SUSIMEIRE GOMES
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
25 resultados
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conferenceObject Changes in Regional Lung Perfusion Along Time and with Different Lung Volume During Mechanical Ventilation of Supine Healthy Swine(2020) TUCCI, M. R.; RIBEIRO, B. M.; VICTOR JUNIOR, M.; MELO, J. R.; BERALDO, M.; MORAIS, C. C.; NAKAMURA, M. A.; GOMES, S.; LIMA, C.; ALCALA, G. C.; AMATO, M. B.conferenceObject Validation of a Recrutability Index Using Electrical Impedance Tomography(2020) ALCALA, G. C.; GOMES, S.; LIMA, C. A. S.; SANTIAGO, R. R.; AMATO, M. B.conferenceObject Peep Titration In Severe Acute Respiratory Distress Syndrome: Different Physiological Consequences When Guided By Electrical Impedance Tomography Versus Esophageal Pressure(2017) ROLDAN, R.; LIMA, C.; YOSHIDA, T.; SANTIAGO, R. R. D. S.; GOMES, S.; TUCCI, M. R.; BERALDO, M. A.; COSTA, E. L. V.; TORSANI, V.; NAKAMURA, M. A. M.; CARVALHO, C. R. R.; AMATO, M. B. P.- Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome(2018) TOUFEN JUNIOR, Carlos; SANTIAGO, Roberta R. De Santis; HIROTA, Adriana S.; CARVALHO, Alysson Roncally S.; GOMES, Susimeire; AMATO, Marcelo Brito Passos; CARVALHO, Carlos Roberto RibeiroBackgroundAcute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed. We obtained serial measurements of plasma NT-PCP-III levels. Whole-lung computed tomography analysis and pulmonary function test were performed at 1 and 6months of follow-up. A health-related quality of life survey after 6months was also performed.ResultsThirty-three patients were enrolled, and 21 patients survived after 6months. In extubation day an association between driving pressure and NT-PCP-III was observed. At 1 and 6months forced vital capacity (FVC) was negatively correlated to driving pressure (p<0.01). At 6months driving pressure was associated with lower FVC independently on tidal volume, plateau pressure and baseline static respiratory compliance after adjustments (r(2)=0.51, p=0.02). There was a significant correlation between driving pressure and lung densities and nonaerated/poorly aerated lung volume after 6months. Driving pressure was also related to general health domain of SF-36 at 6months.ConclusionEven in patients ventilated with protective tidal volume, higher driving pressure is associated with worse long-term pulmonary function and structure.
conferenceObject Use of Coaxial Endotracheal Tube and Moderately High Respiratory Rates to Achieve Ultra- Protective Ventilation(2018) CARVALHO, N.; MORAIS, C. C.; BEDA, A.; NAKAMURA, M. A. M.; GOMES, S.; VOLPE, M. S.; STENQVIST, O.; AMATO, M. B. P.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.- High Pleural Pressure Prevents Alveolar Overdistension and Hemodynamic Collapse in Acute Respiratory Distress Syndrome with Class III Obesity A Clinical Trial(2021) SANTIAGO, Roberta De Santis; DROGHI, Maddalena Teggia; FUMAGALLI, Jacopo; MARRAZZO, Francesco; FLORIO, Gaetano; GRASSI, Luigi G.; GOMES, Susimeire; MORAIS, Caio C. A.; RAMOS, Ozires P. S.; BOTTIROLI, Maurizio; PINCIROLI, Riccardo; IMBER, David A.; BAGCHI, Aranya; SHELTON, Kenneth; SONNY, Abraham; BITTNER, Edward A.; AMATO, Marcelo B. P.; KACMAREK, Robert M.; BERRA, LorenzoRationale: Obesity is characterized by elevated pleural pressure (Ppl) and worsening atelectasis during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Objectives: To determine the effects of a lung recruitment maneuver (LRM) in the presence of elevated Ppl on hemodynamics, left and right ventricular pressure, and pulmonary vascular resistance. We hypothesized that elevated Ppl protects the cardiovascular system against high airway pressure and prevents lung overdistension. Methods: First, an interventional crossover trial in adult subjects with ARDS and a body mass index >= 35 kg/m(2) (n = 21) was performed to explore the hemodynamic consequences of the LRM. Second, cardiovascular function was studied during low and high positive end-expiratory pressure (PEEP) in a model of swine with ARDS and high Ppl (n = 9) versus healthy swine with normal Ppl (n = 6). Measurements and Main Results: Subjects with ARDS and obesity (body mass index = 57612 kg/m(2)) after LRM required an increase in PEEP of 8 (95% confidence interval [95% CI], 7-10) cm H2O above traditional ARDS Network settings to improve lung function, oxygenation and V/Q matching, without impairment of hemodynamics or right heart function. ARDS swine with high Ppl demonstrated unchanged transmural left ventricular pressure and systemic blood pressure after the LRM protocol. Pulmonary arterial hypertension decreased (8 [95% CI, 13-4] mm Hg), as did vascular resistance (1.5 [95% CI, 2.2-0.9] Wood units) and transmural right ventricular pressure (10 [95% CI, 15-6] mm Hg) during exhalation. LRM and PEEP decreased pulmonary vascular resistance and normalized the V/Q ratio. Conclusions: High airway pressure is required to recruit lung atelectasis in patients with ARDS and class III obesity but causes minimal overdistension. In addition, patients with ARDS and class III obesity hemodynamically tolerate LRM with high airway pressure.
