RM. ResultsWe included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2)kg, median PaO2/FIO2 117 (96-139), and median C-dyn 0.48 (0.41-0.68)ml/cmH(2)O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, C-dyn, and PaO2/FIO2 increased significantly (P<0.01 each), without changes in PaCO2 (P=0.4). A >25% improvement in lung function (C-dyn or PaO2/FIO2) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24hr. The 28-day mortality rate was 16%. ConclusionsSequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143. (c) 2012 Wiley Periodicals, Inc.
3Scopus© Citations 31
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Angiotensin-converting enzyme insertion/deletion polymorphism is associated with severe hypoxemia in pediatric ARDS
(2011)
Pablo Cruces
;
Franco Díaz
;
Alonso Puga
;
Benjamín Erranz
;
Alejandro Donoso
Scopus© Citations 26 1
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Consideraciones geográficas en la interpretación de los resultados de revisiones sistemáticas y meta-análisis: fluidos en sepsis pediátrica
(2019)
Franco Díaz
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Sebastian Gonzalez-Dambrauskas
;
Jan Hau Lee
;
Pablo Cruces
1Scopus© Citations 1
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Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis
(2020)
Jesús Alberto Serra
;
Sebastián González-Dambrauskas
;
Pablo Vásquez Hoyos
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CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
;
Alejandro Donoso
<jats:p>Objetivo: describir las terapias utilizadas en lactantes con bronquiolitis aguda admitidos en 20 Unidades de Cuidados Intensivos (UCI) pediátricos miembros de LARed en 5 países latinoamericanos.Pacientes y Método: Estudio observacional retrospectivo, multicéntrico, de datos del Registro Latinoamericano de Falla Respiratoria Aguda Pediátrica. Se incluyeron niños menores de 2 años ingresados a UCI pediátrica por bronquiolitis aguda comunitaria entre mayo-septiembre 2017. Se recolectaron datos demográficos, clínicos, soporte respiratorio, terapias utilizadas y resultados clínicos. Se realizó análisis de subgrupos según ubicación geográfica, tipo financiación y presencia de academia.Resultados: Ingresaron al registro 1.155 pacientes con falla respiratoria aguda. Seis casos fueron excluidos por no tener formulario completo. De los 1.147 pacientes, 908 eran menores de 2 años. De ellos, 467 tuvieron diagnóstico de bronquiolitis aguda, correspondiendo a la principal causa de ingreso a UCI pediátrica por falla respiratoria aguda (51,4%). Las características demográficas y de gravedad entre los centros fueron similares. El soporte máximo respiratorio más frecuente fue cánula nasal de alto flujo (47%), seguido por ventilación mecánica no invasiva (26%) y ventilación mecánica invasiva (17%), con un coeficiente de variación (CV) amplio entre los centros. Hubo una gran dispersión en uso de terapias, siendo frecuente el uso de broncodilatadores, antibióticos y corticoides, con CV hasta 400%. El análisis de subgrupos mostró diferencias significativas en soporte respiratorio y tratamientos utilizados. Un paciente falleció en esta cohorte.Conclusión: Detectamos gran variabilidad en el soporte respiratorio y tratamientos entre UCI pediátricas latinoamericanas. Esta variabilidad no es explicada por disparidades demográficas ni clínicas. Esta heterogeneidad de tratamientos debería promover iniciativas colaborativas para disminuir la brecha entre la evidencia científica y la práctica asistencial.</jats:p>
3Scopus© Citations 11
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Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study
(2022)
Anoopindar K. Bhalla
;
Margaret J. Klein
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Vicent Modesto I Alapont
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Guillaume Emeriaud
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Martin C. J. Kneyber
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective analysis of a prospective observational international cohort study.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), <jats:italic>p</jats:italic> = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.12 [0.94, 1.32], <jats:italic>p</jats:italic> = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.22 [1.01, 1.46], <jats:italic>p</jats:italic> = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> SHR 0.89 (0.82, 0.96), <jats:italic>p</jats:italic> = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO<jats:sub>2</jats:sub> than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation.</jats:p> <jats:p><jats:bold>Take Home Message</jats:bold>: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.</jats:p> </jats:sec>
7Scopus© Citations 23
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Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary
(2021)
Jaime Fernández-Sarmiento
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Daniela Carla De Souza
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Anacaona Martinez
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Victor Nieto
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Jesús López-Herce
<jats:p> Objective: The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America. </jats:p>
8Scopus© Citations 32
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Positive end-expiratory pressure improves elastic working pressure in anesthetized children
(2018)
Pablo Cruces
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Sebastián González-Dambrauskas
;
Federico Cristiani
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Javier Martínez
;
Ronnie Henderson
Scopus© Citations 6 1
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Implementation of preemptive fluid strategy as a bundle to prevent fluid overload in children with acute respiratory distress syndrome and sepsis
(2018)
Franco Díaz
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María José Nuñez
;
Pablo Pino
;
Benjamín Erranz
;
Pablo Cruces
6Scopus© Citations 36

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