About

Fernando Beltramo is a Clinical Associate Professor of Pediatrics (Clinician Educator) at the Keck School of Medicine of USC. His work focuses on pediatric critical care, with research contributions spanning postoperative infections, antimicrobial prophylaxis in pediatric liver transplantation, and protective ventilation strategies in children. He has conducted multicenter studies on ICU resource utilization post-CAR-T therapy, pediatric acute respiratory distress syndrome, and renal replacement therapy modalities in critically ill children. His research aims to improve clinical outcomes and optimize care practices in pediatric intensive care settings.

Research topics

• Internal medicine
• Medicine
• Pediatrics
• Intensive care medicine
• Surgery
• Emergency medicine

Selected publications

• Randomized Trial of Lung and Diaphragm Protective Ventilation in Children

  NEJM Evidence · 2025-05-27 · 10 citations

  article

  BACKGROUND: Mechanical ventilation strategies that balance lung and diaphragm protection have not been extensively tested in clinical trials. METHODS: We conducted a single-center, phase II randomized controlled trial in children with acute respiratory distress syndrome with two time points of random assignment: the acute and weaning phases of ventilation. Patients in the intervention group were managed with a computerized decision support (CDS) tool, named REDvent, and esophageal manometry to deliver lung and diaphragm protective ventilation. The control group received usual care. A daily standardized spontaneous breathing trial (SBT) was performed in both groups. The primary outcome was the length of weaning. RESULTS: O (95% CI, -3.2 to -0.3). For the primary outcome, 55% of REDvent-acute patients passed their SBT or were extubated on the day of the first SBT, compared with 39% in the usual care-acute group. After adjusting for age, immunosuppression, and oxygenation index value, the REDvent-acute intervention resulted in a 1.67 (95% CI, 1.01 to 2.77; P=0.045) odds of a shorter length of weaning than usual care. The median time from intubation to SBT passage was 3.83 days in the intervention group versus 4.75 days in the usual care group. The length of ventilation among survivors was 5.0 days in the intervention group versus 5.6 days in the usual care group. When comparing weaning phase random assignment, clinical outcomes were similar between groups. There were no differences in adverse events between the groups. CONCLUSIONS: A lung and diaphragm protective ventilation strategy using a CDS tool during the acute phase of ventilation resulted in a shorter length of weaning than usual care. Phase III trials in mechanically ventilated patients are warranted. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT03266016.).

  PublisherDOI

• Postoperative Infections and Antimicrobial Prophylaxis in the Pediatric Intensive Care Unit After Liver Transplantation in Children

  Pediatric Transplantation · 2025-08-11 · 1 citations

  article

  OBJECTIVE: To determine the incidence and risk factors for postoperative infections (POI) after pediatric liver transplantation (LT) while in the pediatric intensive care unit (PICU). METHODS: This is a multicenter, retrospective cohort study of isolated pediatric LT recipients from 12 LT centers in the United States over 2 years. Pre- and postoperative variables were examined to determine POI risk factors during the PICU admission. Antimicrobial prophylaxis utilization was assessed. Comparative statistics were performed using chi-squared and Mann-Whitney U tests. Multivariable logistic regression modeling evaluated POI risk factors. RESULTS: 76/327 (23%) patients developed POI (47% bacterial, 3% viral, 4% fungal, 22% polymicrobial, and 21% clinically adjudicated, culture negative). Abdominal/surgical site and bloodstream infections were most common at 29% and 26%, respectively. Independent predictors of POI included age under 1 (OR = 2.37 [95% CI 1.36-4.13], p = 0.002), open fascia (OR = 3.15 [95% CI 1.77-5.61], p < 0.001), and hospitalization pre-transplant (OR = 2.09 [95% CI 1.20-3.64], p = 0.009). Patients with POI had longer hospitalizations (23.0 days [17.0-34.0] vs. 13.0 days [9.0-20.0], p < 0.001), higher graft loss rates (9% vs. 0.4%, p < 0.001), and greater mortality (5% vs. 0.4%, p = 0.01). Significant variability in antimicrobial regimens existed amongst transplant centers. CONCLUSIONS: One in five patients developed POI while in the PICU. Predictors of POI included younger age, open fascia, and hospitalization pre-transplantation. POIs were associated with significant morbidity, including prolonged length of stay, graft loss, and mortality. Future prospective studies are needed to optimize antimicrobial regimens to prevent POI and improve outcomes.

