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
4 resultados
Resultados de Busca
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- 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.
- Lactate and base deficit are predictors of mortality in critically ill patients with cancer(2011) HAJJAR, Ludhmila Abrahao; NAKAMURA, Rosana Ely; ALMEIDA, Juliano Pinheiro de; FUKUSHIMA, Julia T.; HOFF, Paulo Marcelo Gehm; VINCENT, Jean-Louis; AULER JUNIOR, Jose Otavio Costa; GALAS, Filomena Regina Barbosa GomesOBJECTIVE: Cancer patients frequently require admission to intensive care unit. However, there are a few data regarding predictive factors for mortality in this group of patients. The aim of this study was to evaluate whether arterial lactate or standard base deficit on admission and after 24 hours can predict mortality for patients with cancer. METHODS: We evaluated 1,129 patients with severe sepsis, septic shock, or postoperative after high-risk surgery. Lactate and standard base deficit collected at admission and after 24 hours were compared between survivors and non-survivors. We evaluated whether these perfusion markers are independent predictors of mortality. RESULTS: There were 854 hospital survivors (76.5%). 24 h lactate > 1.9 mmol/L and standard base deficit < -2.3 were independent predictors of intensive care unit mortality. 24 h lactate > 1.9 mmol/L and 24 h standard base deficit, -2.3 mmol/Lwere independent predictors of hospital death. CONCLUSION: Our findings suggest that lactate and standard base deficit measurement should be included in the routine assessment of patients with cancer admitted to the intensive care unit with sepsis, septic shock or after high-risk surgery. These markers may be useful in the adequate allocation of resources in this population.
- 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 GomesOBJECTIVE: 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.
- Thrombolysis treatment for submassive pulmonary thromboembolism in patients with cancer: a safe therapeutic tool(2011) ALMEIDA, Juliano Pinheiro de; GALAS, Filomena Regina Barbosa Gomes; KALIL FILHO, Roberto; NAKAMURA, Rosana Ely; NAGAOKA, Daniele; HAJJAR, Ludhmila Abrahao