Examinando por Autor "Jabornisky, Roberto"

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    Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia
    (Sociedad Chilena de Pediatria, 2021) Wooldridge, Gavin; O’Brien, Nicole; Muttalib, Fiona; Abbas, Qalab; Adabie Appiah, John; Baker, Tim; Bansal, Arun; Basnet, Sangita; Campos-Miño, Santiago; Carla de Souza, Daniela; Díaz, Franco; Dramowski, Angela; Fernández-Sarmiento, Jaime; Fustiñana, Ana; González, Gustavo; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Chor Yek Kee Yek Kee; Lang, Hans-Joerg; Soares Lanziott, Vanessa; Kohn Loncarica, Guillermo; Mohsenibod, Hadi; Ode, Bunmi; Murthy, Srinivas; Amelie von Saint Andre-von Arnim; Hansmann, Andreas; González-Dambrauskas, Sebastián
    The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep- sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.
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    Diez recomendaciones clave para fortalecer los cuidados intensivos pediátricos: una revisión narrativa desde América Latina
    (Sociedad y Fundación Española de Cuidados Intensivos Pediátricos, 2025-10-01) Gómez-Lund, Oscar; Donoso-Fuentes, Alejandro; López-Barón, Eliana; Ruge-Joya, Erika Johana; Díaz, Franco; Alzate-Hernández, Hulizay Paola; Morantes-Flórez, Jennifer Giseth; Jaramillo-Bustamante, Juan Camilo; Higuera-Álvarez, Lorena Alejandra; Sarmiento-Guzmán, María Piedad; Aguilar-Zamora, Nadia Sofía Alejandra; Vásquez-Hoyos, Pablo; Torres-González, Pamela; Zárate-Castañon, Patricia; Jabornisky, Roberto; Roa-Giraldo, Juan David
    Esta revisión narrativa presenta diez recomendaciones clave para fortalecer la práctica de las unidades de cuidados intensivos pediátricos (UCIP) en el entorno clínico actual. Estas reflexiones surgieron de la experiencia compartida de intensivistas pediátricos latinoamericanos y se sustentan en la literatura relevante. Abordan desafíos comunes como el reconocimiento y el manejo tempranos del deterioro clínico, el equilibrio entre la reanimación con líquidos y el uso temprano de vasopresores, la detección temprana de la falla de la ventilación no invasiva (VNI) y la promoción de la nutrición enteral. Otros temas incluyen el uso racional de antibióticos, las prácticas éticas de restricción y la integración de las familias como participantes activos en la atención. La revisión también destaca la importancia de tomar decisiones oportunas sobre la extubación, un mejor uso de los recursos y el equilibrio entre el juicio clínico y las herramientas objetivas. Aunque estas recomendaciones surgieron en América Latina, consideramos que son de aplicación universal. This narrative review presents ten key recommendations aimed at strengthening pediatric intensive care unit (PICU) practice in today’s clinical environment. These reflections emerged from the shared experience of Latin American pediatric intensivists and are supported by relevant literature. They address common challenges such as early recognition and management of clinical deterioration, balancing fluid resuscitation with early vasopressor use, early detection of non-invasive ventilation (NIV) failure, and promoting enteral nutrition. Additional topics include rational antibiotic use, ethical restraint practices, and the integration of families as active participants in care. The review also highlights the value of timely extubation decisions, better resource use, and the balancing clinical judgment with objective tools. Although developed from the perspective of Latin American clinicians, we consider these recommendations to have universal applicability.
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    Factores asociados a ventilación mecánica prolongada en niños con fallo respiratorio de causa pulmonar: estudio de cohortes del registro de LARed Network
    (Elsevier, 2023-06-15) Barajas-Romero, Juan Sebastían; Vásquez-Hoyos, Pablo; Pardo, Rosalba; Jaramillo-Bustamante, Juan Camilo; Grigolli, Regina; Monteverde-Fernández, Nicolas; Gonzalez-Dambrauskas, Sebastián; Jabornisky, Roberto; Cruces, Pablo; Wegner, Adriana; Díaz, Franco; Pietroboni, Pietro
    Objectives: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). Design: Secondary analysis of a prospective cohort. Setting: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. Participants: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. Main variables of interest: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). Conclusions: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay
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    Las fisuras del sistema en la publicación académica en pediatría:una crítica al acceso abierto y sus consecuencias
    (Sociedad Chilena de Pediatría, 2025-10-21) Díaz, Franco; Gómez-Lund, Oscar; Riderelli, Jocelyn; Monteverde-Fernández, Nicolás; González-Dambrauskas, Sebastián; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Caporal, Paula
    En las últimas dos décadas, la publicación académica ha experimentado transformaciones profundas con la digitalización y el acceso a internet. En forma concomitante, el movimiento de Acceso Abierto ha desempeñado un papel fundamental en la mejora de la accesibilidad al conocimiento científico mediante la eliminación de pagos y otras barreras restrictivas. Si bien esta democratización de la información ha generado beneficios sustanciales, también ha introducido desafíos complejos, convirtiendo las publicaciones médicas en una industria lucrativa que pone a prueba los límites éticos de las prácticas comerciales y, en última instancia, la integridad de la investigación. La concentración de poder en unas pocas grandes editoriales dentro de un mercado sesgado e inelástico, la proliferación de editoriales con fines de lucro y la creciente carga financiera, trasladada a los autores, son factores críticos que contribuyen a la crisis actual de la academia. El objetivo de este manuscrito es examinar los principales hitos en la evolución de la publicación académica, analizar su panorama actual y discutir los desafíos fundamentales que enfrenta la industria en la era del Acceso Abierto, particularmente desde la perspectiva de investigadores en pediatría en América Latina. Over the past two decades, academic publishing has undergone substantial transformation, largely driven by digitalization and increased global Internet access. In parallel, the Open Access (OA) movement has played a critical role in advancing equitable access to scientific knowledge by eliminating paywalls and licensing restrictions. While these developments have yielded considerable benefits–particularly in enhancing the dissemination and democratization of research– they have also generated complex ethical and structural challenges. Notably, the consolidation of publishing power among a few major editorial houses, the emergence of profit-driven publication models, and the shifting of publication costs onto authors, have contributed to a growing crisis in academic medicine. These trends have raised concerns regarding transparency, editorial independence, and the overall integrity of the scientific record. This manuscript aims to delineate the historical and structural evolution of academic publishing, assess its current landscape, and critically examine the key challenges facing the field in the context of Open Access. Particular attention is given to the implications for pediatric researchers in Latin America, who are disproportionately affected by these systemic barriers.
