JULIANO PINHEIRO DE ALMEIDA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
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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.conferenceObject Evaluation of Late Cardiotoxicity in Lymphoma Survivors(2017) LIGUORI, Thiago; GALAS, Filomena R.; SANTOS, Marilia H.; ALMEIDA, Juliano P. de; FUKUSHIMA, Julia T.; MENEGUETTI, Claudio; PEREIRA, Juliana; BELESSO, Marcelo; ROCHA, Wanderson; HAJJAR, Ludhmila A.- 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.
- 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.
- Bronchial Injury and Pneumothorax after Reintubation using an Airway Exchange Catheter(2013) ALMEIDA, Juliano P. de; HAJJAR, Ludhmila A.; FUKUSHIMA, Julia T.; NAKAMURA, Rosana E.; ALBERTINI, Rodolfo; GALAS, Filomena R. B. G.Background and objectives: We report a case of pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC) in a patient with a head and neck cancer. Case report: A 53 year old man with oropharynx carcinoma was admitted to ICU for severe pneumonia and severe acute respiratory distress syndrome (ARDS). The patient was recognized as a difficult-to-intubate patient and an endotracheal tube (Err) was inserted through a bronchoscope. After one week of treatment, it was observed an endotracheal cuff perforation. Exchanging the endotracheal tube was necessary to achieve satisfactory pulmonary ventilation. An AEC Cook 14 was used to perform the reintubation. After reintubation, the patient presented a worsening in oxygen saturation and a chest radiography (CXR) revealed a large pneumothorax. A chest tube was inserted and we observed immediate improvement in oxygen saturation. A repeat CXR confirmed correct positioning of the chest tube and reexpansion of the right lung. A bronchoscopy performed showed a posterior laceration in the right main bronchus. The patient was extubated the following day. After four days, the chest tube was removed. A CXR performed a day after chest tube removal revealed a small right upper pneumothorax, but the patient remained asymptomatic. Conclusions: Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma - caused by oxygen supplement or jet ventilation through AEC - concern for insertion technique can minimize life threatening complications and increase the safety of AEC.
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.- Liberal Transfusion Practice or Perioperative Treatment of Anemia to Avoid Transfusion? Reply(2015) VINCENT, Jean-Louis; HAJJAR, Ludhmila A.; ALMEIDA, Juliano Pinheiro de
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- Vasopressin versus Norepinephrine after Cardiopulmonary Bypass Reply(2018) HAJJAR, Ludhmila A.; ALMEIDA, Juliano P.; GALAS, Filomena R. B. G.
- Routine Preoperative Intra-Aortic Balloon Pump: Shooting in the Dark Reply(2019) HAJJAR, Ludhmila A.; ALMEIDA, Juliano P. de; LANDONI, Giovanni