SUSIMEIRE GOMES
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
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.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.
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.- 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.
conferenceObject The Role of FIO2 in Lung Perfusion Distribution During Mechanical Ventilation of Supine Healthy Swines Using Low Positive End Expiratory Pressure (PEEP)(2020) RIBEIRO, B. M.; TUCCI, M. R.; VICTOR JUNIOR, M.; MELO, J. R.; MORAIS, C. C.; BERALDO, M.; NAKAMURA, M. A.; GOMES, S.; LIMA, C.; ALCALA, G. C.; AMATO, M. B.