EDSON BOR-SENG SHU
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Dynamic cerebral autoregulation: A marker of post-operative delirium?(2019) CALDAS, Juliana R.; PANERAI, Ronney B.; BOR-SENG-SHU, Edson; FERREIRA, Graziela S. R.; CAMARA, Ligia; PASSOS, R. H.; DE-LIMA-OLIVEIRA, Marcelo; GALAS, Filomena R. B. G.; ALMEIDA, Juliano P.; NOGUEIRA, Ricardo C.; MIAN, Natalia; GAIOTTO, Fabio A.; ROBINSON, Thompson G.; HAJJAR, Ludhmila A.Objective: We investigated the potential association of cerebral autoregulation (CA) with postoperative delirium (PD), a common complication of cardiac surgery with cardiopulmonary bypass (CPB). Methods: In patients undergoing coronary artery bypass graft (CABG) surgery with CPB, cerebral blood flow velocity (CBFV) and blood pressure (BP) were continuously recorded during 5-min preoperatively (T1), after 24 h (T2), and 7 days after procedure (T3). Prospective multivariate logistic regression analysis was performed to determine the independent risk factors of PD. Autoregulation index (ARI) was calculated from the CBFV response to a step change in BP derived by transfer function analysis. Results: In 67 patients, mean age 64.3 +/- 9.5 years, CA was depressed at T2 as shown by values of ARI (3.9 +/- 1.7), compared to T1 (5.6 +/- 1.7) and T3 (5.5 +/- 1.8) (p < 0.001). Impaired CA was found in 37 (55%) patients at T2 and in 7 patients (20%) at T3. Lower ARI at T1 and T2 were predictors of PD (p = 0.003). Conclusion: Dynamic CA was impaired after CABG surgery with CPB and was a significant independent risk factor of PD. Significance: Assessment of CA before and after surgery could have considerable potential for early identification of patients at risk of PD, thus reducing poor outcomes and length of stay.
- Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation(2019) BOR-SENG-SHU, Edson; DE-LIMA-OLIVEIRA, Marcelo; NOGUEIRA, Ricardo Carvalho; ALMEIDA, Kelson James; PASCHOAL, Eric Homero Albuquerque; PASCHOAL JR., Fernando MendesBackground: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.
- Evaluation of Head Computed Tomography Assessment of Brain Swelling after Acute Traumatic Brain Injury: A Pilot study(2019) AMORIM, Robson Luis; MORAIS, Barbara Albuquerque; PEREIRA, Francisco Otavio Camargo; OLIVEIRA, Matheus Fernandes; ANDRADE, Almir Ferreira; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo Lima; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaObjective To evaluate the interobserver reliability of a new scale created for quantitatively assessing brain swelling in traumatic brain injury (TBI) patients using the computed tomography (CT) findings in three levels. Methods Computed tomography scans of severe head injury patients were randomly selected from a tertiary hospital image database and evaluated by independent groups of neurosurgeons, neurosurgery residents, radiologists, and intensivists from the same hospital. Each specialist assessed the tomographic findings, applying zero to six points in a new scale. The Kappa coefficient was calculated to assess interobserver agreement. Results The highest reliability coefficient was obtained by the neurosurgeons group (0.791; 95% confidence interval [CI]: 0.975-0.607; p < 0.001), followed by the neurosurgery residents group (0.402; 95%CI: 0.569-0.236; p < 0.001) and by the radiologists group (0.301; 95%CI: 0.488-0.113; p < 0.002). The lowest coefficient was found among the intensivists (0.248; 95%CI: 0.415-0.081; p = 0.004). Conclusion The proposed scale showed good reliability among neurosurgeons, and moderate overall reliability. This tomographic classification might be useful to better assist severe TBI victims, allowing to identify the worsening or amelioration of brain swelling, which should be further investigated. The scale seems to be feasible, even in low income countries, where the cost of intracranial pressure (ICP) monitoring is higher than that of CTs.
- Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial(2019) CALDAS, Juliana R.; PANERAI, Ronney B.; BOR-SENG-SHU, Edson; FERREIRA, Graziela S. R.; CAMARA, Ligia; PASSOS, Rogerio H.; SALINET, Angela M.; AZEVEDO, Daniel S.; DE-LIMA-OLIVEIRA, Marcelo; GALAS, Filomena R. B. G.; FUKUSHIMA, Julia T.; NOGUEIRA, Ricardo; TACCONE, Fabio S.; LANDONI, Giovanni; ALMEIDA, Juliano P.; ROBINSON, Thompson G.; HAJJAR, Ludhmila A.Background The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the 'Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery' (IABCS) trial. Methods This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction <= 40% or EuroSCORE >= 6 received preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n = 34) and without IABP (n = 33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded. Results There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5 +/- 1.9 vs. 5.7 +/- 1.7; T2: 4.0 +/- 1.9 vs. 4.1 +/- 1.6; T3: 5.7 +/- 2.0 vs. 5.7 +/- 1.6, p = 0.97) or CBFV (T1: 57.3 +/- 19.4 vs. 59.3 +/- 11.8; T2: 74.0 +/- 21.6 vs. 74.7 +/- 17.5; T3: 71.1 +/- 21.3 vs. 68.1 +/- 15.1 cm/s; p = 0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p = 0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00). Conclusions The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registration (NCT02143544).