  PublisherDOI

• Impact of Continuous Renal Replacement Therapy Initiation Time, Kidney Injury, and Hypervolemia in Critically Ill Children

  Critical Care Nurse · 2024-06-01

  article

  BACKGROUND: The mortality rate of pediatric patients who require continuous renal replacement therapy is approximately 42%, and outcomes vary considerably depending on underlying disease, illness severity, and time of dialysis initiation. Delay in the initiation of such therapy may increase mortality risk, prolong intensive care unit stay, and worsen clinical outcomes. LOCAL PROBLEM: In the pediatric intensive care unit of an urban level I trauma children's hospital, continuous renal replacement therapy initiation times and factors associated with delays in therapy were unknown. METHODS: This quality improvement process involved a retrospective review of data on patients who received continuous dialysis in the pediatric intensive care unit from January 1, 2017, to December 31, 2021. The objectives were to examine the characteristics of the children requiring continuous renal replacement therapy, therapy initiation times, and factors associated with initiation delays that might affect unit length of stay and mortality. RESULTS: During the study period, 175 patients received continuous renal replacement therapy, with an average initiation time of 11.9 hours. Statistically significant associations were found between the degree of fluid overload and mortality (P < .001) and between the presence of acute kidney injury and prolonged length of stay (P = .04). No significant association was found between therapy initiation time and unit length of stay or mortality, although the average initiation time of survivors was 5.9 hours shorter than that of nonsurvivors. CONCLUSION: Future studies are needed to assess real time delays and to evaluate if the implementation of a standardized initiation process decreases initiation time.

  PublisherDOI

• Vascular thrombosis after pediatric liver transplantation: Is prevention achievable?

  Journal of Liver Transplantation · 2023-10-19 · 7 citations

  articleOpen access

  : Vascular thromboses (VT) are life-threatening events after pediatric liver transplantation (LT). Single-center studies have identified risk factors for intra-abdominal VT, but large-scale pediatric studies are lacking. : This multicenter retrospective cohort study of isolated pediatric LT recipients assessed pre- and perioperative variables to determine VT risk factors and anticoagulation-associated bleeding complications. : Within seven postoperative days, 31/331 (9.37%) patients developed intra-abdominal VT. Open fascia occurred more commonly in patients with VT (51.61 vs 23.33%) and remained the only independent risk factor in multivariable analysis (OR = 2.84, p=0.012). Patients with VT received more blood products (83.87 vs 50.00%), had significantly higher rates of graft loss (22.58 vs 1.33%), infection (50.00 vs 20.60%), and unplanned return to the operating room (70.97 vs 16.44%) compared to those without VT. The risk of bleeding was similar (p=0.2) between patients on and off anticoagulation. : Prophylactic anticoagulation did not increase bleeding complications in this cohort. The only independent factor associated with VT was open fascia, likely a graft/recipient size mismatch surrogate, supporting the need to improve surgical techniques to prevent VT that may not be modifiable with anticoagulation.

