MARIA JOSE CARVALHO CARMONA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- S100B protein and neuron-specific enolase as predictors of cognitive dysfunction after coronary artery bypass graft surgery A prospective observational study(2016) SILVA, Fernando P.; SCHMIDT, Andre P.; VALENTIN, Livia S.; PINTO, Katia O.; ZEFERINO, Suely P.; OSES, Jean P.; WIENER, Carolina D.; OTSUKI, Denise A.; TORT, Adriano B. L.; PORTELA, Luis V.; SOUZA, Diogo O.; AULER JR., Jose O. C.; CARMONA, Maria J. C.BACKGROUND Postoperative cognitive dysfunction (POCD) may be related to the systemic inflammatory response and an increase in serum markers of brain injury such as S100B protein and neuron-specific enolase (NSE). OBJECTIVE The study aims to evaluate the association between POCD and serum levels of S100B and NSE after coronary artery bypass grafting surgery (CABG). DESIGN Prospective observational study. SETTING Single university teaching hospital. PATIENTS We investigated 88 patients undergoing CABG. MAIN OUTCOMES MEASURES Cognitive function was measured preoperatively, and at the 21st and 180th postoperative days (i.e. 6 months after surgery). S100B protein and NSE serum levels were evaluated preoperatively, after induction of anaesthesia, at the end of surgery and at 6 and 24 h after surgery. RESULTS The incidence of POCD was 26.1% at 21 days after surgery and 22.7% at 6 months after surgery. Increased serum levels of S100B protein and NSE were observed postoperatively and may indicate brain damage. CONCLUSION Although serum levels of S100B protein and NSE are both significantly increased postoperatively, our findings indicate that serum levels of S100B protein may be more accurate than NSE in the detection of POCD after CABG.
- Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study(2019) VANE, Matheus F.; CARMONA, Maria J. C.; PEREIRA, Sergio M.; KERN, Karl B.; TIMERMAN, Sergio; PEREZ, Guilherme; VANE, Luiz Antonio; OTSUKI, Denise Aya; JR, Jose O. C. AulerData on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80-0.93]), with a sensitivity and specificity of 78.4% [69.6-86.3%] and 89.3% [80.4-96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792-0.956]), with a sensitivity of 79.3% [65.5-93.1%] and specificity of 86.1 [74.4-95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.
- Impact of Cardiopulmonary Bypass on Respiratory Mucociliary Function in an Experimental Porcine Model(2015) SANCHEZ-VELIZ, Rodrigo; CARMONA, Maria Jose; OTSUKI, Denise Aya; FREITAS, Claudia; BENICIO, Anderson; NEGRI, Elnara Marcia; MALBOUISSON, Luiz MarceloBackground The impact of cardiac surgery using cardiopulmonary bypass (CPB) on the respiratory mucociliary function is unknown. This study evaluated the effects of CPB and interruption of mechanical ventilation on the respiratory mucociliary system. Methods Twenty-two pigs were randomly assigned to the control (n = 10) or CPB group (n = 12). After the induction of anesthesia, a tracheostomy was performed, and tracheal tissue samples were excised (T0) from both groups. All animals underwent thoracotomy. In the CPB group, an aorto-bicaval CPB was installed and maintained for 90 minutes. During the CPB, mechanical ventilation was interrupted, and the tracheal tube was disconnected. A second tracheal tissue sample was obtained 180 minutes after the tracheostomy (T180). Mucus samples were collected from the trachea using a bronchoscope at T0, T90 and T180. Ciliary beat frequency (CBF) and in situ mucociliary transport (MCT) were studied in ex vivo tracheal epithelium. Mucus viscosity (MV) was assessed using a cone-plate viscometer. Qualitative tracheal histological analysis was performed at T180 tissue samples. Results CBF decreased in the CPB group (13.1 +/- 1.9 Hz vs. 11.1 +/- 2.1 Hz, p < 0.05) but not in the control group (13.1 +/- 1 Hz vs. 13 +/- 2.9 Hz). At T90, viscosity was increased in the CPB group compared to the control (p < 0.05). No significant differences were observed in in situ MCT. Tracheal histology in the CPB group showed areas of ciliated epithelium loss, submucosal edema and infiltration of inflammatory cells. Conclusion CPB acutely contributed to alterations in tracheal mucocilliary function.
