EDUARDO ATSUSHI OSAWA

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Autor e Coautores FMUSP-HC Normalizados: JOSE OTAVIO COSTA AULER JUNIOR ×

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  • article 56 Citação(ões) na Scopus
    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.
  • article 23 Citação(ões) na Scopus
    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 Costa
    OBJECTIVE: 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.
  • article 26 Citação(ões) na Scopus
    Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4) Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection
    (2013) HAMAJI, Adilson; HAJJAR, Ludhmila; CAIERO, Marcelo; ALMEIDA, Juliano; NAKAMURA, Rosana Ely; OSAWA, Eduardo A.; FUKUSHIMA, Julia; GALAS, Filomena R.; AULER JUNIOR, Jose Otavio Costa
    Background and objectives: Hydroxyethyl starch (HES) 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. Methods: In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg(-1) of HES 130/0.4 and 24 patients received a preload of 30 mL.kg(-1) lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. Results: Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029). Postoperative infections were more frequently observed in the Ringer group (17%) compared to the HES group (0), p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. Conclusions: During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated Ringer.
  • article 72 Citação(ões) na Scopus
    Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial
    (2017) BERGAMIN, Fabricio S.; ALMEIDA, Juliano P.; LANDONI, Giovanni; GALAS, Filomena R. B. G.; FUKUSHIMA, Julia T.; FOMINSKIY, Evgeny; PARK, Clarice H. L.; OSAWA, Eduardo A.; DIZ, Maria P. E.; OLIVEIRA, Gisele Q.; FRANCO, Rafael A.; NAKAMURA, Rosana E.; ALMEIDA, Elisangela M.; ABDALA, Edson; FREIRE, Maristela P.; FILHO, Roberto K.; AULER JR., Jose Otavio C.; HAJJAR, Ludhmila A.
    Objective: To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock. Design: Single center, randomized, double-blind controlled trial. Setting: Teaching hospital. Patients: Adult cancer patients with septic shock in the first 6 hours of ICU admission. Interventions: Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay. Measurements and Main Results: Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0-3] vs 0 [0-2] unit; p<0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53-1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53-0.97; p = 0.03). Conclusions: We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.
  • article 119 Citação(ões) na Scopus
    Effect of Perioperative Goal-Directed Hemodynamic Resuscitation Therapy on Outcomes Following Cardiac Surgery: A Randomized Clinical Trial and Systematic Review
    (2016) OSAWA, Eduardo A.; RHODES, Andrew; LANDONI, Giovanni; GALAS, Filomena R. B. G.; FUKUSHIMA, Julia T.; PARK, Clarice H. L.; ALMEIDA, Juliano P.; NAKAMURA, Rosana E.; STRABELLI, Tania M. V.; PILEGGI, Brunna; LEME, Alcino C.; FOMINSKIY, Evgeny; SAKR, Yasser; LIMA, Marta; FRANCO, Rafael A.; CHAN, Raquel P. C.; PICCIONI, Marilde A.; MENDES, Priscilla; MENEZES, Suellen R.; BRUNO, Tatiana; GAIOTTO, Fabio A.; LISBOA, Luiz A.; DALLAN, Luiz A. O.; HUEB, Alexandre C.; POMERANTZEFF, Pablo M.; KALIL FILHO, Roberto; JATENE, Fabio B.; AULER JUNIOR, Jose Otavio Costa; HAJJAR, Ludhmila A.
