ROBERTA RIBEIRO DE SANTIS SANTIAGO

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  • article 20 Citação(ões) na Scopus
    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 Ribeiro
    BackgroundAcute 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.
  • article 27 Citação(ões) na Scopus
    Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial
    (2012) CAVALCANTI, Alexandre B.; BERWANGER, Otavio; AMATO, Marcelo B. P.; TALLO, Fernando S.; REZENDE, Ederlon A. C.; TELLES, Jose M. M.; ROMANO, Edson; GUIMARAES, Helio P.; REGENGA, Marisa M.; TAKAHASHI, Luzia N.; TEIXEIRA, Cassiano; OLIVEIRA, Roselaine P.; CARVALHO, Vitor O.; DIAZ-QUIJANO, Fredi A.; CARVALHO, Carlos R. R.; SUZUMURA, Erica A.; KODAMA, Alessandra A.; RIBEIRO, Gisele F. M.; ABREU, Matheus O.; OLIVEIRA, Ivonaldo M.; GUYATT, Gordon; FERGUSON, Niall; WALTER, Stephen; VASCONCELOS, Marcia O. M.; SEGUNDO, Valerio J.; FERRAZ, Iris L.; SILVA, Rosicley S.; OLIVEIRA FILHO, Wilson de; SILVA, Nelson B.; HEIREL, Debora C. B.; TAKATANI, Rodrigo R.; SOUSA NETO, Jefferson A.; NETO, Jeronimo C. B.; ALMEIDA, Samara D.; CHAMY, Gauco; GONCALVES NETO, Graciliano J. L.; DIAS, Alysson P.; SILVA, Rozangela R.; TAVARES, Roberta C.; SOUZA, Marcia L. V. D.; DECIO, Janaina C.; LIMA, Cyntia M. L. S.; FERREIRA NETO, Fleury; OLIVEIRA, Katia R.; DIAS, Polyana P. L. C.; BRANDAO, Andre L. S. B.; RAMOS JR., Joroastro E.; VASCONCELOS, Paula T.; FLORES, Dimitri G.; PINHEIRO FILHO, Gilvan R.; ANDRADE, Isaac G.; MARTINEZ, Amadeu; FRANCA, Gustavo G. P.; MONTEIRO, Livia L.; CORREIA, Emmanuel I. S.; RIBEIRO, Wagner; PEREIRA, Antonio J.; ANDRADE, Wandalvo; LEITE, Petronio A.; FETO, Jose E. Filgueira; HOLANDA, Marcelo A.; AMORIM, Fabio F.; MARGALHO, Silviano B.; DOMINGUES JR., Sergio M.; FERREIRA, Claiton S.; FERREIRA, Cassia M.; RABELO, Livia A.; DUARTE, Juliana N.; LIMA, Fernando B.; KAWAGUCHI, Ines A. L.; ARAUJO NETO, Jose A.; MAIA, Marcelo O.; CORREA, Fabiano G.; RIBEIRO, Rubens A. B.; CASER, Eliana; MOREIRA, Cora L. C. B.; MARCILINO, Antonielen; FALCAO, Jansen G.; JESUS, Karinne R.; TCHERNIAKOVISK, Leo; DUTRA, Victor G.; THOMPSON, Marlus M.; PIRAS, Claudio; GIUBERTI JR., Jonas; SILVA, Albano S.; SANTOS, Jose R. P.; POTRATZ, Jorge L.; PAULA, Ludmila N.; BOZI, Giovana G.; GOMES, Bruno C.; VASSALLO, Paula F.; ROCHA, Edson P.; LIMA, Maria H. B. S.; FERREIRA, Denise M.; GONCALVES, Fernanda A. F.; PEREIRA, Sheila A.; NOBREGA, Marciano S.; CAIXETA, Carlos R.; MORAES, Ana P. P.; CARVALHO, Alexandre G. R.; ALVES, Janine D.; CARVALHO, Frederico B.; MOREIRA, Fabiana B. R.; STARLING, Claudia M.; COUTO, Wivian A. D.; BITENCOURT, Wesley S.; PEIXOTO, Daniela C.; CARVALHO, Ivana L. V.; SILVA, Silvangela G. A.; FELIZARDO, Livia R. S. M.; NASCIMENTO, Francine J. Magalhaes; SANTOS, Priscila J. C. D.; ZANTA, Camila C.; MARTINS, Marcele F.; NAVES, Sergio A.; SILVA, Fabiano D.; LAUBE JR., Gilberto; GALVAO, Endi L.; SOUSA, Marcelo F.; SOUZA, Marcia M. F.; CARVALHO, Fernanda L. G.; BERGO, Ricardo R.; REZENDE, Claudnei M.; TAMAZATO, Edys Y.; SARAT JR., Saturnino Campo; ALMEIDA, Patricia S.; GORSKI, Anthony G.; MATSUI, Mirna; EBERHART