CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
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CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL
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CRISTOBALCARVAJAL@UDD.CL
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53163308500

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Surfactant deactivation in a pediatric model induces hypovolemia and fluid shift to the extravascular lung compartment

2012 , FRANCO JAVIER DIAZ RUBIO , Benjamín Erranz , Alejandro Donoso , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Tatiana Salomón , María Torres , Pablo Cruces , Andrew Davidson

Surfactant deficiency is the pivotal abnormality in Neonatal and Acute Respiratory Distress Syndrome. Surfactant deactivation can produce hypoxemia, loss of lung compliance, and pulmonary edema, but its circulatory consequences are less understood. Objective To describe the sequential hemodynamic changes and pulmonary edema formation after surfactant deactivation in piglets. Methods: Surfactant deactivation was induced by tracheal instillation of polysorbate 20 in 15 anesthetized and mechanically ventilated Large White piglets. The hemodynamic consequences of surfactant deactivation were assessed at 30, 120, and 240 min by transpulmonary thermodilution and traditional methods. Results: Surfactant deactivation caused hypoxemia, reduced lung compliance, and progressively increased lung water content (P < 0.01). Early hypovolemia was observed, with reductions of the global end-diastolic volume and stroke volume (P < 0.05). Reduced cardiac output was observed at the end of the study (P < 0.05). Standard monitoring was unable to detect these early preload alterations. Surprisingly, the bronchoalveolar protein content was greatly increased at the end of the study compared with baseline levels (P < 0.01). This finding was inconsistent with the notion that the pulmonary edema induced by surfactant deactivation was exclusively caused by high surface tension. Conclusions: Hypovolemia develops early after surfactant deactivation, in part due to the resulting fluid shift from the intravascular compartment to the lungs

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Decreased lung compliance increases preload dynamic tests in a pediatric acute lung injury model

2015 , Benjamín Erranz , Franco Díaz , Alejandro Donoso , Tatiana Salomón , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , María Fernanda Torres , Pablo Cruces

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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 , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Alejandro Donoso , Pablo Cruces , Alicia Fernández , Luis Martínez Arroyo , María Piedad Sarmiento , María José Nuñez , Adriana Wegner Araya , Juan Camilo Jaramillo-Bustamante , Miguel Céspedes-Lesczinsky , Roberto Jabornisky , Nicolás Monteverde-Fernández , Tamara Córdova , Franco Díaz

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.

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Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes

2021 , Jesus A. Serra , Franco Díaz , Pablo Cruces , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Maria J. Nuñez , A. Donoso , J.A. Bravo-Serrano , M. Carbonell , C. Courtie , A. Fernández , L. Martínez-Arroyo , J. Martínez , S. Menta , Luis Pedrozo-Ortiz , A. Wegner , Nicolas Monteverde-Fernández , Juan C. Jaramillo-Bustamante , Roberto Jabornisky , Sebastián González-Dambrauskas , Sapna R. Kudchadkar , Pablo Vásquez-Hoyos

AbstractSeveral challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).

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Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental

2012 , Franco Díaz , Alejandro Donoso , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Tatiana Salomón , María Torres , Benjamín Erranz , Pablo Cruces

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Mild hypothermia increases pulmonary anti-inflammatory response during protective mechanical ventilation in a piglet model of acute lung injury

2013 , Pablo Cruces , Erranz, Benjamín , Alejandro Donoso , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Tatiana Salomón , María Fernanda Torres , Franco Díaz , Brian Anderson

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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 , CARVAJAL BENAVIDES, CÉSAR CRISTÓBAL , Jan Wilhelm , REPETTO LISBOA, MARIA GABRIELA

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