    Objectives: To evaluate the effects of goal-directed therapy on outcomes in high-risk patients undergoing cardiac surgery. Design: A prospective randomized controlled trial and an updated metaanalysis of randomized trials published from inception up to May 1, 2015. Setting: Surgical ICU within a tertiary referral university-affiliated teaching hospital. Patients: One hundred twenty-six high-risk patients undergoing coronary artery bypass surgery or valve repair. Interventions: Patients were randomized to a cardiac output-guided hemodynamic therapy algorithm (goal-directed therapy group, n = 62) or to usual care (n = 64). In the goal-directed therapy arm, a cardiac index of greater than 3 L/min/m(2) was targeted with IV fluids, inotropes, and RBC transfusion starting from cardiopulmonary bypass and ending 8 hours after arrival to the ICU. Measurements and Main Results: The primary outcome was a composite endpoint of 30-day mortality and major postoperative complications. Patients from the goal-directed therapy group received a greater median (interquartile range) volume of IV fluids than the usual care group (1,000 [625-1,500] vs 500 [500-1,000] mL; p < 0.001], with no differences in the administration of either inotropes or RBC transfusions. The primary outcome was reduced in the goal-directed therapy group (27.4% vs 45.3%; p = 0.037). The goal-directed therapy group had a lower occurrence rate of infection (12.9% vs 29.7%; p = 0.002) and low cardiac output syndrome (6.5% vs 26.6%; p = 0.002). We also observed lower ICU cumulative dosage of dobutamine (12 vs 19 mg/kg; p = 0.003) and a shorter ICU (3 [3-4] vs 5 [4-7] d; p < 0.001) and hospital length of stay (9 [8-16] vs 12 [9-22] d; p = 0.049) in the goal-directed therapy compared with the usual care group. There were no differences in 30-day mortality rates (4.8% vs 9.4%, respectively; p = 0.492). The metaanalysis identified six trials and showed that, when compared with standard treatment, goal-directed therapy reduced the overall rate of complications (goal-directed therapy, 47/410 [11%] vs usual care, 92/415 [22%]; odds ratio, 0.40 [95% CI, 0.26-0.63]; p < 0.0001) and decreased the hospital length of stay (mean difference, -5.44 d; 95% CI, -9.28 to -1.60; p = 0.006) with no difference in postoperative mortality: 9 of 410 (2.2%) versus 15 of 415 (3.6%), odds ratio, 0.61 (95% CI, 0.26-1.47), and p = 0.27. Conclusions: Goal-directed therapy using fluids, inotropes, and blood transfusion reduced 30-day major complications in high-risk patients undergoing cardiac surgery.
  • article 94 Citação(ões) na Scopus
    Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications A Randomized Clinical Trial
    (2017) LEME, Alcino Costa; HAJJAR, Ludhmila Abrahao; VOLPE, Marcia S.; FUKUSHIMA, Julia Tizue; SANTIAGO, Roberta Ribeiro De Santis; OSAWA, Eduardo A.; ALMEIDA, Juliano Pinheiro de; GERENT, Aline Muller; FRANCO, Rafael Alves; FELTRIM, Maria Ignez Zanetti; NOZAWA, Emilia; COIMBRA, Vera Regina de Moraes; IANOTTI, Rafael de Moraes; HASHIZUME, Clarice Shiguemi; KALIL FILHO, Roberto; AULER JR., Jose Otavio Costa; JATENE, Fabio Biscegli; GALAS, Filomena Regina Barbosa Gomes; AMATO, Marcelo Britto Passos
    IMPORTANCE Perioperative lung-protective ventilation has been recommended to reduce pulmonary complications after cardiac surgery. The protective role of a small tidal volume (VT) has been established, whereas the added protection afforded by alveolar recruiting strategies remains controversial. OBJECTIVE To determine whether an intensive alveolar recruitment strategy could reduce postoperative pulmonary complications, when added to a protective ventilation with small VT. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of patients with hypoxemia after cardiac surgery at a single ICU in Brazil (December 2011-2014). INTERVENTIONS Intensive recruitment strategy (n=157) or moderate recruitment strategy (n=163) plus protective ventilation with small VT. MAIN OUTCOMES AND MEASURES Severity of postoperative pulmonary complications computed until hospital discharge, analyzed with a common odds ratio (OR) to detect ordinal shift in distribution of pulmonary complication severity score (0-to-5 scale, 0, no complications; 5, death). Prespecified secondary outcomes were length of stay in the ICU and hospital, incidence of barotrauma, and hospital mortality. RESULTS All 320 patients (median age, 62 years; IQR, 56-69 years; 125 women [39%]) completed the trial. The intensive recruitment strategy group had a mean 1.8 (95% CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary complications score vs 2.1 (95% CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the moderate strategy group. Overall, the distribution of primary outcome scores shifted consistently in favor of the intensive strategy, with a common OR for lower scores of 1.86 (95% CI, 1.22 to 2.83; P =.003). The mean hospital stay for the moderate group was 12.4 days vs 10.9 days in the intensive group (absolute difference, -1.5 days; 95% CI, -3.1 to -0.3; P =.04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days for the intensive group (absolute difference, -1.0 days; 95% CI, -1.6 to -0.2; P =.01). Hospital mortality (2.5% in the intensive group vs 4.9% in the moderate group; absolute difference, -2.4%, 95% CI, -7.1% to 2.2%) and barotrauma incidence (0% in the intensive group vs 0.6% in the moderate group; absolute difference, -0.6%; 95% CI, -1.8% to 0.6%; P =.51) did not differ significantly between groups. CONCLUSIONS AND RELEVANCE Among patients with hypoxemia after cardiac surgery, the use of an intensive vs a moderate alveolar recruitment strategy resulted in less severe pulmonary complications while in the hospital.