- Clinical aspects of congenital microcephaly syndrome by Zika virus in a rehabilitation center for patients with microcephaly(2019) ALMEIDA, Kelson James; MARTINS, Augusto Cesar Beserra; ALMENDRA, Isadora Costa Coelho Gayoso e; MENESES, Gabriel Medina Sobreira de; SAMPAIO, Tholes Daniel de Oliveira; CAMPELO, Lose do Cruz Moura; BOR-SENG-SHU, EdsonOBJECTIVE: In this study, we intend to identify the prevalence of clinical variables in children with microcephaly. METHODS: This is a cross-sectional and observational study with data collected from medical records of patients admitted to the microcephaly outpatient clinic of a referral center in Teresina-PI. Demographic (gender and age) and clinical data (presence of epilepsy, dysphagia, irritability, and associated comorbidities)were collected. The frequency of Zika virus as a probable etiology was determined from computed tomography patterns and the exclusion of other etiologies by serological tests. RESULTS: A total of 67 patient records were evaluated, of which 31 were male and 36 were female, with a mean age of 1 year and 10 months. The most prevalent clinical variables were epilepsy, present in 47 children (70.2%), and irritability in 37 (55.2%). Also with a high frequency, 22 had dysphagia (32.8%), and 13 had musculoskeletal comorbidities (19.4%). Only three patients in the sample had cardiac abnormalities (4.5%), and no endocrine comorbidity was found. A total of 38 children in the sample (56.7%) presented ZIKV as a probable etiology and, in these cases, there was a higher frequency of epilepsy and dysphagia compared to other etiologies, although not statistically significant. CONCLUSION: Epilepsy, irritability, dysphagia, and musculoskeletal comorbidities were the most frequent clinical variables in children with microcephaly. There was a high prevalence of congenital ZIKV microcephaly syndrome in this sample.
- Cerebral autoregulation in a fulminant hepatic failure patient who underwent liver transplantation(2019) PASCHOAL- JR., Fernando M.; NOGUEIRA, Ricardo C.; DE-LIMA-OLIVEIRA, Marcelo; PASCHOAL, Eric H.; TEIXEIRA, Manoel J.; D'ALBUQUERQUE, Luiz A.; BOR-SENG-SHU, Edson
- Dynamic Cerebral Autoregulation Reproducibility Is Affected by Physiological Variability(2019) SANDERS, Marit L.; ELTING, Jan Willem J.; PANERAI, Ronney B.; ARIES, Marcel; BOR-SENG-SHU, Edson; CAICEDO, Alexander; CHACON, Max; GOMMERS, Erik D.; HUFFEL, Sabine Van; JARA, Jose L.; KOSTOGLOU, Kyriaki; MANDI, Adam; MARMARELIS, Vasilis Z.; MITSIS, Georgios D.; MULLER, Martin; NIKOLIC, Dragana; NOGUEIRA, Ricardo C.; PAYNE, Stephen J.; PUPPO, Corina; SHIN, Dae C.; SIMPSON, David M.; TARUMI, Takashi; YELICICH, Bernardo; ZHANGS, Rong; CLAASSEN, Jurgen A. H. R.Parameters describing dynamic cerebral autoregulation (DCA) have limited reproducibility. In an international, multi-center study, we evaluated the influence of multiple analytical methods on the reproducibility of DCA. Fourteen participating centers analyzed repeated measurements from 75 healthy subjects, consisting of 5 min of spontaneous fluctuations in blood pressure and cerebral blood flow velocity signals, based on their usual methods of analysis. DCA methods were grouped into three broad categories, depending on output types: (1) transfer function analysis (TFA); (2) autoregulation index (ARI); and (3) correlation coefficient. Only TFA gain in the low frequency (LF) band showed good reproducibility in approximately half of the estimates of gain, defined as an intraclass correlation coefficient (ICC) of >0.6. None of the other DCA metrics had good reproducibility. For TFA-like and ARI-like methods, ICCs were lower than values obtained with surrogate data (p < 0.05). For TFA-like methods, ICCs were lower for the very LF band (gain 0.38 +/- 0.057, phase 0.17 +/- 0.13) than for LF band (gain 0.59 +/- 0.078, phase 0.39 +/- 0.11, p <= 0.001 for both gain and phase). For ARI-like methods, the mean ICC was 0.30 +/- 0.12 and for the correlation methods 0.24 +/- 0.23. Based on comparisons with ICC estimates obtained from surrogate data, we conclude that physiological variability or non-stationarity is likely to be the main reason for the poor reproducibility of DCA parameters.
