ANDRE LUIZ NUNES GOBATTO
Projetos de Pesquisa
Unidades Organizacionais
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- HOW CAN WE ESTIMATE SEPSIS INCIDENCE AND MORTALITY?(2017) GOBATTO, Andre Luiz Nunes; BESEN, Bruno Adler Maccagnan Pinheiro; AZEVEDO, Luciano Cesar PontesSepsis is one of the oldest and complex syndromes in medicine that has been in debate for over two millennia. Valid and comparable data on the population burden of sepsis constitute an essential resource for guiding health policy and resource allocation. Despite current epidemiological data suggesting that the global burden of sepsis is huge, the knowledge of its incidence, prevalence, mortality, and case-fatality rates is subject to several flaws. The objective of this narrative review is to assess how sepsis incidence and mortality can be estimated, providing examples on how it has been done so far in medical literature and discussing its possible biases. Results of recent studies suggest that sepsis incidence rates are increasing consistently during the last decades. Although estimates might be biased, this probably reflects a real increase in incidence over time. Nevertheless, case fatality rates have decreased, which is a probable reflex of advances in critical care provision to this very sick population at high risk of death. This conclusion can only be drawn with a reasonable degree of certainty for high-income countries. Conversely, adequately designed studies from middle-and low-income countries are urgently needed. In these countries, sepsis incidence and case-fatality rates could be disproportionally higher due to health care provision constraints and ineffective preventive measures.
- Inflammatory, nutritional and clinical parameters of individuals with chronic kidney disease undergoing conservative treatment(2015) ALMEIDA, Alessandra Fortes; GUSMAO-SENA, Maria Helena Lima; OLIVEIRA, Layne Carla Gonzaga; GOMES, Tarcisio Santana; NASCIMENTO, Thais Vitorino Neves do; GOBATTO, Andre Luiz Nunes; SAMPAIO, Lilian Ramos; BARRETO-MEDEIROS, Jairza MariaIntroduction: due to the relevance of inflammation in individuals with chronic kidney disease (CKD), inflammation should be taken into account in the interpretation of the clinical-nutritional status. Objective: assess the association between inflammation, nutritional and clinical parameters in patients with CKD. Materials and methods: 92 patients with CKD. C-reactive protein (CRP) was used as an inflammation marker. Assessed nutritional parameters were anthropometry and biochemical exams. Evaluated clinical parameters were comorbidities, CKD characteristics, lipid profile, lipid-lowering agents, urea, creatinine and total leukocytes. Comparisons between two groups (with or without inflammation) were performed using Student's t-test or chi-square test. Results: 15 (16.3%) patients had CRP above >= 10mg/L and were considered with inflammation. In the group with inflammation, 05 (33%) had hypoalbuminemia as compared with 05 (6.5%) in the group without inflammation (p = 0.002). Lipid values were lower in the group with inflammation, with mean total cholesterol 171 (+/- 41.2) mg/dL and mean LDL-C 95 (+/- 31.2) mg/dL as compared with the group without inflammation, which had and a mean total cholesterol 198 (46) mg/dL and mean LDL-C 124 (+/- 40.1) mg/dL, p = 0,038 and p = 0.011, respectively. No other statistically significant differences between groups were found. Conclusion: inflammation was associated with changes in the total cholesterol and LDL levels and with an increased incidence of hypoalbuminemia. We suggest that serum albumin levels should only be used to assess nutritional status in the absence of inflammation and CRP levels ought to be considered in nutritional status interpretation in patients with CKD.
- Transfusion requirements after head trauma: a randomized feasibility controlled trial(2019) GOBATTO, Andre L. N.; LINK, Milena A.; SOLLA, Davi J.; BASSI, Estevao; TIERNO, Paulo F.; PAIVA, Wellingson; TACCONE, Fabio S.; MALBOUISSON, Luiz M.BackgroundAnemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined.MethodsAll eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a restrictive (hemoglobin transfusion threshold of 7g/dL), or a liberal (threshold 9g/dL) transfusion strategy. The transfusion strategy was continued for up to 14days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome.ResultsA total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.41.0 and 9.31.3 (p<0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p=0.02). There was negative correlation (r=-0.265, p<0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p<0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p=0.048) and the liberal group tended to have a better neurological status at 6months (p=0.06).Conclusions The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group.Trial registration ClinicalTrials.gov, NCT02203292. Registered on 29 July 2014.
