Examinando por Autor "Jabornisky, Roberto"

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    Ítem
    A Respiratory Therapist-Driven High-Flow Nasal Cannula Liberation Protocol at High Altitude.
    (SAGE Publications, 2026-08-26) Vásquez Hoyos, Pablo; Villa Rosero, Yinna M.; Jaramillo-Bustamante, Juan C.; Gómez Lund, Oscar; Carvajal, Cristóbal; Díaz, Franco; González-Dambrauskas, Sebastián; Caporal, Paula; Jabornisky, Roberto; Serra, Alberto; Monteverde-Fernandez, Nicolás
    Background: High-flow nasal cannula (HFNC) liberation strategies in pediatric intensive care often transition patients directly from HFNC to room air. At high altitude, oxygen requirements may persist after flow-dependent respiratory support is no longer needed. We evaluated the association between a protocolized, respiratory therapist-driven HFNC liberation strategy and time to successful liberation from high-flow support in children with acute respiratory failure. Methods: We conducted a retrospective cohort study using prospectively collected LARed Network registry data from a tertiary PICU in Bogotá, Colombia (2,600 m altitude). In September 2022, the unit implemented an HFNC liberation strategy designed to separate persistent oxygen requirement from ongoing need for high-flow support. The primary analysis included the first HFNC episode per PICU admission from March 2018 to March 2025. The primary outcome was time to successful HFNC liberation. Kaplan-Meier curves and multivariable Cox regression were used; gamma log-link models were used for sensitivity analyses, including a prespecified bronchiolitis subgroup. Results: We included 1,086 PICU admissions, 627 before and 459 after implementation. Median HFNC duration decreased from 59.8 h (interquartile ranges [IQR] 34.7-91.4) to 53.1 h (IQR 32.3-80.5, P = .01). Kaplan-Meier analysis showed earlier HFNC liberation after implementation (log-rank P < .01). Implementation was associated with earlier liberation in adjusted Cox regression (hazard ratio 1.17, 95% CI 1.03-1.34, P = .02). PICU stay decreased from 4.7 days (IQR 3.2-6.9) to 4.0 days (IQR 2.9-5.8, P < .01). In bronchiolitis, implementation was associated with an 18.2% relative reduction in HFNC duration (95% CI 7.7-27.5%, P < .01). Conclusions: In a high-altitude PICU, a respiratory therapist-driven HFNC liberation strategy was associated with earlier liberation from high-flow support. A strategy that preserves oxygen delivery while testing tolerance of minimal flow may be useful in high-altitude settings
  • Miniatura
    Ítem
    Adenovirus Versus Respiratory Syncytial Virus in Children With Severe Viral Acute Respiratory Failure: A Multicenter Latin American Cohort.
    (Wolters Kluwer Health, 2026-08-26) Barajas-Romero, Juan Sebastián; Reyes-Téllez, Mario Andrés; Jaramillo-Bustamante, Juan Camilo; Gómez-Lund, Oscar; Decía, Mónica; Monteverde-Fernández, Nicolás; Serra, Jesús Alberto; Caporal, Paula; Lasso-Palomino, Rubén; Zemanate Zuñiga, Eliana; Martínez, Javier; Menta, Soledad; Martínez-Arroyo, Luis; Herrera-Salazar, Hernán; Castro-Zamorano, Francisca; Carvajal, Cristóbal; Jabornisky, Roberto; Cruces, Pablo; Díaz, Franco; González-Dambrauskas, Sebastián; Vásquez-Hoyos, Pablo
    Background: Respiratory syncytial virus (RSV) commonly causes severe lower respiratory tract disease. Adenovirus is detected less often, but severe pneumonia may occur. The pediatric intensive care unit (PICU) course associated with adenovirus detection compared with RSV-only detection is not well defined. Methods: We studied clinician-tested, virus-positive PICU admissions of children aged 1 month to 18 years from 37 PICUs in 7 Latin American countries (2017-2025). Children with RSV and/or adenovirus detection who used respiratory support were grouped as RSV-only, adenovirus-only or RSV-adenovirus codetection. The primary outcome was PICU death or worse functional status at discharge. Adjusted associations were estimated with logistic regression; Firth penalization was used for mortality. Results: Among 3196 PICU admissions, 2859 had RSV-only, 257 adenovirus-only and 80 codetection. PICU mortality was 12/257 (4.7%) in adenovirus-only, 13/2859 (0.5%) in RSV-only and 2/80 (2.5%) in codetection. Compared with RSV-only detection, adenovirus-only detection was associated with mortality [adjusted odds ratio (OR): 10.56; 95% confidence interval (CI): 4.57-24.43] and with PICU death or worse functional status at discharge [21/222 (9.5%) vs 45/2308 (1.9%); adjusted OR: 6.57; 95% CI: 3.59-12.03]. Among nonsurvivors, the median PICU day of death was 3 (IQR: 2-6) with adenovirus-only detection and 8 (IQR: 3-9) with RSV-only detection. Conclusions: In this multicenter Latin American PICU cohort, adenovirus-only detection was associated with a higher-risk acute course than RSV-only detection, including higher mortality and worse functional status at PICU discharge.