- Transcranial brain sonography for Parkinsonian syndromes(2019) BOR-SENG-SHU, Edson; PASCHOAL, Fernando M.; ALMEIDA, Kelson J.; OLIVEIRA, Marcelo De Lima; NOGUEIRA, Ricardo C.; TEIXEIRA, Manoel J.; WALTER, UweSubstantia nigra (SN) hyperechogenicity has been proved to be a characteristic finding for idiopathic Parkinson's disease (PD), occurring in more than 90% of the patients. This echofeature is owed to increased amounts of iron in the SN region and reflects a functional impairment of the nigrostriatal dopaminergic system. In a prospective blinded study in which a group of patients with early mild signs and symptoms of unclear Parkinsonism were followed until a definite clinical diagnosis of PD, the hyperechogenicity of the SN was demonstrated to be highly predictive of a final diagnosis of PD. For the diagnosis of PD in individuals with early motor symptoms, both the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90% and both the specificity and negative predictive value were higher than 80%. For early differential diagnosis between PD and atypical Parkinsonian syndromes, the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90%, and both the specificity and negative predictive value were higher than 80%. The diagnostic specificity is increased if combining the TCS findings of SN, lenticular nucleus and third ventricle. In asymptomatic adult subjects, SN hyperechogenicity, at least unilaterally, indicates a subclinical functional insufficiency of the nigrostriatal dopaminergic system. Recent papers revealed that SN hyperechogenicity might suggest preclinical PD. Reduced echogenicity of midbrain raphe indicates increased risk of depression in PD patients. Caudate nucleus hyperechogenicity has been associated with drug-induced psychosis, and frontal horn dilatation > 20 mm with dementia. Transcranial brain sonography can be a valuable tool for managing patients with Parkinsonian signs and symptoms.
- Do acute stroke patients develop hypocapnia? A systematic review and meta-analysis(2019) SALINET, Angela S. M.; MINHAS, Jatinder S.; PANERAI, Ronney B.; BOR-SENG-SHU, Edson; ROBINSON, Thompson G.Purpose: Carbon dioxide (CO2) is a potent cerebral vasomotor agent. Despite reduction in CO2 levels (hypocapnia) being described in several acute diseases, there is no clear data on baseline CO2 values in acute stroke. The aim of the study was to systematically assess CO2 levels in acute stroke. Material and methods: Four online databases, Web of Science, MEDLINE, EMBASE and CENTRAL, were searched for articles that described either partial pressure of arterial CO2 (PaCO2) and end-tidal CO2 (EtCO2) in acute stroke. Results: After screening, based on predefined inclusion and exclusion criteria, 20 studies were retained. There were 5 studies in intracerebral hemorrhage and 15 in ischemic stroke, totalling 660 stroke participants. Acute stroke was associated with a significant decrease in CO2 levels compared to controls. Cerebral haemodynamic studies using transcranial Doppler ultrasonography demonstrated a significant reduction in cerebral blood flow velocities and cerebral autoregulation in acute stroke patients. Conclusion: The evidence from this review suggests that acute stroke patients are significantly more likely than controls to be hypocapnic, supporting the value of routine CO2 assessment in the acute stroke setting. Further studies are required in order to evaluate the clinical impact of these findings.
- Impaired cerebral autoregulation and neurovascular coupling in middle cerebral artery stroke: Influence of severity?(2019) SALINET, Angela S. M.; SILVA, Nathalia C. C.; CALDAS, Juliana; AZEVEDO, Daniel S. de; DE-LIMA-OLIVEIRA, Marcelo; NOGUEIRA, Ricardo C.; CONFORTO, Adriana B.; TEXEIRA, Manoel J.; ROBINSON, Thompson G.; PANERAI, Ronney B.; BOR-SENG-SHU, EdsonWe aimed to assess cerebral autoregulation (CA) and neurovascular coupling (NVC) in stroke patients of differing severity comparing responses to healthy controls and explore the association between CA and NVC with functional outcome. Patients admitted with middle cerebral artery (MCA) stroke and healthy controls were recruited. Stroke severity was defined by the National Institutes of Health Stroke Scale (NIHSS) scores: <= 4 mild, 5-15 moderate and >= 16 severe. Transcranial Doppler ultrasound and Finometer recorded MCA cerebral blood flow velocity (CBFv) and blood pressure, respectively, over 5 min baseline and 1 min passive movement of the elbow to calculate the autoregulation index (ARI) and CBFv amplitude responses to movement. All participants were followed up for three months. A total of 87 participants enrolled in the study, including 15 mild, 27 moderate and 13 severe stroke patients, and 32 control subjects. ARI was lower in the affected hemisphere (AH) of moderate and severe stroke groups. Decreased NVC was seen bilaterally in all stroke groups. CA and NVC correlated with stroke severity and functional outcome. CBFv regulation is significantly impaired in acute stroke, and further compromised with increasing stroke severity. Preserved CA and NVC in the acute period were associated with improved three-month functional outcome.