  PublisherDOI

• Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative*

  Pediatric Critical Care Medicine · 2022 · 10 citations

  • Medicine
  • Internal medicine
  • Surgery

  OBJECTIVES: We aimed to determine which characteristics and management approaches were associated with postoperative invasive mechanical ventilation (IMV) and with a prolonged course of IMV in children post liver transplant as well as describing the utilization of critical care resources. DESIGN: Retrospective, multicenter, cohort study of children who underwent an isolated liver transplantation between January 2017 and December 2018. SETTING: Twelve U.S., pediatric, liver transplant centers. PATIENTS: Three hundred thirty children post liver transplant admitted to the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six patients died in our cohort. The median length of PICU stay was 4.5 days (interquartile range [IQR], 2.9-8.2 d). Most patients were initially monitored with arterial catheters (96%), central venous pressures (95%), and liver ultrasound (93%). Anticoagulation (80%), blood product administration (52.4%), and vasoactive agents (23.0%) were commonly used therapies in the first 7 days. In multivariable logistic regression analysis, age (adjusted odds ratio [aOR] 0.9 [0.86-0.95]), open fascia (aOR 7.0 [95% CI, 2.6-18.9]), large center size (aOR 4.3 [95% CI 2.2-8.3]), and higher Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores (aOR 1.04 [95% CI, 1.01-1.06]) were associated with postoperative IMV. In multivariable logistic regression analysis, postoperative day 0 peak inspiratory pressure (PIP) (aOR 1.2 [95% CI, 1.1-1.3]), large center size (aOR 2.9 [95% CI, 1.6-5.4]), and age (aOR 0.89 [95% CI, 0.85-0.95]) were associated with length of IMV greater than 24 hours. Length of IMV greater than 24 hours was associated with bleeding complications ( p = 0.03), infections ( p = 0.03), graft loss ( p = 0.02), and reoperation ( p = 0.03). CONCLUSIONS: Younger age, preoperative hospitalization, large center size, and open fascia are associated with use of IMV, and younger age, large center size, and postoperative day 0 PIP are associated with prolonged IMV on multivariable analysis. Longer IMV is associated with negative outcomes, making it an important clinical marker.

  PublisherDOI

• A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy

  Frontiers in Oncology · 2022 · 4 citations

  • Medicine
  • Intensive care medicine
  • Pediatrics

  Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0-43) versus 1 (0-116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning.

  PublisherOA PDFDOI

• 1165: PREDICTIVE FACTORS FOR POSTOPERATIVE MECHANICAL VENTILATION IN PEDIATRIC LIVER TRANSPLANT PATIENTS

  Critical Care Medicine · 2021-12-16

  article

  Maue, Danielle; Martinez, Mercedes; Beltramo, Fernando; Alcamo, Alicia; Ridall, Leslie; Nares, Michael; Jeyapalan, Asumthia; Zinter, Matthew; Betters, Kristina; Kamath, Sameer; Monde, Alexandra; Kaushik, Shubhi; Resch, Joseph; Kang, Elise; Pike, Francis; Mangus, Richard; Rowan, Courtney Author Information

  PublisherDOI

• 1022: ICU ADMISSION IN CHILDREN AFTER TONSILLECTOMY

  Critical Care Medicine · 2021-12-16

  article

  Gutierrez, Elyse1; Toomey, Vanessa2; Ross, Patrick2; Beltramo, Fernando2; Bhalla, Anoopindar3 Author Information

  PublisherDOI

• Miliary Tuberculosis Presenting as Altered Mental Status

  Consultant · 2021-01-01

  articleOpen accessSenior author
  PublisherOA PDFDOI

• 589: Predictive Factors for Bleeding Complications in Children Post Liver Transplant

  Critical Care Medicine · 2020-12-11

  article

  Maue, Danielle; Alcamo, Alicia; Beltramo, Fernando; Betters, Kristina; Kamath, Sameer; Kaushik, Shubhi; Mangus, Richard; Martinez, Mercedes; Monde, Alexandra; Nares, Michael; Resch, Joseph; Ridall, Leslie; Zinter, Matthew; Rowan, Courtney Author Information

  PublisherDOI

Frequent coauthors

• Robinder G. Khemani

  26 shared

• Balagangadhar Totapally

  Miami Children's Hospital

  16 shared

• Patrick A. Ross

  Children's Hospital of Los Angeles

  12 shared

• Danielle Maue

  Indiana University – Purdue University Indianapolis

  8 shared

• Courtney M. Rowan

  Indiana University School of Medicine

  8 shared

• Asma Razavi

  Baylor College of Medicine

  8 shared

• Leslie Ridall

  University of Colorado Denver

  8 shared

• Anoopindar Bhalla

  University of Southern California

  7 shared