- Cardiac arrest animal model: a simple device for small animals' chest compression(2017) VANE, Matheus F.; CARMONA, Maria Jose Carvalho; OTSUKI, Denise A.; MAIA, Debora R. R.; VANE, Lucas F.; VANE, Luiz A.; ARAUJO FILHO, Elson Alberto Fernandes de; XAVIER, Marcelo; AULER JUNIOR, Jose Otavio Costa
conferenceObject IMPACT OF DIFFERENT HAEMODYNAMIC RESUSCITATION STRATEGIES ON BRAIN PERFUSION AND TISSUE EDEMA MARKERS IN A MODEL OF SEVERE HAEMORRHAGIC SHOCK(2013) MALBOUISSON, L. M.; IDA, K. K.; OTSUKI, D. A.; CASTRO, L. U.; SANCHES, T. R.; SHIMIZU, M. M.; ANDRADE, L. C.; CARMONA, M. C.- Myocardial protection induced by fentanyl in pigs exposed to high-dose adrenaline(2015) LUZ, Vinicius Fernando da; OTSUKI, Denise Aya; GONZALEZ, Maria Margarita Castro; NEGRI, Elnara Marcia; CALDINI, Elia Garcia; DAMACENO-RODRIGUES, Nilsa Regina; MALBOUISSON, Luiz Marcelo Sa; VIANA, Bruno Goncalves; VANE, Matheus Fachini; CARMONA, Maria Jose CarvalhoThe use of high doses of adrenaline is common in critical patients, especially during cardiac arrest. During these situations, myocardial dysfunction can be a result of multiple factors, including adrenaline use. In addition, opioids have been shown to have anti-arrhythmic and anti-ischemic mechanisms that may confer cardiac protection. This study aimed to evaluate the effects of fentanyl on myocardial function in pigs exposed to high-dose adrenaline. After institutional ethics committee approval, 26 pigs were randomly allocated to receive either 20 mu g/kg fentanyl (n = 10; fentanyl group) administered 5 min before five doses of adrenaline (20 mu g/kg), equivalent-volume saline (n = 10; saline group) using the same adrenaline dosing protocol, or neither fentanyl nor adrenaline (n = 6; sham group). The fentanyl group showed lower levels of troponin at the end of the sixth hour compared with the saline group (1.91 +/- 1.47 vs 5.44 +/- 5.35 ng/mL, P = 0.019). Transmission electron microscopy and immunohistochemistry also showed less myocardial injury in the fentanyl group. The conclusion was reached that fentanyl attenuates myocardial injury caused by high-dose adrenaline without blunting the hemodynamic effect of adrenaline.
