FILOMENA REGINA BARBOSA GOMES GALAS
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
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- Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment(2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
bookPart Pós-operatório de cirurgia cardíaca: admissão na UTI, rotinas e monitorização(2012) GALAS, Filomena; HAJJAR, Ludhmila AbrahãoconferenceObject In-hospital mortality prediction by American Society of Anesthesiology and POSSUM score in patients with cancer undergoing abdominal surgery(2012) SIMOES, Claudia Marquez; CARVALHO, Maria Jose; LUDHMILA, Carmona; HAJJAR, Abrahao; REGINA, Filomena; GALLAS, Barbosa; FUKUSHIMA, Julia TizueIntroduction: Preoperative evaluation and risk stratification is essential to perioperative planning. There are multiple risk scores applied to predict different outcomes. However, specific populations as patients with cancer may have specific risk factors, so it is needed to evaluate if global risk scoresas ASA and POSSUM or P POSSUM are able to assist the surgical team. Objective: To retrospectively assess the value of the ASA classification (American Society of Anesthesiology), POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity), and Porthsmouth POSSUM in prediction of hospital mortality in patients with cancer undergoing abdominal surgery. Methods: Three hundred and thirteen patients who under-went three hundred and nineteen oncologic abdominal surgeries were evaluated using ASA, POSSUM and Porthsmouth-POSSUM in relation to hospital mortality. The variables observed were: age, gender, ASA classification, pul- monary diseases, cardiovascular diseases, preoperative sys-tolic arterial pressure and cardiac rate, Glasgow scale, urea, potassium, sodium, hemoglobin, white cell count, number of simultaneous surgical procedures, observed blood losses, peritoneal contamination, oncological disease and dissemination, elective, emergent or urgent surgery, intensive care support and hospital mortality. Results: The overall hospital mortality rate was 5.59%. These results showed that POSSUM over predicted in-hospital deaths when compared to American Society of Anesthesiologists classification (relative risk, 0.55; P=.07) and Porths- mouth POSSUM (relative risk, 0,43; P=.0007) didn’t equally correspond to ASA predicted perioperative mortality. All evaluated scores didn’t equally predict observed mortality as the standardized mortality rate was 2.25 for ASA classification, 0.4 for POSSUM and 0.8 for P-POSSUM. Conclusion: The ASA classification, POSSUM and P POSSUM scores were not useful in predicting perioperative mortality for patients with cancer submitted to abdominal surgeries. It is needed to evaluate specific populations to adjust the existing perioperative prediction scores to serve as objective methods to assist the surgical team in classifying patients into risk groups with different probabilities of perioperative complications. ASA classification is based mainly on subjective clinical judgments and probably POSUUM and P-POSSUM need to have the equations balanced to specific populations.- Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management(2012) TEDDE, Miguel L.; VASCONCELOS FILHO, Paulo; HAJJAR, Ludhmila Abrahao; ALMEIDA, Juliano Pinheiro de; FLORA, Gustavo Fagundes; OKUMURA, Erica Mie; OSAWA, Eduardo A.; FUKUSHIMA, Julia Tizue; TEIXEIRA, Manoel Jacobsen; GALAS, Filomena Regina Barbosa Gomes; JATENE, Fabio Biscegli; AULER JR., Jose Otavio CostaOBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov:NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
- Positive fluid balance is associated with reduced survival in critically ill patients with cancer(2012) ALMEIDA, J. P. de; PALOMBA, H.; GALAS, F. R. B. G.; FUKUSHIMA, J. T.; DUARTE, F. A.; NAGAOKA, D.; TORRES, V.; YU, L.; VINCENT, J. -L.; AULER JR., J. O. C.; HAJJAR, L. A.Background There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients. Method One hundred twenty-two cancer patients were prospectively evaluated for survival during a 30-day period. Univariate (Chi-square, t-test, MannWhitney) and multiple logistic regression analyses were used to identify the admission parameters associated with mortality. Results The mean cumulative fluid balance was significantly higher in non-survivors than in survivors [1675?ml/24?h (4712921) vs. 887?ml/24?h (104557), P?=?0.017]. We used the area under the curve and the intersection of the sensibility and specificity curves to define a cumulative fluid balance value of 1100?ml/24?h. This value was used in the univariate model. In the multivariate model, the following variables were significantly associated with mortality in cancer patients: the Acute Physiology and Chronic Health Evaluation II score at admission [Odds ratio (OR) 1.15; 95% confidence interval (CI) (1.051.26), P?=?0.003], the Lung Injury Score at admission [OR 2.23; 95% CI (1.293.87), P?=?0.004] and a positive fluid balance higher than 1100?ml/24?h at ICU [OR 5.14; 95% CI (1.4518.24), P?=?0.011]. Conclusion A cumulative positive fluid balance higher than 1100?ml/24?h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.
