Pediatric intensive care resources in Ibero-Latin America: SPREAD PED Ibero–Latin America, a multinational, multicentre, cross-sectional study
Year: 2026
Type: article
Abstract: Background Pediatric intensive care units (PICUs) are a cornerstone of child survival, yet their structure, staffing, and adherence to evidence-based protocols vary widely across regions. Comprehensive and contemporary data from Ibero-Latin America are lacking. We aimed to characterize the organization, human resources, and implementation of standardized care practices in PICUs across this region. Methods We conducted an international, multicentre, cross-sectional study including all PICUs admitting patients during a five-day period (Sept 2024) across 21 countries in Latin America, Spain, and Portugal. Unit-level data were obtained through a standardized electronic survey describing hospital characteristics, workforce distribution, monitoring capabilities, and clinical protocols. The primary objective was to characterize the distribution of structural and organizational features of participating PICUs across the región; secondary outcomes examined multidisciplinary coverage and adherence to standardized care practices. Findings Among 339 PICUs (70.6% public; 61.4% university-affiliated), nearly half had fewer than ten beds. Median physician-to-patient ratio was 1:5–6 by day and 1:8–10 overnight. Nursing ratios varied widely, most favourable in the Iberian region (≈1:1–2) and least in the Andean block (≈1:3–4), underscoring inequities in bedside care capacity. Only 68% of units had dedicated physiotherapists, with far lower coverage from nutritionists, psychologists, or pharmacists. Basic monitoring and ventilation were nearly universal (>95%), yet advanced technologies—cardiac output, near-infrared spectroscopy, renal replacement therapy—were available in fewer than 40% of centers. Structured protocols for sepsis, mechanical ventilation, sedation, or antimicrobial stewardship were reported in only 56% of PICUs, with adherence highest in the Iberian and lowest in the Andean and Caribbean regions. Interpretation This multinational, multicentre assessment provides the first comprehensive and contemporary map of pediatric critical care capacity across Ibero-Latin America, revealing major disparities in infrastructure, human resources, and protocol implementation. Strengthening human capital, multidisciplinary training, and regionally adapted strategies is essential to achieve equitable, high-quality critical care for children across the region. Funding This work was supported by institutional funding from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; Grant No. 2017/21052-0), provided to the Latin American Sepsis Institute (ILAS) to support the conduct of the study, including research assistant and statistical support.
Authors: Roberto Jabornisky, Claudio Flauzino de Oliveira, Juan Camilo Jaramillo-Bustamante, Jaime Fernández-Sarmiento, L. Nelson Sanchez-Pinto, Vanessa Soares Lanziotti, Juan David Bustos, Diogo Scordamaglia de Oliveira, Facundo Jorro Barón, Patricia Zárate Castañón, Gustavo González, Franco Diaz, Manuel Munaico, Raffo Escalante-Kanashiro, Maria Slöcker-Barrio, Alejandro Martínez, Nicolás Monteverde, Andrés Andrés Matos, Publio Toala, Andrea Sofia da Silva Dias, Adriana Yock-Corrales, Luis Moya Marroquin, Paulo Bandiera-Paiva, Flavia Ribeiro Machado, Daniela Carla de Souza, Karina Cinquegrani, María de los