- Nebulization of Vancomycin Provides Higher Lung Tissue Concentrations than Intravenous Administration in Ventilated Female Piglets with Healthy Lungs(2020) MORAIS, Cristiane Luchesi de Mello; NASCIMENTO, Jorge Willian Leandro; RIBEIRO, Aline Correa; CORTINEZ, Luis Ignacio; CARMONA, Maria Jose Carvalho; MAIA, Debora Rothstein Ramos; MONSEL, Antoine; AULER JR., Jose Otavio Costa; ROUBY, Jean-Jacques; OTSUKI, Denise AyaBackground: Intravenous vancomycin is used to treat ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus, but achieves high rates of failure. Vancomycin nebulization may be efficient to provide high vancomycin lung tissue concentrations. The aim of this study was to compare lung tissue and serum concentrations of vancomycin administered intravenously and by aerosol in mechanically ventilated and anesthetized healthy piglets. Methods: Twelve female piglets received a single intravenous dose of vancomycin (15mg/kg) and were killed 1 (n = 6) or 12h (n = 6) after the end of administration. Twelve piglets received a single nebulized dose of vancomycin (37.5mg/kg) and were killed 1 (n = 6) or 12h (n = 6) after the end of the aerosol administration. In each group, vancomycin lung tissue concentrations were assessed on postmortem lung specimens using high-performance liquid chromatography. Blood samples were collected for serum vancomycin concentration measurement 30min and 1, 2, 4, 6, 8, and 12h after the end of vancomycin administration. Pharmacokinetics was analyzed by nonlinear mixed effect modeling. Results: One hour after vancomycin administration, lung tissue concentrations in the aerosol group were 13 times the concentrations in the intravenous group (median and interquartile range: 161 [71, 301] mu g/g versus 12 [4, 42] mu g/g; P < 0.0001). Twelve hours after vancomycin administration, lung tissue concentrations in the aerosol group were 63 (23, 119) mu g/g and 0 (0, 19) mu g/g in the intravenous group (P < 0.0001). A two-compartment weight-scaled allometric model with first-order absorption and elimination best fit serum pharmacokinetics after both routes of administration. Area under the time-concentration curve from 0 to 12 h was lower in the aerosol group in comparison to the intravenous group (56 [8, 70] mg . h . l(-1)vs. 121 [103, 149] mg . h . l(-1), P = 0.002). Using a population model, vancomycin bioavailability was 13% (95% CI, 6 to 69; coefficient of variation = 85%) and absorption rate was slow (absorption half life = 0.3h). Conclusions: Administration of vancomycin by nebulization resulted in higher lung tissue concentrations than the intravenous route.
- Lung Perfusion and Ventilation During Cardiopulmonary Bypass Reduces Early Structural Damage to Pulmonary Parenchyma(2016) FREITAS, Claudia Regina da Costa; MALBOUISSON, Luiz Marcelo Sa; BENICIO, Anderson; NEGRI, Elnara Marcia; BINI, Filipe Minussi; MASSOCO, Cristina Oliveira; OTSUKI, Denise Aya; MELO, Marcos Francisco Vidal; CARMONA, Maria Jose CarvalhoBACKGROUND: It is unclear whether maintaining pulmonary perfusion and ventilation during cardiopulmonary bypass (CPB) reduces pulmonary inflammatory tissue injury compared with standard CPB where the lungs are not ventilated and are minimally perfused. In this study, we tested the hypothesis that maintenance of lung perfusion and ventilation during CPB decreases regional lung inflammation, which may result in less pulmonary structural damage. METHODS: Twenty-seven pigs were randomly allocated into a control group only submitted to sternotomy (n = 8), a standard CPB group (n = 9), or a lung perfusion group (n = 10), in which lung perfusion and ventilation were maintained during CPB. Hemodynamics, gas exchanges, respiratory mechanics, and systemic interleukins (ILs) were determined at baseline (T0), at the end of 90 minutes of CPB (T90), and 180 minutes after CPB (T180). Bronchoalveolar lavage (BAL) ILs were obtained at T0 and T180. Dorsal and ventral left lung tissue samples were examined for optical and electron microscopy. RESULTS: At T90, there was a transient reduction in Pao(2)/Fio(2) in CPB (126 64 mm Hg) compared with the control and lung perfusion groups (296 +/- 46 and 244 +/- 57 mm Hg; P < 0.001), returning to baseline at T180. Serum ILs were not different among the groups throughout the study, whereas there were significant increases in BAL IL-6 (P < 0.001), IL-8 (P < 0.001), and IL-10 (P < 0.001) in both CPB and lung perfusion groups compared with the control group. Polymorphonuclear counts within the lung tissue were smaller in the lung perfusion group than in the CPB group (P = 0.006). Electron microscopy demonstrated extrusion of surfactant vesicles into the alveolar spaces and thickening of the alveolar septa in the CPB group, whereas alveolar and capillary histoarchitecture was better preserved in the lung perfusion group. CONCLUSIONS: Maintenance of lung perfusion and ventilation during CPB attenuated early histologic signs of pulmonary inflammation and injury compared with standard CPB. Although increased compared with control animals, there were no differences in serum or BAL IL in animals receiving lung ventilation and perfusion during CPB compared with standard CPB.