NETO, Ervin; NOMOTO, Silmara H.; LIMA, Zildamara B.; INAGAKI, Alexandre S.; GIL, Fernando S. U.; ARAUJO, Mario F. A.; OLIVEIRA, Aline E.; CORREA, Tiago A.; MENDONCA, Angela; REIS, Helder; CARNEIRO, Saul R.; CASTANELO, Carlos; COELHO JR., Edward; AMARAL, Karine A. E. H.; REGO, Leila R. M.; CUNHA, Adenard F. C.; BARRA, Williams F.; CARNEIRO, Mauricio; BATISTA, Roseane A.; ZOGHBI, Karina K.; MACHADO, Nelma J. N.; FERREIRA, Reinaldo; APOENA, Pablo; LEAO, Rosangela M.; MARTINS, Eliauria R.; OLIVEIRA, Marcelo E.; ODIR, Isaura; KLEBER, Wladimy; TAVARES, Daniele; ARAUJO, Marcelo E. U.; BRILHANTE, Yuzeth Nobrega; TAVARES, Daniele C. C.; KLEBER, Wladmy; CARVALHO, Waneska L. N.; WINVELER, Georgia F. P.; CHAGAS FILHO, Aldir; CAVALCANTI, Raphael Ali; GRION, Cintia M. C.; REIS, Andrezza T. J. B.; FESTTI, Josiane; GIMENEZ, Francielli M. P.; LARANGEIRA, Alexandre S.; CARDOSO, Lucienne T. Q.; MEZZAROBA, Ana L.; GIANCURSI, Thiago S.; KAUSS, Ivanil A. M.; DUARTE, Pericles A. D.; TOZO, Tatiane C.; PELISER, Priscila; GERMANO, Almir; GURGEL, Sanderland J. T.; SILVA, Sandra R. B.; KURODA, Cristina M.; HEREK, Andrea; YAMADA, Sergio S.; SCHIAVETTO, Paulo M.; WYSOCKI, Natacha; MATSUBARA, Rosely R.; SALES JR., Joao A. L.; LAPROVITA, Maria P.; PENA, Felipe M.; SA, Alexandre; VIANNA, Arthur; VERDEAL, Juan C.; MARTINS, Gloria A.; SALGADO, Diamantino R.; COELHO, Adalberto M.; COELHO, Milena P. P. M.; MORONG, Aline S.; POQUIRIQUI, Rodolfo M. B.; FERREIRA, Ana P.; LUCENA, Debora N. L.; MARINO, Nathalia F.; MOREIRA, Monique A.; URATANI, Cristiana C. S.; SEVERINO, Marta A.; SILVA, Patricia N.; MEDEIROS, Luciana G.; CHAVES FILHO, Francisco G.; GUIMARAES, Daniela M. Q. S.; REZENDE, Valeria M. C.; CARBONELL, Roberto C. C.; TRINDADE, Renata S.; PELLEGRINI, Jose A. S.; BONIATTI, Marcio M.; SANTOS, Moreno C.; BOLDO, Rodrigo; OLIVEIRA, Vanessa M.; CORREA, Viviane M.; NEDEL, Wagner; SCHAICH, Felipe; TAGLIARI, Luciana; SAVI, Augusto; SCHULZ, Luis F.; MACCARI, Juara G.; SEEGER, Gabriela M.; FOERNGES, Rafael B.; RIEDER, Marcelo M.; BECKER, Daniel A.; BROILO, Fabiano P.; SCHWARZ, Patricia; ALENCASTRO, Andre; BERTO, Paula; BACKES, Fabiane; DIAS, Fernando S.; BLATTNER, Clarissa; MARTINS, Edna T. J.; SCAGLIA, Nris C.; VIEIRA, Silvia R. R.; PRADO, Karen F.; FIALKOW, Lea; FRANKE, Cristiano; VIEIRA, Debora F. V. B.; MORAES, Rafael B.; MARQUES, Leonardo S.; HOPF, Joao L. S.; WAWRZENIAK, Iuri C.; RECH, Tatiana H.; ALBUQUERQUE, Regis B.; GUERREIRO, Marcio O.; TEIXEIRA, Luciano O.; MACEDO, Pedro L.; BAINY, Marina P.; FERREIRA, Edgard V.; MARTINS, Marcio A.; ANDRADE, Luciana A. S.; MACHADO, Fernando O.; BURIGO, Ana C.; PINCELLI, Mariangela; KRETZER, Lara; MAIA, Israel S.; CORDEIRO, Rodrigo B.; WESTPHAL, Glauco; CALDEIRA, Milton; CRAMER, Amanda S.; DADAM, Michelli M.; BARBOSA, Pierry O.; BRILENGER, Caroline O.; HORNER, Marina B. W.; OLIVEIRA, Glauce L.; GERMINIANI, Bruno C.; TEIXEIRA, Cristina; DUARTE, Robson; ASSEF, Maria G. P. L.; ROSSO, Deorgelis; BIGOLIN, Rodrigo; VANZUITA, Raquel; PRADO, Luiz F. A.; OLIVEIRA, Andre L. V.; REIS, Diego L.; MORAIS, Mirene O.; BASTOS, Rafael S.; SANTANA, Hericalizandra S. R.; SILVA, Alline