SUSIMEIRE GOMES
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
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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.conferenceObject Wharton's Jelly-derived mesenchymal stem cells modulate autonomic activity and systemic inflammation in rats with sepsis(2017) CONDOR, J.; RODRIGUES, C.; MOREIRA, R.; NORONHA, I.; SANTOS, F. Dos; IRIGOYEN, M.; GOMES, S.; ANDRADE, L.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.conferenceObject WHARTON'S JELLY-DERIVED MESENCHYMAL STEM CELLS MODULATE AUTONOMIC ACTIVITY AND SYSTEMIC INFLAMMATION IN RATS WITH SEPSIS(2017) CONDOR, J. M.; RODRIGUES, C.; MOREIRA, R.; SANTOS, F. Dos; NORONHA, I.; IRIGOYEN, M.; GOMES, S.; ANDRADE, L.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.conferenceObject HUMAN WHARTON'S JELLY-DERIVED MESENCHYMAL STEM CELLS IMPROVE SEPSIS-ASSOCIATED HEART AND LUNG INJURY(2017) CONDOR, J. M.; RODRIGUES, C.; MOREIRA, R.; NORONHA, I.; DOURADO, P.; IRIGOYEN, M.; GOMES, S.; ANDRADE, L.- Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity(2017) FUMAGALLI, Jacopo; BERRA, Lorenzo; ZHANG, Changsheng; PIRRONE, Massimiliano; SANTIAGO, Roberta R. De Santis; GOMES, Susimeire; MAGNI, Federico; SANTOS, Glaucia A. B. dos; BENNETT, Desmond; TORSANI, Vinicius; FISHER, Daniel; MORAIS, Caio; AMATO, Marcelo B. P.; KACMAREK, Robert M.Objectives: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. Design: Prospective, crossover, nonrandomized interventional study. Setting: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (Sao Paulo, Brazil). Patients/Subjects: Critically ill obese patients with acute respiratory failure and anesthetized swine. Interventions: Clinical data from 16 mechanically ventilated critically ill obese patients were analyzed. An animal model of obesity with reversible atelectasis was developed by placing fluid filled bags on the abdomen to describe changes of lung mechanics, lung morphology, and pulmonary hemodynamics in 10 swine. Measurements and Main Results: In obese patients (body mass index, 48 +/- 11 kg/m(2)), 21.7 +/- 3.7 cm H2O of positive end-expiratory pressure resulted in the lowest elastance of the respiratory system (18.6 +/- 6.1 cm H2O/L) after a recruitment maneuver and decremental positive end-expiratory pressure and corresponded to a positive (2.1 +/- 2.2 cm H2O) end-expiratory transpulmonary pressure. Ventilation at lowest elastance positive end-expiratory pressure preceded by a recruitment maneuver restored end-expiratory lung volume (30.4 +/- 9.1 mL/kg ideal body weight) and oxygenation (273.4 +/- 72.1 mm Hg). In the swine model, lung collapse and intratidal recruitment/derecruitment occurred when the positive end-expiratory transpulmonary pressure decreased below 2-4 cm H2O. After the development of atelectasis, a decremental positive end-expiratory pressure trial preceded by lung recruitment identified the positive end-expiratory pressure level (17.4 +/- 2.1 cm H2O) needed to restore poorly and nonaerated lung tissue, reestablishing lung elastance and oxygenation while avoiding increased pulmonary vascular resistance. Conclusions: In obesity, low-to-negative values of transpulmonary pressure predict lung collapse and intratidal recruitment/derecruitment. A decremental positive end-expiratory pressure trial preceded by a recruitment maneuver reverses atelectasis, improves lung mechanics, distribution of ventilation and oxygenation, and does not increase pulmonary vascular resistance.