Ángeles Nieva Motrán, Marcia Ludueña, María Fernanda Arrillaga, Alejandro Cocuza, Adriana Claudia Bordogna, Melina Rabino, Sabrina Lucrecia Bollada, Gustavo Gabriel Pinela, Antonio Ávila, Gonzalo Rostagno, Natalia Montes, Josefina Pérez, Anabel Barlasina, Valeria Rombola, Shirly Magee Bahl, Gladys Palacio, Jessica Pedraza Coronel, Anahí Aybar, Javier Ponce, María Eugenia Galván, Ivana Marinelli Triler, Leonardo De Lillo, María José Bruera, Mariam Sarli, Jesica Widmer, Pablo Vattimo, Oscar Horacio Gómez Lund, Angela Gloria Méndez, Alejandro Omar Mansur, Rafael Alfredo Fraire, Thomas Iolster, Ana Rodríguez Calvo, Guido Cosentino, Rossana María Poterala, Virginia Altuna, María Griselda Gutiérrez, María Alejandra Boretto, Mariela Ivana Subirá, Facundo Jorro Barón, Gladys Abreo de Almirón, Gustavo Sciolla, Verónica Córdoba, Mariano Stang, María Sol Gálvez, Verónica Serlin, Gabriel Boggio, Martin Gustavo Lafuente, Natalia Soledad Dovis, Adriana Arto, Andrea Debonis, Silvina Lardone Olivera, Raúl Ricardo Acosta, Marcelo Chervin, Germán Kaltenbach, Carla Ávila, Óscar Eduardo Sotelo, Antonio Pérez Sánchez, Gabriela López Cruz María, Carolina Laffont, Daniel Ricardo Capra, Jimena Izquierdo, José Luis Cucurullo, Alejandra Cobos, Natalia Soledad Dovis, Analía Costantini, Lucía Ramasco, Silvina Abalos, Rodrigo Burgos Pratx, Alejandro Fabio Martínez León, Jhovana Elizabeth Paco Barral, Claudia Pamela Castro Auza, Carol Yadira Mendoza Montoya, Pablo Mattos Navarro, Juan Pablo Velasco Balderrama, Miguel Céspedes Lesczinsky, Naya Krause Suárez, Reynaldo Carvajal Choque, Eber Delgado, Tita Fernández, Giovani Miller Mamani, Vladimir Aguilera Avendaño, Adriana Koliski, Dafne Cardoso Bourguignon da Silva, Rafael Teixeira Azevedo, Juliana Torres Pacheco, Gabriel Tesche Roman, Marizete Molon, Jaisson Gustavo da Fonseca, Ana P.C.P. Carlotti, Cristian Tedesco Tonial, Marizete Molon, José Colleti Junios, Luis Fernando Andrade de Carvalho, Alexandre Serafim, Natallie Nicolle Moreira Monteiro, Regina Grigolli Cesar, Claudia Mei Lan Jae, Paula Ferreira, Fafioloa Peixoto Ferreira La Torre, Simone Caldeira Silva, Claudia Betania Rodriguez Abreu Ferreira, Raquel de Seixas Zeitel, Marcia Nascimento, Luis Fernando Andrade de Carvalho, Lucio Flavio Peioto de Lima, Flavia Andrea Krepel Foronda, Marcia Nascimento, Joelma Gonçalves Martin, Ramone do Amaral Bertussi, Emmerson Carlos Franco De Farias, Joelma Gonçalves Martin, Luiz Marcelo Sá Malbouisson, Ana Camila Flores Farah, Verônica Ferreir Cury, Caline Daisy Da Silva Ojeda, Liliane de Sousa Borges Pinheiro, Veronica Indicatti Fiamenghi, Marizete Elisa Molon, Emílio Lopes Junior, Ana Karina de Sousa Fernandes, Renata Seixas, Tiago Carvalho Pontes, Luziene Alencar Bonates dos Santos, Viviana Sampietro Serafim, Ivan Pollastrini Pistelli, Denise Fronza, Valéria Cardoso Alves Cunali, Jorge Yussef Afiune, Alexandre Schwarzbold, Maura Cristina Negrelli, Otávio Domingues Prado Franco, Cristiane Costa Araujo, Debora Scordamaglia, Thallys Ramalho Suzart Alves, Ely Patrícia Tiquisara Saravia, Vanessa Lanziotti, José Ernesto Augusto Trigo, Euzenir Pires Moura Maia, Ana Paula Novaes Bellinat, Paula Sena Gomes Santoro, Gabriela Cerqueira Caldas Pinto, Claudia Pires Ricachinevsky, Daniel Arcoverde de Sousa, Katia Regina de Oliveira, Regina Grigolli Cesar, Fernanda Vieira de Souza Leite, Felipe Conceição Ananias, Fabiola Peixoto Ferreira La Torre, Bruno Beloti Barreto, Roberto Ramos Leitão Filho, Paulo