BRUNO ADLER MACCAGNAN PINHEIRO BESEN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Calcium use during cardiac arrest: A systematic review(2022) PADRAO, Eduardo Messias Hirano; BUSTOS, Brian; MAHESH, Ashwin; RANDHAWA, Ravneet; DIPOLLINA, Christopher John; CARDOSO, Rhanderson; GROVER, Prashant; BESEN, Bruno Adler Maccagnan Pinheiro; CASTRO, Monaliza de AlmeidaIntroduction: Calcium use during cardiac arrest has conflicting results in terms of efficacy. Therefore, we performed a systematic review evaluating the role of calcium administration in cardiac arrest. Methods: We searched PubMed, Cochrane, and EMBASE for studies comparing calcium administration versus no calcium administration during cardiac arrest. The study was prospectively registered in PROSPERO (CRD42022316641) adhering to PRISMA guideline recommendations. The primary outcome was return of spontaneous circulation (ROSC) or survival at one hour. The secondary outcomes included survival to discharge or at 30 days, and favorable neurologic outcomes at 30 and 90 days. We planned to perform a random-effects meta-analysis of low risk of bias studies. We evaluated risk of bias with RoB-2 and ROBINS-I.Results: We identified 1,921 articles and included ten studies with 2509 patients. We were not able to perform a meta-analysis with low-risk of bias studies as only one study was found to be at low-risk of bias. However, for the primary outcome, the three RCTs included showed no benefit with calcium administration during cardiac arrest for ROSC. For the secondary outcomes, based on the most recent study and lower risk of bias, there was a neutral effect for survival to discharge or at 30 days and neurologic outcomes at 30 days. However, there was unfavorable neurologic out-comes at 90 days. Conclusion: Based on our results, calcium administration in cardiac arrests shows no benefit and can cause harm. Further studies on this matter are likely not advisable.
- Methodological issues in meta-analyses of observational studies: the need for attention to the details(2022) PADRAO, Eduardo M. H.; RAHHAL, Hassan; VALENTE, Fernando S.; BESEN, Bruno A. M. P.
- Awake Prone Positioning in COVID-19 Hypoxemic Respiratory Failure: Exploratory Findings in a Single-center Retrospective Cohort Study(2020) PADRAO, Eduardo M. H.; VALENTE, Fernando S.; BESEN, Bruno A. M. P.; RAHHAL, Hassan; MESQUITA, Paula S.; DEALENCAR, Julio C. G.; DACOSTA, Millena G. P.; WANDERLEY, Annelise P. B.; EMERENCIANO, Debora L.; BORTOLETO, Felipe M.; FORTES, Julio C. L.; MARQUES, Bruno; DESOUZA, Stefany F. B.; MARCHINI, Julio F. M.; NETO, Rodrigo A. B.; DESOUZA, Heraldo P.Background Awake prone positioning has been widely used in patients with COVID-19 respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care. Methods This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo. We retrieved data from all admitted patients in need of oxygen supplementation (>3 L/min) and tachypnea (>24 ipm) from March 1 to April 30, 2020, excluding those who had any contraindication to the prone position or who had an immediate need for intubation. The primary endpoint was endotracheal intubation up to 15 days. Secondary outcomes included a 6-point clinical outcome ordinal scale, mechanical ventilation-free days, admission to the intensive care unit, and need of hemodialysis and of vasoactive drugs, all assessed at or up to 15 days. We analyzed unadjusted and adjusted effect estimates with Cox proportional hazards models, logistic regression, quantile regression, and sensitivity analyses using propensity score models. Results Of 925 suspected COVID-19 patients admitted off mechanical ventilation, 166 patients fulfilled inclusion and exclusion criteria: 57 were exposed to prone positioning and 109 to usual care. In the intervention group, 33 (58%) were intubated versus 53 (49%) in the control group. We observed no difference in intubation rates in the univariate analysis (hazard ratio = 1.21, 95% confidence interval [CI] = 0.78 to 1.88, p = 0.39) nor in the adjusted analysis (hazard ratio = 0.90, 95% CI = 0.55 to 1.49, p = 0.69). Results were robust to the sensitivity analyses. Secondary outcomes did not differ between groups. Conclusions Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials.
- HEMOCOVID-19 Study: An International Clinical Study to Evaluate Microvascular and Endothelial Impairments in Severe COVID-19 Patients Using Near-Infrared Spectroscopy(2021) CORTESE, L.; OLIVEIRA, L. Bacchin de; BARCELONA, M.; DELAZARI, L. E. Bernardes; BESEN, B. A. M. P.; BUSCH, D. R.; CABALLER, A.; ROBLES, V. Carbajal; CASTRO, P.; LIMA, A. L. Cavallaro Barauna; CHERUKU, S.; CHISCANO, L.; CHOI, C.; MESQUITA, R. Coelho; DAVE, S.; RATTI, L. dos Santos Roceto; FALCAO, A. L. Eiras; ESPINAL, C.; FERNANDEZ, S.; FERRER, R.; FONT, F.; ACILU, M. Garcia de; GRUARTMONER, G.; KARADENIZ, U.; LAHSAEI, P.; EMIDIO, G. Livio; CORRAL, J. Marin; MATAS, A.; FORTI, R. Menezes; MERA, A.; HERNANDEZ, F. J. Monte de Oca; MYERS, T.; NOGALES, S.; OLSON, D.; PAGLIAZZI, M.; GUZMAN, M. Parada; PACHECO, A. Perez; TERAN, P. Perez; PICAZO, L.; VAZQUEZ, D. Pineda; SOTO, A. F. Quiroga; SICCHA, R. M. Quispe; ROMERO, D.; AGUAYO, E. Santillan; SERRA, I; LOYOLA, R. Serrano; TELLEZ, A.; TANIGUCHI, L. Utino; VILA, C.; ZANOLETTI, M.; MESQUIDA, J.; DURDURAN, T.We present the HEMOCOVID-19 study spanning four countries and eight hospitals where near-infrared spectroscopy is utilized to evaluate microvascular and endothelial health of severe COVID-19 patients at the intensive care.