BRUNO MARTINS TOMAZINI
Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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bookPart Miopatia e neuropatia no paciente crítico(2017) TOMAZINI, Bruno MartinsbookPart Estratégias Protetoras Orgânicas no Perioperatório(2021) BASSI, Estevão; TOMAZINI, Bruno Martins; MALBOUISSON, Luiz Marcelo SábookPart Trauma cranioencefálico e manejo da hipertensão intracraniana(2022) ROEPKE, Roberta Muriel Longo; TOMAZINI, Bruno Martins; MALBOUISSON, Luiz Marcelo Sá- Computed tomography angiography accuracy in brain death diagnosis(2020) BRASIL, Sergio; BOR-SENG-SHU, Edson; DE-LIMA-OLIVEIRA, Marcelo; TACCONE, Fabio Silvio; GATTAS, Gabriel; NUNES, Douglas Mendes; OLIVEIRA, Raphael A. Gomes de; TOMAZINI, Bruno Martins; TIERNO, Paulo Fernando; BECKER, Rafael Akira; BASSI, Estevao; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson da Silva; TEIXEIRA, Manoel Jacobsen; NOGUEIRA, Ricardo de CarvalhoOBJECTIVE The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest. METHODS A unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score <= 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally. RESULTS A total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS. CONCLUSIONS CTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.
- Fraturas de esterno em uma unidade de tratamento intensivo especializada em trauma(2019) PEREIRA, Leonardo Dantas da Silva; BASSI, Estevão; TOMAZINI, Bruno Martins; JESUS, Vinicius Luiz Menezes; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; NOVO, Fernando Da Costa Ferreira; MALBOUISSON, Luiz Marcelo; UTIYAMA, Edivaldo MassazoABSTRACT Objective: to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. Methods: retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. Results: 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. Conclusion: sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.
- Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 A Meta-analysis(2020) STERNE, Jonathan A. C.; MURTHY, Srinivas; V, Janet Diaz; SLUTSKY, Arthur S.; VILLAR, Jesus; ANGUS, Derek C.; ANNANE, Djillali; AZEVEDO, Luciano Cesar Pontes; BERWANGER, Otavio; CAVALCANTI, Alexandre B.; DEQUIN, Pierre-Francois; DU, Bin; EMBERSON, Jonathan; FISHER, David; GIRAUDEAU, Bruno; GORDON, Anthony C.; GRANHOLM, Anders; GREEN, Cameron; HAYNES, Richard; HEMING, Nicholas; HIGGINS, Julian P. T.; HORBY, Peter; JUNI, Peter; LANDRAY, Martin J.; GOUGE, Amelie Le; LECLERC, Marie; LIM, Wei Shen; MACHADO, Flavia R.; MCARTHUR, Colin; MEZIANI, Ferhat; MOLLER, Morten Hylander; PERNER, Anders; PETERSEN, Marie Warrer; SAVOVIC, Jelena; TOMAZINI, Bruno; VEIGA, Viviane C.; WEBB, Steve; MARSHALL, John C.IMPORTANCE Effective therapies for patients with coronavirus disease 2019 (COVID-19) are needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced mortality in hospitalized patients with COVID-19 who required respiratory support. OBJECTIVE To estimate the association between administration of corticosteroids compared with usual care or placebo and 28-day all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Prospective meta-analysis that pooled data from 7 randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I-2 statistic. The primary analysis was an inverse variance-weighted fixed-effect meta-analysis of overall mortality, with the association between the intervention and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp adjustment) and an inverse variance-weighted fixed-effect analysis using risk ratios. EXPOSURES Patients had been randomized to receive systemic dexamethasone, hydrocortisone, or methylprednisolone (678 patients) or to receive usual care or placebo (1025 patients). MAIN OUTCOMES AND MEASURES The primary outcome measure was all-cause mortality at 28 days after randomization. A secondary outcome was investigator-defined serious adverse events. RESULTS A total of 1703 patients (median age, 60 years [interquartile range, 52-68 years]; 488 [29%] women) were included in the analysis. Risk of bias was assessed as ""low"" for 6 of the 7 mortality results and as ""some concerns"" in 1 trial because of the randomization method. Five trials reported mortality at 28 days, 1 trial at 21 days, and 1 trial at 30 days. There were 222 deaths among the 678 patients randomized to corticosteroids and 425 deaths among the 1025 patients randomized to usual care or placebo (summary OR, 0.66 [95% CI, 0.53-0.82]; P < .001 based on a fixed-effect meta-analysis). There was little inconsistency between the trial results (I-2 = 15.6%; P = .31 for heterogeneity) and the summary OR was 0.70 (95% CI, 0.48-1.01; P = .053) based on the random-effects meta-analysis. The fixed-effect summary OR for the association with mortality was 0.64 (95% CI, 0.50-0.82; P < .001) for dexamethasone compared with usual care or placebo (3 trials, 1282 patients, and 527 deaths), the OR was 0.69 (95% CI, 0.43-1.12; P = .13) for hydrocortisone (3 trials, 374 patients, and 94 deaths), and the OR was 0.91 (95% CI, 0.29-2.87; P = .87) for methylprednisolone (1 trial, 47 patients, and 26 deaths). Among the 6 trials that reported serious adverse events, 64 events occurred among 354 patients randomized to corticosteroids and 80 events occurred among 342 patients randomized to usual care or placebo. CONCLUSIONS AND RELEVANCE In this prospective meta-analysis of clinical trials of critically ill patients with COVID-19, administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality.
- Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19 The CoDEX Randomized Clinical Trial(2020) TOMAZINI, Bruno M.; MAIA, Israel S.; CAVALCANTI, Alexandre B.; BERWANGER, Otavio; ROSA, Regis G.; VEIGA, Viviane C.; AVEZUM, Alvaro; LOPES, Renato D.; BUENO, Flavia R.; SILVA, Maria Vitoria A. O.; BALDASSARE, Franca P.; V, Eduardo L. Costa; MOURA, Ricardo A. B.; HONORATO, Michele O.; COSTA, Andre N.; DAMIANI, Lucas P.; LISBOA, Thiago; KAWANO-DOURADO, Leticia; ZAMPIERI, Fernando G.; OLIVATO, Guilherme B.; RIGHY, Cassia; AMENDOLA, Cristina P.; ROEPKE, Roberta M. L.; FREITAS, Daniela H. M.; FORTE, Daniel N.; FREITAS, Flavio G. R.; FERNANDES, Caio C. F.; MELRO, Livia M. G.; JUNIOR, Gedealvares F. S.; MORAIS, Douglas Costa; ZUNG, Stevin; MACHADO, Flavia R.; AZEVEDO, Luciano C. P.IMPORTANCE Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) is associated with substantial mortality and use of health care resources. Dexamethasone use might attenuate lung injury in these patients. OBJECTIVE To determine whether intravenous dexamethasone increases the number of ventilator-free days among patients with COVID-19-associated ARDS. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, open-label, clinical trial conducted in 41 intensive care units (ICUs) in Brazil. Patients with COVID-19 and moderate to severe ARDS, according to the Berlin definition, were enrolled from April 17 to June 23, 2020. Final follow-up was completed on July 21, 2020. The trial was stopped early following publication of a related study before reaching the planned sample size of 350 patients. INTERVENTIONS Twenty mg of dexamethasone intravenously daily for 5 days, 10 mg of dexamethasone daily for 5 days or until ICU discharge, plus standard care (n = 151) or standard care alone (n = 148). MAIN OUTCOMES AND MEASURES The primary outcome was ventilator-free days during the first 28 days, defined as being alive and free from mechanical ventilation. Secondary outcomes were all-cause mortality at 28 days, clinical status of patients at day 15 using a 6-point ordinal scale (ranging from 1, not hospitalized to 6, death), ICU-free days during the first 28 days, mechanical ventilation duration at 28 days, and Sequential Organ Failure Assessment (SOFA) scores (range, 0-24, with higher scores indicating greater organ dysfunction) at 48 hours, 72 hours, and 7 days. RESULTS A total of 299 patients (mean [SD] age, 61 [14] years; 37% women) were enrolled and all completed follow-up. Patients randomized to the dexamethasone group had a mean 6.6 ventilator-free days (95% CI, 5.0-8.2) during the first 28 days vs 4.0 ventilator-free days (95% CI, 2.9-5.4) in the standard care group (difference, 2.26; 95% CI, 0.2-4.38; P =.04). At 7 days, patients in the dexamethasone group had a mean SOFA score of 6.1 (95% CI, 5.5-6.7) vs 7.5 (95% CI, 6.9-8.1) in the standard care group (difference, -1.16; 95% CI, -1.94 to -0.38; P = .004). There was no significant difference in the prespecified secondary outcomes of all-cause mortality at 28 days, ICU-free days during the first 28 days, mechanical ventilation duration at 28 days, or the 6-point ordinal scale at 15 days. Thirty-three patients (21.9%) in the dexamethasone group vs 43 (29.1%) in the standard care group experienced secondary infections, 47 (31.1%) vs 42 (28.3%) needed insulin for glucose control, and 5 (3.3%) vs 9 (6.1%) experienced other serious adverse events. CONCLUSIONS AND RELEVANCE Among patients with COVID-19 and moderate or severe ARDS, use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days.
- Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study(2021) BRASIL, Sergio; TACCONE, Fabio Silvio; WAYHS, Samia Yasin; TOMAZINI, Bruno Martins; ANNONI, Filippo; FONSECA, Sergio; BASSI, Estevao; LUCENA, Bruno; NOGUEIRA, Ricardo De Carvalho; DE-LIMA-OLIVEIRA, Marcelo; BOR-SENG-SHU, Edson; PAIVA, Wellingson; TURGEON, Alexis Fournier; TEIXEIRA, Manoel Jacobsen; MALBOUISSON, Luiz Marcelo SaIntroduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00-1.28] vs. 1.00 [0.88-1.16]; p = 0.03) and eICP (14 [11-25] vs. 11 [7-15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8-12] vs. 6 [5-7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75-0.97); a score > 8.5 had 63 (46-77)% sensitivity and 87 (62-97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5-31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.
- High-Flow Oxygen vs Noninvasive Ventilation for Postextubation Respiratory Failure(2017) TOMAZINI, Bruno Martins; BESEN, Bruno Adler Maccagnan Pinheiro
bookPart Miopatia e neuropatia no paciente crítico(2015) TOMAZINI, Bruno Martins