MARCELO PARK
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
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Resultados de Busca
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conferenceObject EPIDEMIOLOGY OF ACUTE RESPIRATORY INSUFFICIENCY IN CRITICAL CARE (ERICC TRIAL): A PROSPECTIVE, MULTICENTER, OBSERVATIONAL STUDY IN BRAZILIAN ICUS(2012) AZEVEDO, L.; SOARES, M.; SALLUH, J.; PARK, M.; REA-NETO, A.; SILVA, U.; VARASCHIN, P.; DANTAS, V.; KNIBEL, M.; SCHETTINO, G.- Association between education in EOL care and variability in EOL practice: a survey of ICU physicians(2012) FORTE, Daniel Neves; VINCENT, Jean Louis; VELASCO, Irineu Tadeu; PARK, MarceloThis study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 +/- A 8 years, with a mean of 14 +/- A 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply ""full code"" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.
conferenceObject THE ROLE OF RESIDUAL PULMONARY FUNCTION DURING VV-ECMO SUPPORT IN AN EXPERIMENTAL MODEL OF MULTIORGAN FAILURE ASSOCIATED WITH SEVERE RESPIRATORY FAILURE(2012) PARK, M.; AZEVEDO, L.; COSTA, E.; AMATO, M.; CARVALHO, C.; SCHETTINO, G.- Effect modification in a clinical trial should be assessed through interaction terms, not prognostic modelling (vol 48, pg 1122, 2022)(2022) ROEPKE, Roberta M. L.; MENDES, Pedro V.; CARDOZO JUNIOR, Luis C. M.; PARK, Marcelo; BESEN, Bruno A. M. P.
- Effect modification in a clinical trial should be assessed through interaction terms, not prognostic modelling(2022) ROEPKE, Roberta M. L.; MENDES, Pedro V.; CARDOZO JUNIOR, Luis C. M.; PARK, Marcelo; BESEN, Bruno A. M. P.
conferenceObject RELATIONSHIP BETWEEN RENAL DOPPLER RESISTIVE INDEX AND SERUM CHLORIDE IN CRITICALLY ILL PATIENTS(2014) OLIVEIRA, R. A. G.; MENDES, P. V.; PARK, M.; TANIGUCHI, L. U.- Highlighting the important effect of systemic lupus erythematosus on platelet count of critically ill patients(2013) RANZANI, Otavio T.; ZAMPIERI, Fernando G.; PARK, Marcelo
conferenceObject EFFECT OF DISCHARGE TO A STEP-DOWN UNIT AFTER CRITICAL ILLNESS ON MORTALITY AND HOSPITAL LENGTH OF STAY: A PROPENSITY MATCHED ANALYSIS(2012) RANZANI, O. T.; ZAMPIERI, F. G.; FORTE, D. N.; TANIGUCHI, L. U.; PARK, M.; AZEVEDO, L. C.- Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis(2016) SERPA NETO, Ary; SCHMIDT, Matthieu; AZEVEDO, Luciano C. P.; BEIN, Thomas; BROCHARD, Laurent; BEUTEL, Gernot; COMBES, Alain; COSTA, Eduardo L. V.; HODGSON, Carol; LINDSKOV, Christian; LUBNOW, Matthias; LUECK, Catherina; MICHAELS, Andrew J.; PAIVA, Jose-Artur; PARK, Marcelo; PESENTI, Antonio; PHAM, Tai; QUINTEL, Michael; RANIERI, V. Marco; RIED, Michael; RONCON-ALBUQUERQUE JR., Roberto; SLUTSKY, Arthur S.; TAKEDA, Shinhiro; TERRAGNI, Pier Paolo; VEJEN, Marie; WEBER-CARSTENS, Steffen; WELTE, Tobias; ABREU, Marcelo Gama de; PELOSI, Paolo; SCHULTZ, Marcus J.Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality. Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO(2), higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)]. In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.
- Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial(2016) GOBATTO, Andre Luiz Nunes; BESEN, Bruno A. M. P.; TIERNO, Paulo F. G. M. M.; MENDES, Pedro V.; CADAMURO, Filipe; JOELSONS, Daniel; MELRO, Livia; CARMONA, Maria J. C.; SANTORI, Gregorio; PELOSI, Paolo; PARK, Marcelo; MALBOUISSON, Luiz M. S.Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool to assist PDT and reduce procedure-related complications. An open-label, parallel, non-inferiority randomized controlled trial was conducted comparing an ultrasound-guided PDT with a bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy, unplanned associated use of bronchoscopy or ultrasound during PDT, or the occurrence of a major complication. A total of 4965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7 %) patient in the ultrasound group and one (1.7 %) patient in the bronchoscopy group, with no absolute risk difference between the groups (90 % confidence interval, -5.57 to 5.85), in the ""as treated"" analysis, not including the prespecified margin of 6 % for noninferiority. No other patient had any major complication in either group. Procedure-related minor complications occurred in 20 (33.3 %) patients in the ultrasound group and in 12 (20.7 %) patients in the bronchoscopy group (P = 0.122). The median procedure length was 11 [7-19] vs. 13 [8-20] min (P = 0.468), respectively, and the clinical outcomes were also not different between the groups. Ultrasound-guided PDT is noninferior to bronchoscopy-guided PDT in mechanically ventilated critically ill patients.