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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
    (SAGE Publications, 2022) Fernández-Sarmiento, Jaime; De Souza, Daniela Carla; Martinez, Anacaona; Nieto, Victor; López-Herce, Jesús; Soares Lanziotti, Vanessa; Arias López, María del Pilar; Brunow De Carvalho, Werther; Oliveira, Claudio F.; Jaramillo-Bustamante, Juan Camilo; Díaz, Franco; Yock-Corrales, Adriana; Ruvinsky, Silvina; Munaico, Manuel; Pavlicich, Viviana; Iramain, Ricardo; Márquez, Marta Patricia; González, Gustavo; Yunge, Mauricio; Tonial, Cristian; Cruces, Pablo; Palacio, Gladys; Grela, Carolina; Slöcker- Barrio, Maria; Campos-Miño, Santiago; González- Dambrauskas, Sebastian; Sánchez-Pinto, Nelson L.; Celiny García, Pedro; Jabornisky, Roberto
    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.
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    Pediatric fluid resuscitation: an oxymoron?
    (Frontiers Media S.A., 2025-06-01) Díaz, Franco; Riderelli, Jocelyn; Jabornisky, Roberto
    In conclusion, fluid therapy is vital for caring for critically ill children, but the rationale for employing fluid boluses as a blind blanket treatment for hemodynamic instability requires thorough reassessment. A comprehensive understanding of fluids as a drug in critical care, including a dose, duration, and de-escalation (4D’s defined by Malbrain et al.), is essential, with specific indications and duration (25). A more rational, individualized approach may facilitate the adoption of alternative strategies aimed at minimizing excessive fluid administration and preventing fluid overload (26). As underscored by FernandezSarmiento et al. (13), it is imperative that clinicians systematically assess and clearly document, at least on a daily basis, the current phase of critical illness in each pediatric patient to ensure fluid management is appropriately tailored. Given the mounting evidence highlighting the potential harms and only transient benefits of fluid resuscitation, a precise, individualized, and context-driven approach to fluid therapy is no longer optional—it is essential. Such a strategy is crucial for optimizing outcomes and minimizing iatrogenic complications in critically ill children globally
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    Relationship between national changes in mobility due to non-pharmaceutical interventions and emergency department visits due to pediatric acute respiratory infections during the COVID-19 pandemic
    (Yale University; Cold Spring Harbor Laboratory (CSHL), 2022-01) Díaz, Franco; Carvajal, Cristóbal; Gatica, Sebastián; Vásquez-Hoyos, Pablo; Jabornisky, Roberto; Von Moltke, Richard; Jaramillo-Bustamante, Juan Camilo; Pizarro, Federico; Cruces, Pablo
    Background Strong social distancing measures were quickly implemented in Chile during the SARS-CoV-2 outbreak. One of the aims of non-pharmaceutical interventions (NPI) mandates was to decrease overcrowding, thus is usually measured as mobility changes. Methods we gather data from national health statistics for pediatric emergency (PED) visits for acute respiratory infection (ARI) in children younger than 15. We defined a historical cohort, including data from 2016 to 2019, and compared them with 2020 and 2021 pandemic years. Also, Chile’s national mobility reports from the online google database were downloaded. We tested the correlation between changes in mobility and relative reduction in PED-ARI by Spearman’s Rank Test. Results Historical data showed a mean of 46863 ± 3071 PED-ARI weekly visits with a high seasonal variation, with two peaks in weeks 20 and 28 and weeks 32 to 36. This transient drop was temporally associated with the mid-winter 2-week holiday of schools. The usual PED visits peaks did not occur in 2020 and 2021. Mobility declined from week 9, reaching lower than historical data from week 12 and a minimum of 43% in week 15 of 2020 . The correlation between mobility and PED-ARI visits showed a strong monotonic relationship (quadratic) with a Spearman’s rho of 0.80 (95% CI 0.75 to 0.86) . Conclusion NPI resulting in a decrease in mobility should be considered a robust public health measure to relieve the winter’s collapse of the national health system, decreasing morbimortality in children due to PED-ARI.