SERGIO MARTINS PEREIRA
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
14 resultados
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Agora exibindo 1 - 10 de 14
conferenceObject Higher Positive End-Expiratory Pressures Affect The Distribution Of Lung Inflammation During Spontaneous Breathing In An Experimental Model Of Severe Acute Respiratory Distress Syndrome(2017) MORAIS, C. C. A.; PLENS, G.; TUCCI, M. R.; YOSHIDA, T.; BORGES, J. B.; RAMOS, O. P.; PEREIRA, S. M.; LIMA, C. A. S.; GOMES, S.; MELO, M. Vidal; AMATO, M. B. P.; COSTA, E. L. V.- 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.
- High Positive End-Expiratory Pressure Renders Spontaneous Effort Noninjurious(2018) MORAIS, Caio C. A.; KOYAMA, Yukiko; YOSHIDA, Takeshi; PLENS, Glauco M.; GOMES, Susimeire; LIMA, Cristhiano A. S.; RAMOS, Ozires P. S.; PEREIRA, Sergio M.; KAWAGUCHI, Naomasa; YAMAMOTO, Hirofumi; UCHIYAMA, Akinori; BORGES, Joao B.; MELO, Marcos F. Vidal; TUCCI, Mauro R.; AMATO, Marcelo B. P.; KAVANAGH, Brian P.; COSTA, Eduardo L. V.; FUJINO, YujiRationale: In acute respiratory distress syndrome (ARDS), atelectatic solid-like lung tissue impairs transmission of negative swings in pleural pressure (Ppl) that result from diaphragmatic contraction. The localization of more negative Ppl proportionally increases dependent lung stretch by drawing gas either from other lung regions (e.g., nondependent lung [pendelluft]) or from the ventilator. Lowering the level of spontaneous effort and/or converting solid-like to fluid-like lung might render spontaneous effort noninjurious. Objectives: To determine whether spontaneous effort increases dependent lung injury, and whether such injury would be reduced by recruiting atelectatic solid-like lung with positive end-expiratory pressure (PEEP). Methods: Established models of severe ARDS (rabbit, pig) were used. Regional histology (rabbit), inflammation (positron emission tomography; pig), regional inspiratory Ppl (intrabronchial balloon manometry), and stretch (electrical impedance tomography; pig) were measured. Respiratory drive was evaluated in 11 patients with ARDS. Measurements and Main Results: Although injury during muscle paralysis was predominantly in nondependent and middle lung regions at low (vs. high) PEEP, strong inspiratory effort increased injury (indicated by positron emission tomography and histology) in dependent lung. Stronger effort (vs. muscle paralysis) caused local overstretch and greater tidal recruitment in dependent lung, where more negative Ppl was localized and greater stretch was generated. In contrast, high PEEP minimized lung injury by more uniformly distributing negative Ppl, and lowering the magnitude of spontaneous effort (i.e., deflection in esophageal pressure observed in rabbits, pigs, and patients). Conclusions: Strong effort increased dependent lung injury, where higher local lung stress and stretch was generated; effort-dependent lung injury was minimized by high PEEP in severe ARDS, which may offset need for paralysis.
- Selected oncological patients may even restart cancer treatment after in-hospital cardiac arrest(2020) VANE, Matheus F.; PEREIRA, Sergio M.; NASSAR JUNIOR, Antonio Paulo; RANZANI, Otavio T.; CARUSO, Pedro
- Driving pressure monitoring during acute respiratory failure in 2020(2021) CHEN, Lu; JONKMAN, Annemijn; PEREIRA, Sergio M.; LU, Cong; BROCHARD, LaurentPurpose of review Assess the most recent studies using driving pressure (DP) as a monitoring technique under mechanical ventilation and describe the technical challenges associated with its measurement. Recent findings DP is consistently associated with survival in acute respiratory failure and acute respiratory distress syndrome (ARDS) and can detect patients at higher risk of ventilator-induced lung injury. Its measurement can be challenged by leaks and ventilator dyssynchrony, but is also feasible under pressure support ventilation. Interestingly, an aggregated summary of published results suggests that its level is on average slightly lower in patients with coronavirus disease-19 induced ARDS than in classical ARDS. The DP is easy to obtain and should be incorporated as a minimal monitoring technique under mechanical ventilation.
- Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study(2020) TONELOTTO, Bruno; PEREIRA, Sergio Martins; TUCCI, Mauro Roberto; VAZ, Diogo Florenzano; VIEIRA, Joaquim Edson; MALBOUISSON, Luiz Marcelo; GAY, Frederick; SIMOES, Claudia Marquez; CARMONA, Maria Jose Carvalho; MONSEL, Antoine; AMATO, Marcelo Brito; ROUBY, Jean-Jacques; JR, Jose Otavio Costa AulerIntroduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4 cmH(2)O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4 cmH(2)O to 10 (8, 13) at PEEP 20 cmH(2)O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p = 0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.
conferenceObject Positive End-Expiratory Pressure (peep) Titration Using Electrical Impedance Tomography (eit) In Laparoscopic Surgery: Before Or During Pneumoperitoneum?(2017) PEREIRA, S. M.; TUCCI, M. R.; TONELOTTO, B. F. F.; SIMOES, C. M.; MORAIS, C. C. A.; POMPEO, M. S.; KAY, F. U.; CARVALHO, C. R. R.; VIEIRA, J. E.; AMATO, M. B. P.bookPart Hepatite fulminante(2016) PEREIRA, Sérgio Martins; VANE, Matheus Fachini; ROCHA FILHO, Joel Avancini- Mechanical ventilation during thoracic surgery: towards individualized medicine(2020) TUCCI, Mauro Roberto; PEREIRA, Sergio Martins; COSTA, Eduardo Leite Vieira; VIEIRA, Joaquim Edson
- High-flow nasal cannula compared with continuous positive airway pressure: a bench and physiological study(2022) VIEIRA, Fernando; BEZERRA, Frank Silva; COUDROY, Remi; SCHREIBER, Annia; TELIAS, Irene; DUBO, Sebastian; CAVALOT, Giulia; PEREIRA, Sergio Martins; PIRAINO, Thomas; BROCHARD, Laurent JeanHigh-flow nasal cannula (HFNC) is extensively used for acute respiratory failure. However, questions remain regarding its physiological effects. We explored 1) whether HFNC produced similar effects to continuous positive airway pressure (CPAP); 2) possible explanations of respiratory rate changes; 3) the effects of mouth opening. Two studies were conducted: a bench study using a manikin's head with lungs connected to a breathing simulator while delivering HFNC flow rates from 0 to 60 L/min; a physiological crossover study in 10 healthy volunteers receiving HFNC (20-60 L/min) with the mouth open or closed and CPAP 4 cmH(2)O delivered through face mask. Nasopharyngeal and esophageal pressures were measured; tidal volume and flow were estimated using calibrated electrical impedance tomography. In the bench study, nasopharyngeal pressure at end-expiration reached 4 cmH(2)O with HFNC at 60 L/min, whereas tidal volume decreased with increasing flow. In volunteers with HFNC at 60 L/min, nasopharyngeal pressure reached 6.8 cmH(2)O with mouth closed and 0.8 cmH(2)O with mouth open; P < 0.001. When increasing HFNC flow, respiratory rate decreased by lengthening expiratory time, tidal volume did not change, and effort decreased (pressure-time product of the respiratory muscles per minute); effort was equivalent between CPAP and HFNC 40 L/min and became lower at 60 L/min (P = 0.045). During HFNC with mouth closed, and not during CPAP, resistance to breathing was increased, mostly during expiration. In conclusion, mouth closure during HFNC induces a positive nasopharyngeal pressure proportional to flow rate and an increase in expiratory resistance that might explain the prolonged expiration and reduction in respiratory rate and effort, and contribute to physiological benefits. NEW & NOTEWORTHY High-flow nasal cannula generates positive airway pressure and reduces respiratory rate. Our findings confirm these physiological effects when the mouth is kept closed. An increased resistance to breathing induces a longer expiratory phase, which leads to decreased respiratory rate and minute ventilation, and therefore to a decreased respiratory workload, counterbalancing the increased pressure-time product per liter. These effects are less apparent with the mouth open and are not observed with continuous positive airway pressure.