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
42 resultados
Resultados de Busca
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- NEGATIVE FLUID BALANCE IN SEPSIS: WHEN AND HOW?(2017) BESEN, Bruno Adler Maccagnan Pinheiro; TANIGUCHI, Leandro UtinoFluid resuscitation plays a fundamental role in the treatment of septic shock. Administration of inappropriately large quantities of fluid may lead to volume overload, which is increasingly recognized as an independent risk factor for morbidity and mortality in critical illness. In the early treatment of sepsis, timely fluid challenges should be given to optimize organ perfusion, but continuous positive fluid balance is discouraged. In fact, achievement of a negative fluid balance during treatment of sepsis is associated with better outcomes. This review will discuss the relationship between fluid overload and unfavorable outcomes in sepsis, and how fluid overload can be prevented and managed.
- 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.
- Fluid management in diabetic ketoacidosis: new tricks for old dogs?(2021) BESEN, Bruno Adler Maccagnan Pinheiro; BOER, Willem; HONORE, Patrick M.
- Efeito da taxa de hemoglobina na saturação arterial de oxigênio durante suporte com oxigenação por membrana extracorpórea veno-venosa em pacientes com síndrome do desconforto respiratório agudo: uma abordagem matemática marginal(2022) CARVALHO, Luisa Tajra; MENDES, Pedro Vitale; BESEN, Bruno Adler Maccagnan Pinheiro; PARK, Marcelo
- Análise do comportamento do sódio ao longo de 24 horas de terapia renal substitutiva(2016) ROMANO, Thiago Gomes; MARTINS, Cassia Pimenta Barufi; MENDES, Pedro Vitale; BESEN, Bruno Adler Maccagnan Pinheiro; ZAMPIERI, Fernando Godinho; PARK, MarceloABSTRACT Objective: The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation. Methods: Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations. Results: In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values. Conclusions: Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose - formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible.
- 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.
- Implantação de um protocolo de manejo de dor e redução do consumo de opioides na unidade de terapia intensiva: análise de série temporal interrompida(2019) BESEN, Bruno Adler Maccagnan Pinheiro; NASSAR JÚNIOR, Antonio Paulo; LACERDA, Fábio Holanda; SILVA, Carla Marchini Dias da; SOUZA, Vanessa Tota de; MARTINS, Eliana Vieira do Nascimento; LOPES, Ana Tarina Alvarez; BRANDÃO, Carlos Eduardo; OLIVEIRA, Lucas Fernandes deABSTRACT Objective: To evaluate the impact of an opioid-sparing pain management protocol on overall opioid consumption and clinical outcomes. Methods: This was a single-center, quasi-experimental, retrospective, before and after cohort study. We used an interrupted time series to analyze changes in the levels and trends of the utilization of different analgesics. We used bivariate comparisons in the before and after cohorts as well as logistic regression and quantile regression for adjusted estimates. Results: We included 988 patients in the preintervention period and 1,838 in the postintervention period. Fentanyl consumption was slightly increasing before the intervention (β = 16; 95%CI 7 - 25; p = 0.002) but substantially decreased in level with the intervention (β = - 128; 95%CI -195 - -62; p = 0.001) and then progressively decreased (β = - 24; 95%CI -35 - -13; p < 0.001). There was an increasing trend in the utilization of dipyrone. The mechanical ventilation duration was significantly lower (median difference: - 1 day; 95%CI -1 - 0; p < 0.001), especially for patients who were mechanically ventilated for a longer time (50th percentile difference: -0.78; 95%CI -1.51 - -0.05; p = 0.036; 75th percentile difference: -2.23; 95%CI -3.47 - -0.98; p < 0.001). Conclusion: A pain management protocol could reduce the intensive care unit consumption of fentanyl. This strategy was associated with a shorter mechanical ventilation duration.
- Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review(2024) PEDRO, Rodolpho Augusto de Moura; BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro Vitale; GOMES, Augusto Cezar Marins; CARVALHO, Marcelo Ticianelli de; MALBOUISSON, Luiz Marcelo Sa; PARK, Marcelo; TANIGUCHI, Leandro UtinoIntroduction: Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data.Methods: This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE.Results: Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a pre-ventability rate of 54% (95% CI 42%-66%).Conclusions: In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.
- Effect modification in a clinical trial should be assessed through interaction terms, not prognostic modelling (vol 48, pg 1122, 2022)(2022) ROEPKE, Roberta M. L.; MENDES, Pedro V.; CARDOZO JUNIOR, Luis C. M.; PARK, Marcelo; BESEN, Bruno A. M. P.
- Flexible Versus Restrictive Visiting Policies in ICUs: A Systematic Review and Meta-Analysis*(2018) NASSAR JUNIOR, Antonio Paulo; BESEN, Bruno Adler Maccagnan Pinheiro; ROBINSON, Caroline Cabral; FALAVIGNA, Maicon; TEIXEIRA, Cassiano; ROSA, Regis GoulartObjectives:To synthesize data on outcomes related to patients, family members, and ICU professionals by comparing flexible versus restrictive visiting policies in ICUs. Data Sources:Medline, Scopus, and Web of Science. Study Selection:Observational and randomized studies comparing flexible versus restrictive visiting policies in the ICU and evaluating at least one patient-, family member-, or ICU staff-related outcome. Data Extraction:Duplicate independent review and data abstraction. Data Synthesis:Of 16 studies identified for inclusion, seven were meta-analyzed. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium (odds ratio, 0.39; 95% CI, 0.22-0.69; I-2 = 0%) and lower severity of anxiety symptoms (mean difference, -2.20; 95% CI, -3.80 to -0.61; I-2 = 71%). Flexible visiting policies were not associated with increased risk of ICU mortality (odds ratio, 0.71; 95% CI, 0.38-1.36; I-2 = 86%), ICU-acquired infections (odds ratio, 0.98; 95% CI, 0.68-1.42; I-2 = 11%), or longer ICU stay (mean difference, -0.26 d; 95% CI, -0.57 to 0.05; I-2 = 54%). Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels. Conclusions:Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU professionals. These conclusions are based on few studies, with small samples and moderate risk of bias.