- Anesthesia for cardiac surgery under cardiopulmonary bypass in pregnant patients: experience with nine cases(2012) BLIACHERIENE, F.; AVILA, W. S.; BORTOLOTTO, M. R. F. L.; OKANO, F. T.; FONTES, E. S.; GALAS, F. R. B. G.; CARMONA, M. J. C.
article 8 Citação(ões) na Scopus Use of pulse pressure variation to estimate changes in preload during experimental acute normovolemic hemodilution(2012) SANT'ANA, A. J.; OTSUKI, D. A.; NOEL-MORGAN, J.; LEITE, V. F.; FANTONI, D. T.; HAJJAR, L. Abrahao; GALAS, F. R. Barbosa Gomes; ALMEIDA, J. Pinheiro De; FUKUSHIMA, J.; AULER JR., J. O. CostaBackground. Acute normovolemic hemodilution (ANH) is an alternative to blood transfusion in surgeries involving blood loss. This experimental study was designed to evaluate whether pulse pressure variation (PPV) would be an adequate tool for monitoring changes in preload during ANH, as assessed by transesophageal echocardiography. Methods. Twenty-one anesthetized and mechanically ventilated pigs were randomized into three groups: CTL (control), HES (hemodilution with 6% hydroxyethyl starch at a 1:1 ratio) or NS (hemodilution with saline 0.9% at a 3:1 ratio). Hemodilution was performed in animals of groups NS and HES in two stages, with target hematocrits 22% and 15%, achieved at 30-minute intervals. After two hours, 50% of the blood volume withdrawn was transfused and animals were monitored for another hour. Statistical analysis was based on ANOVA for repeated measures followed by multiple comparison test (P<0.05). Pearson's correlations were performed between changes in left ventricular end-diastolic volume (LVEDV) and PPV, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP). Results. Group NS received a significantly greater amount of fluids during ANH (NS, 900 +/- 168 mL vs. HES, 200 +/- 50 mL, P<0.05) and presented greater urine output (NS, 2643 +/- 1097mL vs. HES, 641 +/- 338mL, P<0.001). Significant decreases in LVEDV were observed in group NS from completion of ANH until transfusion. In group HES, only increases in LVEDV were observed, at the end of ANH and at transfusion. Such changes in LVEDV (Delta LVEDV) were better reflected by changes in PPV (Delta PPV, R=-0.62) than changes in CVP (Delta CVP R=0.32) or in PAOP (Delta PAOP, R=0.42, respectively). Conclusion. Changes in preload during ANH were detected by changes in PPV. Delta PPV was superior to Delta PAOP and Delta CVP to this end. (Minerva Anestesiol 2012;78:426-33)- Alveolar recruitment maneuver in refractory hypoxemia and lobar atelectasis after cardiac surgery: A case report(2012) HERBST-RODRIGUES, Marcus Vinicius; CARVALHO, Vitor Oliveira; ABRAHAO, Ludhmila Hajjar; NOZAWA, Emilia; FELTRIM, Maria Ignez Zanetti; GOMES-GALAS, Filomena Regina BarbosaObjective: This case report describes an unusual presentation of right upper lobe atelectasis associated with refractory hypoxemia to conventional alveolar recruitment maneuvers in a patient soon after coronary artery bypass grafting surgery. Method: Case-report. Results: The alveolar recruitment with PEEP = 40cmH(2)O improved the patient's atelectasis and hypoxemia. Conclusion: In the present report, the unusual alveolar recruitment maneuver with PEEP 40cmH(2)O showed to be safe and efficient to reverse refractory hypoxemia and uncommon atelectasis in a patient after cardiac surgery.
- The Impact of Tacrolimus as Rescue Therapy in Children Using a Double Immunosuppressive Regimen After Heart Transplantation(2012) BRANCO, K. C.; AZEKA, E.; TRINDADE, E.; GALAS, F. R. B.; HAJJAR, L. A.; BENVENUTI, L.; RISO, A.; TANAMATI, C.; PENHA, J.; AULER JR., J. O. C.; JATENE, M.Background. Organ transplant recipients with refractory rejection or intolerance to the prescribed immunosuppressant may respond to rescue therapy with tacrolimus. We sought to evaluate the clinical outcomes of children undergoing heart transplantation who required conversion from a cyclosporine-based, steroid-free therapy to a tacrolimus-based regimen. Methods. We performed a prospective, observational, cohort study of 28 children who underwent conversion from cyclosporine-based, steroid-free therapy to a tacrolimus-based therapy for refractory or late rejection or intolerance to cyclosporine. Results. There was complete resolution of refractory rejection episodes and adverse side effects in all patients. The incidence rate (X100) of rejection episodes before and after conversion was 7.98 and 2.11, respectively (P <= .0001). There was a 25% mortality rate in patients using tacrolimus after a mean period of 60 months after conversion. Conclusion. Tacrolimus is effective as rescue therapy for refractory rejection and is a therapeutic option for pediatric patients.