WERTHER BRUNOW DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
136 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 136
- Knowledge and Practice of the Concept of Driving Pressure: A Survey of Pediatric Intensivists in Brazil(2019) JR, Jose Colleti; ARAUJO, Orlei; REZENDE, Felipe Caino de Oliveira; CARVALHO, Werther Brunow deThe objective of this study was to investigate the knowledge and clinical practices of Brazilian pediatric intensivists in relation to usage of the concept of driving pressure. Knowledge and practice patterns were assessed using a survey tool. The overall response rate was 22.8% (84 of 369); 69% of physicians responded that they had sufficient knowledge on the concept of driving pressure but only 56% correctly answered to specific knowledge questions about it. The majority of respondents (72.6%) claim to use this concept in their clinical practice although pediatric data are insufficient to routinely support the practice. This also suggests a good degree of knowledge translation from adult studies.
- Chest compression vibrations and manual hyperinflation in pediatric patients(2012) BARCELLOS, Patricia Gombai; CARVALHO, Werther Brunow de
- Are Children Similar to Adults When There Is Fluid Overload?(2013) RODRIGUES, Priscila Correa; MENEZES, Aline Motta; CARVALHO, Werther Brunow; DELGADO, Artur Figueiredo
- Infections in Pediatric Living Donor Transplantation in Undernourished Patients in a Developing Country: Aspects to Consider(2019) RAMOS, Gabriel F.; SANTOS, Maria Lucia M. B.; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo
- Perioperative Factors Associated with Prolonged Intensive Care Unit and Hospital Length of Stay after Pediatric Neurosurgery(2011) MEKITARIAN FILHO, Eduardo; CARVALHO, Werther Brunow de; CAVALHEIRO, Sergio; HORIGOSHI, Nelson Kazunobu; FREDDI, Norberto AntonioObjectives: This study aims to describe the association between different postoperative complications and the length of hospital stay among children undergoing neurosurgical procedures. Methods: A retrospective cohort study was carried out between May 2004 and May 2009 in a tertiary community hospital. All postoperative complications following neurosurgical procedures and their association with the main outcomes [length of intensive care unit (ICU) and hospital stay] were investigated in a univariate and multivariate analysis. Results: The medical records of 198 patients treated during the study period were reviewed. The most frequently performed surgeries were ventriculoperitoneal shunting (16.7%), correction of craniosynostosis (30%) and brain tumor resections (28.3%). Of the 198 patients eligible for this analysis, 79 (39.9%) suffered from at least one complication. The most frequent complications were fever (30.3%), hypothermia (16%), postextubation laryngitis (15.1%) and postoperative bleeding (7%). Factors independently associated with a longer pediatric ICU stay were fever (odds ratio 1.39, 95% confidence interval 1.1-3.2; p = 0.001), laryngitis (odds ratio 2.24, 95% confidence interval 1.8-5.2; p = 0.001), postoperative bleeding requiring reoperation (odds ratio 1.8, 95% confidence interval 1.4-3.9; p < 0.001) and infection (odds ratio 3.71, 95% confidence interval 1.8-12.4; p = 0.033). Fever (odds ratio 2.54, 95% confidence interval 2-7.4; p = 0.001) and infection (odds ratio 11.23, 95% confidence interval 4-22.4; p = 0.003) were related to the total length of the patient's hospital stay. Conclusions: In this study population, most elective neurosurgical procedures were not associated with significant complications, and morbidity and mortality were low. Some complications significantly influenced patients' outcomes and should be monitored for early diagnosis. This study may improve our understanding and identification of postoperative outcomes in pediatric neurosurgery.
- Is the Obesity Paradox Valid in Pediatric Intensive Care?(2017) ZAMBERLAN, Patricia; DELGADO, Artur Figueiredo; CARVALHO, Werther Brunow de
- Fluid Overload: A Question in Pediatric Intensive Care Spotlight?(2016) LUGLIO, Michele; DELGADO, Artur Figueiredo; CARVALHO, Werther Brunow de
- Association between fluid creep and infection in burned children: A cohort study(2020) DITTRICH, Maria Helena M.; HOSNI, Nicole Dittrich; CARVALHO, Werther B. deIntroduction: Aggressive fluid resuscitation has been extensively discussed after the establishment of fluid creep phenomenon as a morbidity and mortality factor in burn children. Sepsis is currently the leading cause of death in survivors of burn shock. Objectives: To evaluate the association between fluid creep and infection in burn children exposed to two different fluid resuscitation strategies with the use of albumin. Methods: A cohort of 46 burn children with 15-45% of body surface area (BSA) admitted up to 12 h after the incident were evaluated. Patients from early albumin group (n = 23) received 5% albumin between 8 and 12 h from injury and patients from delayed albumin group (n = 23) received 5% albumin after 24 h. Outcomes analysed were development of fluid creep, length of stay in the hospital, number of surgery procedures and infection until hospital discharge. Results: Compared to the delayed group, patients that received early albumin had a shorter length of stay in the hospital (p = 0.007), less fluid creep (4.3% x 56.5%) (p < 0.001), less skin graft procedure (47.8% xd 78.3%) (p = 0.032) and less debridement (73.9% x 100%) (p = 0.022). Both length of stay in the hospital and fluid creep arising were associated with infection (p < 0.05). Conclusion: Fluid creep, surgery procedures and length of stay in hospital parameters showed better results in burn children treated with early albumin. Fluid creep and length of stay in the hospital were associated with infection, providing a negative prognosis.
- First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction(2019) KOSTIC, Dusan; BEOZZO, Glenda Priscila Neves dos Santos; COUTO, Saulo Brasil do; KATO, Andre Henrique Teruaki; LIMA, Laila; PALMEIRA, Patricia; KREBS, Vera Lucia Jornada; BUNDUKI, Victor; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; CARVALHO, Werther Brunow de; KOCH, Vera Hermina KalikaBackground Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. Methods This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinol-binding protein (RBP), cystatin C (mu CyC), and microalbuminuria (ALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Results All urine biomarkers showed significantly higher values at the first month of life (p <= 0.009), while NGAL (p = 0.005), TGF-beta 1 (p<0.001), and mu ALB (p<0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-beta 1 or KIM-1 and NGAL with CyC ([AUC] <= 0.934; sensitivity <= 92.4%; specificity <= 92.8%). Conclusions RBP, NGAL, KIM-1, TGF-beta 1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
- Stress Ulcer Prophylaxis Remains a Controversial Management in the PICU(2020) RAMOS, Gabriel F.; LUGLIO, Michele; CARVALHO, Werther Brunow de; DELGADO, Artur Figueiredo