- Ultrasound-guided percutaneous dilatational tracheostomy: Going deep into the sea(2015) GOBATTO, Andre Luiz Nunes; BESEN, Bruno Adler Maccagnan Pinheiro; TIERNO, Paulo Fernando Guimaraes Morando Marzocchi; MENDES, Pedro Vitale; CADAMURO, Filipe; JOELSONS, Daniel; MELRO, Livia; PARK, Marcelo; MALBOUISSON, Luiz Marcelo Sa
bookPart Tratamento do Choque Circulatório(2017) BESEN, Bruno Adler Maccagnan Pinheiro; GOBATTO, André Luiz Nunes; AZEVEDO, Luciano Cesar Pontes- TG/HDL-c reason, anthropometrics and biochemical indicators of cardiovascular risk in chronic renal in conservative treatment(2017) ALMEIDA, Fortes Alessandra; SENA, Maria Helena Lima Gusmao; GOMES, Santana Tarcisio; RAMOS, Barbosa Lilian; GOBATTO, Luiz Andre Nunes; CONCEICAO, Maria Ester Pereira da; MEDEIROS, Jairza Maria BarretoIntroduction: Cardiovascular diseases (CVD) area major cause of morbidity and mortality, and its prevalence is growing worldwide. Patients with chronic kidney disease (CKD) are at high risk of group, especially those with dyslipidennia. Triglycerides (TG) and high-density lipoprotein (HDL-c) are independent predictors of cardiovascular events. Excessive adipose tissue also increases the cardiovascular risk. Therefore, CVD predictors, such as the Triglycerides / HDL cholesterol (TG / HDL-c) ratio and the anthropometric measurements for assessing body fat are important in clinical practice. Objective: To evaluate the association between TG / HDL ratio, anthropometric measurements and the cardiovascular risk in CKD patients on dialysis. Methods: A cross-sectional study involving 90 clinically stable outpatients. The TG / HDL-c ratio was defined according to a predetermined equation, considering high CVD risk values greater than 2.5 for women and greater than 3.5 for men. The anthropometric parameters used were the body mass index (BMI) and the waist circumference (WC). Social data, lifestyle, clinical and biochemical data were also collected. Results: Fifty patients (55.6%) had a high TG / HDL ratio. Patients with abnormal BMI and WC were at a higher cardiovascular risk, as measured by the TG / HDL-c ratio. There was a statistically significant difference between the anthroponnetric measurements (BMI and the WC), and the TG / HDL-c ratio in the stratified analysis. However, in the adjusted analysis no association between the BMI or the WC and the TG/HDL ratio was observed. Conclusion: There was no association between the TG / HDL-C ratio and the adiposity measurements (BMI and WC) in the adjusted analysis. The results of this study question the real influence of overweight and central obesity in the TG / HDL-c ratio.
- Spinal hematoma complicating a Churg-Strauss syndrome patient: a previously unreported association(2012) KUKITA, Camila Cristina; GOBATTO, Andre Luiz Nunes; LOBO, Alice Zoghbi; TANIGUCHI, Leandro Utino
- 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.
- Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: A retrospective cohort study(2015) GOBATTO, Andre Luiz Nunes; BESEN, Bruno Adler Maccagnan Pinheiro; TIERNO, Paulo Fernando Guimaraes Morando Marzocchi; MENDES, Pedro Vitale; CADAMURO, Filipe; JOELSONS, Daniel; MELRO, Livia; PARK, Marcelo; MALBOUISSON, Luiz Marcelo SaIntroduction: Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopic guidance. Recently, ultrasound (US) has emerged as a new safety adjunct tool to increase the efficacy of PDT. However, the available data are limited to case series without any control group. Hence, a retrospective cohort study was designed to evaluate the efficacy of US-guided PDT compared with bronchoscopy-guided PDT. Methods: All patients who were submitted to PDT after the standardization of US-guided PDT technique in our institution were analyzed. Demographic and procedure-related variables, complications, and clinical outcomes were collected and compared in patients undergoing US- or bronchoscopy-guided PDT. Results: Sixty patients who had been submitted to PDT were studied, including 11 under bronchoscopy guidance and 49 under US guidance. No surgical conversion was necessary in any of the procedures, and bronchoscopy assistance was only required in 1 case in the US group. The procedure length was shorter in the US group than in the bronchoscopy group (12 vs 15 minutes, P = .028). None of the patients had any major complications. The minor complication rates were not significantly different between the groups, nor was the probability of breathing without assistance within 28 days, intensive care unit length of stay, or hospital mortality. Conclusion: Ultrasound-guided PDT is effective, safe, and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided PDT.