Pediatric intensive care resources in Ibero-Latin America: SPREAD PED Ibero–Latin America, a multinational, multicentre, cross-sectional study

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.