Ramos David João, Marcelo Barciela Brandão, Luis Gonzaga Gerlin, Valeria Borba de Souza, Carlos Acuña Aguirre, R. Zuleta, Daniel Casanova Wang, Marta Zamora Astudillo, Daniel Caro Ide, Manuel Valenzuela, Michele Drago Thibaut, Franco Diaz, Raúl Bustos B, Adriana Diettes González, César Águila Barría, Manuel Valenzuela Castillo, Cristian Valverde, Mauricio Yunge, Pietro Pietroboni Fuster, Yuraima Valera, María José Villarroel Carreño, Felipe Silva Demuleo, Maryel Riquelme Quiroga, Karin Scheuch, Juan Molina Pared, Michelangelo Lapadula Amelina, Ricardo Carvajal, Beatriz Elena Duque Leal, Carolina Bonilla, Rafael José Orozco Marun, David Barrios Andrade, Camilo González, Carlos Alberto Gallón Arango, Stacey Johana Fragozo Messino, Shirley Lamprea, José Alberto Betancur Vergara, Maribel Niño Mendivelso, Byron Piñeres-Olave, Iván José Ardila Gómez, Miguel Ruz, Luisa Vélez Carolina, Nathalie Guladrón Barreto, Mónica Arias Andrade, Lorena Acevedo, Juan Pablo Fernández-Sarta, Arieth Figueroa Vargas, Juanita Uribe-Londoño, Lorena Duitama-Vergara, Rubén E. Lasso-Palomino, María José Soto-Aparicio, Diana Paola Escobar-Serna, Diana Bravo, Francisco J. Montoya-Ochoa, Liliana Mazzillo Vega, Alejandro Luna Mazzillo, Ledys Maria Izquierdo, Hernán Darío Herrera Salazar, Cesar David Llanos Sanclemente, Yessica Adriana Bravo Enriquez, Jorge Rojas, Armando León, Diana Ruiz, Carolina Guzmán Gómez, Alfredo de La Hoz Pastor, Javier Godoy-Cordobés, Silvia Catalian Corrales Martínez, Mario Reyes-Téllez, Pablo Vásquez-Hoyos, Beatriz Giraldo Duran, María del Rosario Charry, Edgar Mauricio Buitrago Anaya, Edgar Mauricio Buitrago Anaya, Gerardo Iglesias Martínez, María Paula Salazar González, Alejandra Vega Rojas, Darling Carvajal Duque, Marleny Lara Bernal, Jaime Piracoca Mejía, Andrea Paola Rodríguez Mayorga, Linda Andrea Betancur, Jorge Carreño Rueda, Adriana Yock-Corrales, Ericka Ureña-Chavarria, Glennis Morales Torres, Yanet de los Angeles Camejo Serrano, Reinaldo Alcides Llerena Cárdenas, Andrés Andrés Matos, Harlam Reynier De la Cruz De la Cruz, Yaimet Sánchez Hernández, Xavier Páez Pesantes, Tania Cecilia Hurtado Cherrez, Rosa Esthela Ávila Espinoza, Rocio Yerovi, Santiago Campos-Miño, Evelin Antonia Resplandor Millán, Erika Montalvo, Lupe Nataly Mora Robles, Erika Montalvo, Luis Stalin Donoso, Servio Valle, Luis José Guzmán, Javier Rodríguez-Fanjul, Miriam Gutiérrez Jimeno, Cristina Schüffelmann, María Laplaza González, Iolanda Jordan, Elena Fresan Ruiz, Francisco Javier Pilar-Orive, Rosalía Pérez Hernández, María del Carmen Martínez Padilla, Jesús de la Cruz Moreno, María José Pérez Durán, Natalia Ramos Sánchez, Ana Ortiz Álvarez Hosp, Laia Reixach-Asperó, Montserrat Pujol-Jover, Sonia Brió Sanagustin, Mónica Gabriela Rivera Sandoval, Elisabet Coca Fernández, Laura Herrera-Castillo, Alberto García-Salido, María Gual, Ana María Diaz Vico, María Amalia Ballesta Yagüe, Ana Abril Molina, Antonio Rodríguez Nuñez, Mónica Gabriela Rivera Sandoval, Luis Sabajan, Andrea María Mazariegos Domínguez, Juan Pablo Zaldaña Figueroa, Eyfi Roca Giron, Ricardo Mack, Claudia De León Gutiérrez, Sofía Posadas, Wendy Urbina Martínez, Wendy Urbina, Sindy Sarahi Aguilar Espinoza, Sandra Waleska Flores Irias, Edwin Mauricio Cantillano, Maricela García Arellano, Deysi Guadalupe Hernández Ortiz, Luis Felipe Domínguez Jiménez, Emmanuelle Dexeus Gabriel Fernández Vera, Cuauhtémoc Molina-Ruiz, Daniel Torres-Rodríguez, Astrid Cortés Vargas, Alin Itzel