O.; CACAU, Lucas A. P.; ALMEIDA, Marilia S.; CANAVESSI, Hugo Schlebinger; NOGUEIRA, Eduardo E. F.; PAVIA, Caio L. P.; ARAUJO, Jose F.; LIRA, Jose A.; NIENSTEDT, Esteban C.; SMITH, Thiago C.; ROMANO, Marcelo; BARROS, Dalton; COSTA, Andre F.; TAKAHASHI, Luzia; WERNECK, Vinicius; FARRAN, Jorge; HENRIQUES, Lilian A.; MIURA, Claudia; LOPES, Renato D.; VENDRAME, Leticia S.; SANDRI, Priscila; GALASSI, Marcela S.; TOUFEN JR., Carlos; SANTIAGO, Roberta R. S.; HIROTA, Adriana S.; PARK, Marcelo; AZEVEDO, Luciano C. P.; MALBOUISON, Luiz M.; COSTA, Maristela C.; TANIGUCHI, Leandro; POMPILIO, Carlos E.; BARUZZI, Claudio; ANDRADE, Ana H. V.; TAIRA, Elisabete E.; TAINO, Bruno; OLIVEIRA, Clezio S.; SILVA, Anselmo C.; ISOLA, Alexandre; REZENDE, Ederlon; RODRIGUES, Ricardo G.; RANGEL, Vivian P. L.; LUZZI, Sergio; GIACOMASSI, Ivens W. S.; NASSAR JR., Antonio P.; SOUZA, Ana R.; RAHAL, Luciana; NUNES, Andre L.; GIANNINI, Fabio; MENESCAL, Brena; MORAIS, Jussara E. P.; TOLEDO, Diogo; MORSCH, Rafaela D.; MERLUZZI, Thalita; AMORIM, Denise S.; BASTOS, Ana C. A. G.; SANTOS, Patricia L.; SILVA, Sabrina F.; GALLEGO, Raquel C. N.; SANTOS, Gheisa D.; TUCCI, Mauro; COSTA, Ramon T.; SANTOS, Lucio S.; DEMARZO, Sergio E.; SCHETTINO, Guilherme P. P.; SUZUKI, Vivian C.; PATROCINIO, Ana C. L.; MARTINS, Mariana L.; PASSOS, Denise B. V. G.; CAPPI, Sylas B.; GONCALVES JR., Iran; BORGES, Marcos C.; LOVATO, Wilson; TAVARES, Marcel V.; MORALES, Daniela; MACHADO, Luis A. M. W.; TORRES, Franciele C. C.; GOMES, Tania M.; CERANTOLA, Rodrigo B.; GOIS, Aecio; MARRACCINI, Thiago; MARGARIDA, Kathia; CAVALCANTE, Eulalia; MACHADO, Flavia R.; MAZZA, Bruno F.; SANTANA, Heloisa B. Rossetti; MENDEZ, Vanessa M. F.; XAVIER, Patricia A.; RABELO, Melina V.; SCHIEVANO, Fabiana R.; PINTO, Walkyria A. M.; FRANCISCO, Renata S.; FERREIRA, Elaine M.; SILVA, Dafne C. B.; ARDUINI, Rodrigo G.; ALDRIGHI, Jose R.; AMARO, Andreson F.; CONDE, Katia A. P.; PEREIRA, Cesar A.; TARKIELTAUB, Elcio; OLIVER, Wilson R.; GUADALUPE, Erika G. L.; ACERBI, Paulo S. C.; TOMIZUKA, Carlos I.; OLIVEIRA, Tatiana A.; GEHA, Nadia N.; MECATTI, Giovana C.; PIOVESAN, Maysa Z. R.; SALOMAO, Maria C.; MORENO, Marcelo S.; ORSATTI, Vinicius N.; MIRANDA, Whiniton; RAY, Alexandre; GUERRA, Andre; BAPTISTA FILHO, Mario L. A.; FERREIRA JR., Firmino H.; VIERA FILHO, Edesio; CANZI, Regina A.; GIUBERTI, Adriana F. T.; GARCEZ, Melissa C. M.; PEDRO, A.; SALA, Andrea D.; SUGUITANI, Edmundo O.; KAZUE, Priscila; OLIVEIRA, Luiz R. C.; INFANTINI, Rodrigo M.; CARVALHO, Fabricio R. T.; ANDRADE, Lucia C.; SANTOS, Thiago M.; CARMONA, Cesar V.; FIGUEIREDO, Luciana C.; FALCAO, Antonio; DRAGOSAVAK, Desanka; NOGUEIRA FILHO, Wilson; LUNARDI, Maria C.; LAGO, Roberto; GATTI, Ciro; CHIASSO, Tatiana M.; SANTOS, Grazielle O.; SILVA, Aline C. F.; ARAUJO, Arthur C.; ORNELLAS, Izadora B.; VIEIRA, Vitor M.; HAJJAR, Ludhmila A.; FIGUEIREDO, Adelaide C.; DAMASCENO, Bruna; PIZARRO, Camilo; HINESTROSA, Alfredo; DIAZ-QUIJANO, Fredi A.; GARCIA L., Sandra M. C.; GONZALEZ C., Octavio; DIAZ S., Edgard; RAINERI, Santi M.; CORTEGIANI, Andrea
    Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.