EDUARDO ATSUSHI OSAWA
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article 0 Citação(ões) na Scopus Dobutamine administration in patients after cardiac surgery: beneficial or harmful?(2011) HAJJAR, Ludhmila A.; FUKUSHIMA, Julia T.; OSAWA, Eduardo; ALMEIDA, Juliano P.; GALAS, Filomena R. B. G.- Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment(2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
- Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients(2013) GALAS, Filomena R. B. G.; ALMEIDA, Juliano P.; FUKUSHIMA, Julia T.; OSAWA, Eduardo A.; NAKAMURA, Rosana E.; SILVA, Carolina M. P. D. C.; ALMEIDA, Elisangela Pinto Marinho de; AULER JR., Jose Otavio Costa; VINCENT, Jean-Louis; HAJJAR, Ludhmila A.Background: Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients. Methods: Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study. Results: According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of >3 units. Conclusion: RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery.
- Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study(2020) OSAWA, Eduardo A.; CUTULI, Salvatore L.; CIOCCARI, Luca; BITKER, Laurent; PECK, Leah; YOUNG, Helen; HESSELS, Lara; YANASE, Fumitaka; FUKUSHIMA, Julia T.; HAJJAR, Ludhmila A.; SEEVANAYAGAM, Siven; MATALANIS, George; EASTWOOD, Glenn M.; BELLOMO, RinaldoObjective: The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery. Design: Sequential, matched, case-controlled pilot study. Setting: Tertiary university hospital. Participants: Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol. Interventions: The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge. Measurements and Main Results: The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L 0.34 on day 1, 1.32 0.36 on day 2 versus 1.01 +/- 1.14 and 0.97 +/- 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004). Conclusion: The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.
article Dobutamine administration in patients after cardiac surgery: beneficial or harmful? response(2011) HAJJAR, Ludhmila A.; FUKUSHIMA, Julia T.; OSAWA, Eduardo; ALMEIDA, Juliano P.; GALAS, Filomena R. B. G.- Strategies to reduce blood transfusion: a Latin-American perspective(2015) HAJJAR, Ludhmila Abrahao; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; OSAWA, Eduardo Atsushi; GALAS, Filomena Regina Barbosa GomesPurpose of review Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion. Recent findings In the past decades, clinical studies comparing transfusion strategies in different populations were conducted. Despite the challenges imposed by the development of such studies, evidence-based medicine on transfusion medicine in critically ill patients is being created. Different results arising from these studies reflect population heterogeneity, specific circumstances, and difficulties in measuring the impact of anemia and transfusion in a clinical trial. Summary An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
- Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management(2012) TEDDE, Miguel L.; VASCONCELOS FILHO, Paulo; HAJJAR, Ludhmila Abrahao; ALMEIDA, Juliano Pinheiro de; FLORA, Gustavo Fagundes; OKUMURA, Erica Mie; OSAWA, Eduardo A.; FUKUSHIMA, Julia Tizue; TEIXEIRA, Manoel Jacobsen; GALAS, Filomena Regina Barbosa Gomes; JATENE, Fabio Biscegli; AULER JR., Jose Otavio CostaOBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov:NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.
conferenceObject VASOPRESSIN OR NOREPINEPHRINE IN VASOPLEGIC AFTER CARDIAC SURGERY (YANCS STUDY): A RANDOMIZED, DOUBLE-BLIND AND CONTROLLED STUDY(2014) HAJJAR, L. A.; VINCENT, J. L.; RHODES, A.; GALAS, F.; FUKUSHIMA, J. T.; OSAWA, E. A.; GRANDE, S. M.; ALMEIDA, J. P.; ZEFFERINO, S.; CAMARA, L.; JATENE, F. B.; FILHO, R. K.conferenceObject Chemotherapy in the intensive care unit patient: A friend or a foe?(2014) HAJJAR, Ludhmila A.; PARK, Clarice H.; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano; OSAWA, Eduardo A.; NAKAMURA, Rosana; NAGAOKA, Danielle; GALAS, Filomena; ESTEVEZ-DIZ, Maria Del Pilar- Nitric Oxide in Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials(2018) SARDO, Salvatore; OSAWA, Eduardo Atsushi; FINCO, Gabriele; GALAS, Filomena Regina Barbosa Gomes; ALMEIDA, Juliano Pinheiro de; CUTULI, Salvatore Lucio; FRASSANITO, Claudia; LANDONI, Giovanni; HAJJAR, Ludhmila AbrahaoObjectives: To investigate the efficacy and safety of perioperative administration of nitric oxide in cardiac surgery. Design: Meta-analysis of randomized controlled trials (RCTs). Participants: Cardiac surgery patients. Interventions: A search of Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE for RCTs that compared nitric oxide with placebo or other comparators. Measurements and Main Results: The primary outcome was intensive care unit (ICU) stay, and secondary outcomes were mortality, duration of mechanical ventilation, and reduction of mean pulmonary artery pressure. The study included 18 RCTs comprising 958 patients. The authors calculated the pooled odds ratio (OR) and the mean difference (MD) with random-effects model. Quantitative synthesis of data demonstrated a clinically negligible reduction in the length of ICU stay (MD -0.38 days, confidence interval CI [-0.65 to -0.11]; p = 0.005) and mechanical ventilation duration (MD -4.81 hours, CI [-7.79 to -1.83]; p = 0.002) compared with all control interventions with no benefit on mortality. Conclusions: Perioperative delivery of inhaled nitric oxide resulted to be of no or minimal benefit in patients with pulmonary hypertension undergoing cardiac surgery. Large, randomized trials are needed to further assess its effect on major clinical outcomes and its cost-effectiveness.
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