Méndez Alpizar, Sandra Tania Ventura Gómez, Araceli Maldonado Cisneros, Patricia Zárate Castañón, Martha Patricia Márquez Aguirre, Rosalinda Jimenez-Aguilar, Javier Pérez-Mendoza, María de Lourdes Marroquín Yáñez, María Elena Molina Garza, Luis Fernando Mendoza Moreno, Rafael Heberto Guillén Villatoro, Lucina Andrea Rodríguez Durán, Arturo Gualberto Estrada López, Gabriel Alberto Moguel Cuesy, Luis Adrián González Mercado, Liliana Camarena Vielma, Christian Manuel Herrera Hidalgo, Liliana Olivera Romero, Arturo Gerardo Garza Alatorre, Alma Rebeca Gaytán López, Nidia Iveth Duarte Martínez, Daniel Torres Rodríguez, Carlos Enrique Ríos González, Fátima Guadalupe de Araujo de La Vega, Alfredo Gutiérrez Hernández, Daniela Sifuentes, Gabriela Alvarado Jiménez, Celia Isabel Mulgado Agua, David Gonzales Loya, Andrés Blanco, Vianey Melchor, Glorinella Aguilar M, Edgar Guadarrama Granados, Lidia Elizabeth Tepexpa Uc, José Félix Urbina Hernández, Manuel Correa Flores, José Luis Escudero Castro, Luis Ramiro García López, Julio López Kerlegand, Wendy Elba Estrella Espinoza, Jesús Alejandro Romero Rodríguez, Antonio González Guevara, Miguel Ángel González Soto, Miguel Ignacio Flores Monsreal, Juan Enrique García Maytorena, Samantha Quiroz Marín, Prima Esmeralda Gómez Hernández, María Johana Alexandra Barberena Prado, Blanca Ríos, Manuel Alvarado, Jorge Omar Castillo, Jorge Omar Castillo, Publio B. Toala González, Lorena Delgadillo V, Natalia Gómez Arriola, Jorge Alfonso, Julia Acuña, Lorena Quintero Verdecchia, Lissa Samudio, Rafael Hiroky Valdivia Higuchi, Jesús Ángel Domínguez Rojas, Liza María Manchego Rosado, Yesica Luna Delgado, Sandra Meléndez-Hoyos, Andrés Infante Llanos, Mariza Vashley Montañez Vásquez, Jesús Ángel Domínguez Rojas, Liza Lizette López Lavinto, Aaron Daniel Nureña Jara, Susan Cedrón Gutiérrez, Aurea Rosa Rojas Medina, Manuel Eduardo Munaico Abanto, Jorge Luis Reynoso Tantaleán, Tommy Prado Gomez, Priscilla Fiorella Ruiz Catter, Fiorella Ruiz Catter, Rosario Becerra, Rosa León, Raffo Escalante, Andrea Dias, Catarina Marques Duarte, Emma Almonte Baéz, Maureen Ventura, Pablo Pereira Altman, Adriana Pedemonti, Sebastián González-Dambrauskas, Carolina Grela, María José Gómez, Magali España, Soledad Menta, Nicolás Monteverde Fernández, Raúl Navatta, Eduardo Moraes, Luis Castro, Luis Martínez, María Eugenia Hernández, Mónica Decia, Rodrigo Franchi, Cecilia Mislej, Akbar Fuenmayor Arocha, Nilce Salgar Sánchez, Michelle Alvarado, Nubia Galeano, María Elena González Inciarte
Institutions: National University of the Northeast, Latin American Sepsis Institute, Hospital Pablo Tobon Uribe, Universidad de La Sabana, Institute of Cardiology, Northwestern University, Lurie Children's Hospital, Universidade Federal do Rio de Janeiro, University College London, Hospital Pedro de Elizalde, Instituto de Efectividad Clínica y Sanitaria, Instituto Nacional de Pediatria, Finis Terrae University, Hospital Nacional Edgardo Rebagliati Martins, Instituto Nacional de Salud del Niño, Instituto de Salud Carlos III, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital del Niño, Unidade Local de Saúde de Coimbra, Hospital Nacional de Niños, Universidad de San Carlos de Guatemala, Hospital General San Juan de Dios, Universidade Federal de São Paulo, Hospital São Paulo, Hospital Universitário da Universidade de São Paulo, Hospital Sírio-Libanês
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
OpenAlex ID: W7111293104