- Physiologic effects of alveolar recruitment and inspiratory pauses during moderately-high-frequency ventilation delivered by a conventional ventilator in a severe lung injury model(2017) CORDIOLI, Ricardo Luiz; COSTA, Eduardo Leite Vieira; AZEVEDO, Luciano Cesar Pontes; GOMES, Susimeire; AMATO, Marcelo Britto Passos; PARK, MarceloBackground and aims To investigate whether performing alveolar recruitment or adding inspiratory pauses could promote physiologic benefits (VT) during moderately-high-frequency positive pressure ventilation (MHFPPV) delivered by a conventional ventilator in a porcine model of severe acute respiratory distress syndrome (ARDS). Methods Prospective experimental laboratory study with eight pigs. Induction of acute lung injury with sequential pulmonary lavages and injurious ventilation was initially performed. Then, animals were ventilated on a conventional mechanical ventilator with a respiratory rate (RR) = 60 breaths/minute and PEEP titrated according to ARDS Network table. The first two steps consisted of a randomized order of inspiratory pauses of 10 and 30% of inspiratory time. In final step, we removed the inspiratory pause and titrated PEEP, after lung recruitment, with the aid of electrical impedance tomography. At each step, PaCO2 was allowed to stabilize between 57-63 mmHg for 30 minutes. Results The step with RR of 60 after lung recruitment had the highest PEEP when compared with all other steps (17 [16,19] vs 14 [10, 17]cmH(2)O), but had lower driving pressures (13 [13,11] vs 16 [14, 17]cmH(2)O), higher P/F ratios (212 [191,243] vs 141 [105, 184] mmHg), lower shunt (23 [20, 23] vs 32 [27, 49]%), lower dead space ventilation (10 [0, 15] vs 30 [20, 37]%), and a more homogeneous alveolar ventilation distribution. There were no detrimental effects in terms of lung mechanics, hemodynamics, or gas exchange. Neither the addition of inspiratory pauses or the alveolar recruitment maneuver followed by decremental PEEP titration resulted in further reductions in VT. Conclusions During MHFPPV set with RR of 60 bpm delivered by a conventional ventilator in severe ARDS swine model, neither the inspiratory pauses or PEEP titration after recruitment maneuver allowed reduction of VT significantly, however the last strategy decreased driving pressures and improved both shunt and dead space.
- Volume-controlled Ventilation Does Not Prevent Injurious Inflation during Spontaneous Effort(2017) YOSHIDA, Takeshi; NAKAHASHI, Susumu; NAKAMURA, Maria Aparecida Miyuki; KOYAMA, Yukiko; ROLDAN, Rollin; TORSANI, Vinicius; SANTIS, Roberta R. De; GOMES, Susimeire; UCHIYAMA, Akinori; AMATO, Marcelo B. P.; KAVANAGH, Brian P.; FUJINO, YujiRationale: Spontaneous breathing during mechanical ventilation increases transpulmonary pressure and VT, and worsens lung injury. Intuitively, controlling VT and transpulmonary pressure might limit injury caused by added spontaneous effort. Objectives: To test the hypothesis that, during spontaneous effort in injured lungs, limitation of VT and transpulmonary pressure by volume-controlled ventilation results in less injurious patterns of inflation. Methods: Dynamic computed tomography was used to determine patterns of regional inflation in rabbits with injured lungs during volume-controlled or pressure-controlled ventilation. Transpulmonary pressure was estimated by using esophageal balloon manometry [PL(es)] with and without spontaneous effort. Local dependent lung stress was estimated as the swing (inspiratory change) in transpulmonary pressure measured by intrapleural manometry in dependent lung and was compared with the swing in PL(es). Electrical impedance tomography was performed to evaluate the inflation pattern in a larger animal (pig) and in a patient with acute respiratory distress syndrome. Measurements and Main Results: Spontaneous breathing in injured lungs increased PL(es) during pressure-controlled (but not volume-controlled) ventilation, but the pattern of dependent lung inflation was the same in both modes. In volume-controlled ventilation, spontaneous effort caused greater inflation and tidal recruitment of dorsal regions (greater than twofold) compared with during muscle paralysis, despite the same VT and PL(es). This was caused by higher local dependent lung stress (measured by intrapleural manometry). In injured lungs, esophageal manometry underestimated local dependent pleural pressure changes during spontaneous effort. Conclusions: Limitation of VT and PL(es) by volume-controlled ventilation could not eliminate harm caused by spontaneous breathing unless the level of spontaneous effort was lowered and local dependent lung stress was reduced.
conferenceObject Validation Of Esophageal Pressure By Direct Measurement Of Pleural Pressure In Normal And Injured Lungs(2017) YOSHIDA, T.; LIMA, C.; ROLDAN, R.; MORAIS, C. C. A.; GOMES, S.; GRIECO, D.; RICHARD, J. -C. M.; BROCHARD, L. J.; KAVANAGH, B. P.; AMATO, M. B. P.