ROBERTA RIBEIRO DE SANTIS SANTIAGO
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- The Recruitability Paradox(2016) AMATO, Marcelo B. P.; SANTIAGO, Roberta R. De Santis
- 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.
- Spontaneous Effort Causes Occult Pendelluft during Mechanical Ventilation(2013) YOSHIDA, Takeshi; TORSANI, Vinicius; GOMES, Susimeire; SANTIS, Roberta R. De; BERALDO, Marcelo A.; COSTA, Eduardo L. V.; TUCCI, Mauro R.; ZIN, Walter A.; KAVANAGH, Brian P.; AMATO, Marcelo B. P.Rationale: In normal lungs, local changes in pleural pressure (P-pl) are generalized over the whole pleural surface. However, in a patient with injured lungs, we observed (using electrical impedance tomography) a pendelluft phenomenon (movement of air within the lung from nondependent to dependent regions without change in tidal volume) that was caused by spontaneous breathing during mechanical ventilation. Objectives: To test the hypotheses that in injured lungs negative P-pl generated by diaphragm contraction has localized effects (in dependent regions) that are not uniformly transmitted, and that such localized changes in P-pl cause pendelluft. Methods: We used electrical impedance tomography and dynamic computed tomography (CT) to analyze regional inflation in anesthetized pigs with lung injury. Changes in local P-pl were measured in nondependent versus dependent regions using intrabronchial balloon catheters. The airway pressure needed to achieve comparable dependent lung inflation during paralysis versus spontaneous breathing was estimated. Measurements and Main Results: In all animals, spontaneous breathing caused pendelluft during early inflation, which was associated with more negative local P-pl in dependent regions versus nondependent regions (-13.0 +/- 4.0 vs. -6.4 +/- 3.8 cm H2O; P < 0.05). Dynamic CT confirmed pendelluft, which occurred despite limitation of tidal volume to less than 6 ml/kg. Comparable inflation of dependent lung during paralysis required almost threefold greater driving pressure (and tidal volume) versus spontaneous breathing (28.0 +/- 0.5 vs. 10.3 +/- 0.6 cm H2O, P < 0.01; 14.8 +/- 4.6 vs. 5.8 +/- 1.6 ml/kg, P < 0.05). Conclusions: Spontaneous breathing effort during mechanical ventilation causes unsuspected overstretch of dependent lung during early inflation (associated with reciprocal deflation of nondependent lung). Even when not increasing tidal volume, strong spontaneous effort may potentially enhance lung damage.
- Quantitative Dual-Energy Computed Tomography Predicts Regional Perfusion Heterogeneity in a Model of Acute Lung Injury(2018) KAY, Fernando Uliana; BERALDO, Marcelo A.; NAKAMURA, Maria A. M.; SANTIAGO, Roberta De Santis; TORSANI, Vinicius; GOMES, Susimeire; ROLDAN, Rollin; TUCCI, Mauro R.; ABBARA, Suhny; AMATO, Marcelo B. P.; AMARO JR., EdsonObjective The aims of this study were to investigate the ability of contrast-enhanced dual-energy computed tomography (DECT) for assessing regional perfusion in a model of acute lung injury, using dynamic first-pass perfusion CT (DynCT) as the criterion standard and to evaluate if changes in lung perfusion caused by prone ventilation are similarly demonstrated by DECT and DynCT. Methods This was an institutional review board-approved study, compliant with guidelines for humane care of laboratory animals. A ventilator-induced lung injury protocol was applied to 6 landrace pigs. Perfused blood volume (PBV) and pulmonary blood flow (PBF) were respectively quantified by DECT and DynCT, in supine and prone positions. The lungs were segmented in equally sized regions of interest, namely, dorsal, middle, and ventral. Perfused blood volume and PBF values were normalized by lung density. Regional air fraction (AF) was assessed by triple-material decomposition DECT. Per-animal correlation between PBV and PBF was assessed with Pearson R. Regional differences in PBV, PBF, and AF were evaluated with 1-way analysis of variance and post hoc linear trend analysis ( = 5%). Results Mean correlation coefficient between PBV and PBF was 0.70 (range, 0.55-0.98). Higher PBV and PBF values were observed in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were -10.24 mL/100 g per zone for PBV (P < 0.001) and -223.0 mL/100 g per minute per zone for PBF (P < 0.001). Prone ventilation also revealed higher PBV and PBF in dorsal versus ventral regions. Dorsal-to-ventral linear trend slopes were -16.16 mL/100 g per zone for PBV (P < 0.001) and -108.2 mL/100 g per minute per zone for PBF (P < 0.001). By contrast, AF was lower in dorsal versus ventral regions in supine position, with dorsal-to-ventral linear trend slope of +5.77%/zone (P < 0.05). Prone ventilation was associated with homogenization of AF distribution among different regions (P = 0.74). Conclusions Dual-energy computed tomography PBV is correlated with DynCT-PBF in a model of acute lung injury, and able to demonstrate regional differences in pulmonary perfusion. Perfusion was higher in the dorsal regions, irrespectively to decubitus, with more homogeneous lung aeration in prone position.
- 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, AndreaBackground: 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.