- Spontaneous Effort During Mechanical Ventilation: Maximal Injury With Less Positive End-Expiratory Pressure(2016) YOSHIDA, Takeshi; ROLDAN, Rollin; BERALDO, Marcelo A.; TORSANI, Vinicius; GOMES, Susimeire; SANTIS, Roberta R. De; COSTA, Eduardo L. V.; TUCCI, Mauro R.; LIMA, Raul G.; KAVANAGH, Brian P.; AMATO, Marcelo B. P.Objectives: We recently described how spontaneous effort during mechanical ventilation can cause ""pendelluft,"" that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury. We hypothesize that higher positive end-expiratory pressure levels decrease the propensity to pendelluft and that with lower positive end-expiratory pressure levels, pendelluft is associated with improved gas exchange but increased tidal recruitment. Design: Crossover design. Setting: University animal research laboratory. Subjects: Anesthetized landrace pigs. Interventions: Surfactant depletion was achieved by saline lavage in anesthetized pigs, and ventilator-induced lung injury was produced by ventilation with high tidal volume and low positive end-expiratory pressure. Ventilation was continued in each of four conditions: positive end-expiratory pressure (low or optimized positive end-expiratory pressure after recruitment) and spontaneous breathing (present or absent). Tidal recruitment was assessed using dynamic CT and regional ventilation/perfusion using electric impedance tomography. Esophageal pressure was measured using an esophageal balloon manometer. Measurements and Results: Among the four conditions, spontaneous breathing at low positive end-expiratory pressure not only caused the largest degree of pendelluft, which was associated with improved ventilation/perfusion matching and oxygenation, but also generated the greatest tidal recruitment. At low positive end-expiratory pressure, paralysis worsened oxygenation but reduced tidal recruitment. Optimized positive end-expiratory pressure decreased the magnitude of spontaneous efforts (measured by esophageal pressure) despite using less sedation, from -5.6 +/- 1.3 to -2.0 +/- 0.7 cm H2O, while concomitantly reducing pendelluft and tidal recruitment. No pendelluft was observed in the absence of spontaneous effort. Conclusions: Spontaneous effort at low positive end-expiratory pressure improved oxygenation but promoted tidal recruitment associated with pendelluft. Optimized positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.
conferenceObject Transpulmonary Pressure Based On Absolute Esophageal Pressure Measurement Predicts Morphological Changes Of Lung Parenchyma In An Experimental Animal Model(2016) FUMAGALLI, J.; ZHANG, C.; TORSANI, V.; PIRRONE, M.; GOMEZ, S.; SANTIS, S. De; TUCCI, M.; RAMOS, O.; LIMA, C.; BENTO, G.; BERRA, L.; KACMAREK, R.; AMATO, M. B. P.conferenceObject Interactive Effects Of Peep And Fio2 During Anesthesia: Different Consequences Indicated By Computed Tomography (ct) Versus Electric Impedance Tomography (eit)(2017) MELO, J. R.; RIBEIRO, B. M.; NAKAMURA, M. A. M.; MORAIS, C. C. A.; BERALDO, M. A.; GOMES, S.; AMATO, M. B. P.; TUCCI, M. R.
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