CLAUDIA MARQUEZ SIMOES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
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- A pragmatic multi-center trial of goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery(2017) MALBOUISSON, Luiz Marcelo Sa; SILVA JR., Joao Manoel; CARMONA, Maria Jose Carvalho; LOPES, Marcel Rezende; ASSUNCAO, Murilo Santucci; VALIATTI, Jorge Luis dos Santos; SIMOES, Claudia Marques; AULER JR., Jose Otavio CostaBackground: Intraoperative fluid therapy guided by mechanical ventilation-induced pulse-pressure variation (PPV) may improve outcomes after major surgery. We tested this hypothesis in a multi-center study. Methods: The patients were included in two periods: a first control period (control group; n = 147) in which intraoperative fluids were given according to clinical judgment. After a training period, intraoperative fluid management was titrated to maintain PPV < 10% in 109 surgical patients (PPV group). We performed 1:1 propensity score matching to ensure the groups were comparable with regard to age, weight, duration of surgery, and type of operation. The primary endpoint was postoperative hospital length of stay. Results: After matching, 84 patients remained in each group. Baseline characteristics, surgical procedure duration and physiological parameters evaluated at the start of surgery were similar between the groups. The volume of crystalloids (4500 mL [3200-6500 mL] versus 5000 mL [3750-8862 mL]; P = 0.01), the number of blood units infused during the surgery (1.7 U [0.9-2.0 U] versus 2.0 U [1.7-2.6 U]; P = 0.01), the fraction of patients transfused (13.1% versus 32.1%; P = 0.003) and the number of patients receiving mechanical ventilation at 24 h (3.2% versus 9.7%; P = 0.027) were smaller postoperatively in PPV group. Intraoperative PPV-based improved the composite outcome of postoperative complications OR 0.59 [95% CI 0.35-0.99] and reduced the postoperative hospital length of stay (8 days [6-14 days] versus 11 days [7-18 days]; P = 0.01). Conclusions: In high-risk surgeries, PPV-directed volume loading improved postoperative outcomes and decreased the postoperative hospital length of stay.
- First Brazilian pediatric hospital to adopt 1-hour preoperative fasting time for clear fluids for elective surgeries(2021) CARDOSO, Priscilla Ferreira Neto; QUINTAO, Vinicius Caldeira; PERINI, Bruno; CARMONA, Maria Jose Carvalho; CARLOS, Ricardo Vieira; SIMOES, Claudia Marquez
- A Brazilian national preparedness survey of anesthesiologists during the coronavirus pandemic(2021) QUINTAO, Vinicius Caldeira; SIMOES, Claudia Marquez; MUNOZ, Gibran Elias Harcha; BARACH, Paul; CARMONA, Maria Jose Carvalho
- Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study(2020) TONELOTTO, Bruno; PEREIRA, Sergio Martins; TUCCI, Mauro Roberto; VAZ, Diogo Florenzano; VIEIRA, Joaquim Edson; MALBOUISSON, Luiz Marcelo; GAY, Frederick; SIMOES, Claudia Marquez; CARMONA, Maria Jose Carvalho; MONSEL, Antoine; AMATO, Marcelo Brito; ROUBY, Jean-Jacques; JR, Jose Otavio Costa AulerIntroduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4 cmH(2)O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4 cmH(2)O to 10 (8, 13) at PEEP 20 cmH(2)O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p = 0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.