  • article 49 Citação(ões) na Scopus
    A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery
    (2015) NAKAMURA, Rosana Ely; VINCENT, Jean-Louis; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; FRANCO, Rafael Alves; PARK, Clarice Lee; OSAWA, Eduardo Atsushi; SILVA, Carolina Maria Pinto; AULER JR., Jose Otavio Costa; LANDONI, Giovanni; GALAS, Filomena Regina Barbosa Gomes; KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao
    Objective: The aim of this study was to compare outcomes in patients undergoing cardiac surgery who are aged 60 years or more or less than 60 years after implementation of a restrictive or a liberal transfusion strategy. Methods: This is a substudy of the Transfusion Requirements After Cardiac Surgery (TRACS) randomized controlled trial. In this subgroup analysis, we separated patients into those aged 60 years or more (elderly) and those aged less than 60 years randomized to a restrictive or a liberal strategy of red blood cell transfusion. The primary outcome was a composite defined as a combination of 30-day all-cause mortality and severe morbidity. Results: Of the 502 patients included in the Transfusion Requirements After Cardiac Surgery study, 260 (51.8%) were aged 60 years or more and 242 (48.2%) were aged less than 60 years and were included in this study. The primary end point occurred in 11.9% of patients in the liberal strategy group and 16.8% of patients in the restrictive strategy group (P = .254) for those aged 60 years or more and in 6.8% of patients in the liberal strategy group and 5.6% of patients in the restrictive strategy group for those aged less than 60 years (P = .714). However, in the older patients, cardiogenic shock was more frequent in patients in the restrictive transfusion group (12.8% vs 5.2%, P = .031). Thirty-day mortality, acute respiratory distress syndrome, and acute renal injury were similar in the restrictive and liberal transfusion groups in both age groups. Conclusions: Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy may result in an increased rate of cardiogenic shock in elderly patients undergoing cardiac surgery compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients.
  • article 157 Citação(ões) na Scopus
    Transfusion Requirements in Surgical Oncology Patients A Prospective, Randomized Controlled Trial
    (2015) ALMEIDA, Juliano Pinheiro de; VINCENT, Jean-Louis; GALAS, Filomena Regina Barbosa Gomes; ALMEIDA, Elisangela Pinto Marinho de; FUKUSHIMA, Julia T.; OSAWA, Eduardo A.; BERGAMIN, Fabricio; PARK, Clarice Lee; NAKAMURA, Rosana Ely; FONSECA, Silvia M. R.; CUTAIT, Guilherme; ALVES, Joseane Inacio; BAZAN, Mellik; VIEIRA, Silvia; SANDRINI, Ana C. Vieira; PALOMBA, Henrique; RIBEIRO JR., Ulysses; CRIPPA, Alexandre; DALLOGLIO, Marcos; DIZ, Maria del Pilar Estevez; KALIL FILHO, Roberto; AULER JR., Jose Otavio Costa; RHODES, Andrew; HAJJAR, Ludhmila Abrahao
    Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
  • article 0 Citação(ões) na Scopus
    Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial (vol 126, pg 85, 2017)
    (2017) HAJJAR, L. A.; VINCENT, J. L.; GALAS, Barbosa Gomes F. R.; RHODES, A.; LANDONI, G.; OSAWA, E. A.; MELO, R. R.; SUNDIN, M. R.; GRANDE, S. M.; GAIOTTO, F. A.; POMERANTZEFF, P. M.; DALLAN, L. O.; FRANCO, R. A.; NAKAMURA, R. E.; LISBOA, L. A.; ALMEIDA, J. P. de; GERENT, A. M.; SOUZA, D. H.; GAIANE, M. A.; FUKUSHIMA, J. T.; PARK, C. L.; ZAMBOLIM, C.; FERREIRA, Rocha G. S.; STRABELLI, T. M.; FERNANDES, F. L.; CAMARA, L.; ZEFERINO, S.; SANTOS, V. G.; PICCIONI, M. A.; JATENE, F. B.; AULER JR., Costa J. O.; FILHO, R. K.
  • article 22 Citação(ões) na Scopus
    High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery
    (2013) LARA, Thiago Martins; HAJJAR, Ludhmila Abrahao; ALMEIDA, Juliano Pinheiro de; FUKUSHIMA, Julia Tizue; BARBAS, Carmem Silvia Valente; RODRIGUES, Adriano Rogerio Baldacin; NOZAWA, Emilia; FELTRIM, Maria Ignes Zanetti; ALMEIDA, Elisangela; COIMBRA, Vera; OSAWA, Eduardo; IANOTTI, Rafael de Moraes; LEME, Alcino Costa; JATENE, Fabio Biscegli; AULER- JR., Jose Otavio Costa; GALAS, Filomena Regina Barbosa Gomes
    OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.