HO YEH LI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
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- Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1) virus infection(2011) TOUFEN JR., Carlos; COSTA, Eduardo Leite V.; HIROTA, Adriana Sayuri; LI, Ho Yeh; AMATO, Marcelo Brito Passos; CARVALHO, Carlos Roberto RibeiroBACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.
- Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study(2021) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno Adler Maccagnan Pinheiro; MALBOUISSON, Luiz Marcelo Sa; TANIGUCHI, Leandro Utino; MENDES, Pedro Vitale; COSTA, Eduardo Leite Vieira; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; SILVA-JR, Joao M.; CARMONA, Maria Jose Carvalho; CARVALHO, Carlos R. R.Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 +/- 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 +/- 1.3 mL/kg of ideal body weight, plateau pressure was 24 +/- 5 cmH(2)O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH(2)O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.
- Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in Sao Paulo, Brazil - study protocol(2020) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno A. M. P.; MALBUISSON, Luiz M. S.; TANIGUCHI, Leandro U.; V, Pedro Mendes; V, Eduardo L. Costa; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; JR, Joao M. Silva; CARMONA, Maria Jose C.; CARVALHO, Carlos Roberto RibeiroOBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials. gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
- Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves(2024) FREITAS, Daniela Helena Machado; COSTA, Eduardo Leite Vieira; ZIMMERMANN, Natalia Alcantara; GOIS, Larissa Santos Oliveira; ANJOS, Mirella Vittig Alves; LIMA, Felipe Gallego; ANDRADE, Pamela Santos; JOELSONS, Daniel; HO, Yeh-Li; SALES, Flavia Cristina Silva; SABINO, Ester Cerdeira; CARVALHO, Carlos Roberto Ribeiro; FERREIRA, Juliana Carvalho; NGAH, Veranyuy; REYES, Luis Felipe; REYES, Luis FelipeBackground The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. Methods This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). Results We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12). Conclusions In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.
- Phrenic Nerve Block and Respiratory Effort in Pigs and Critically Ill Patients with Acute Lung Injury(2022) PEREIRA, Sergio M.; SINEDINO, Bruno E.; V, Eduardo L. Costa; MORAIS, Caio C. A.; SKLAR, Michael C.; LIMA, Cristhiano Adkson Sales; NAKAMURA, Maria A. M.; RANZANI, Otavio T.; GOLIGHER, Ewan C.; TUCCI, Mauro R.; HO, Yeh-Li; TANIGUCHI, Leandro U.; VIEIRA, Joaquim E.; BROCHARD, Laurent; AMATO, Marcelo B. P.Background: Strong spontaneous inspiratory efforts can be difficult to control and prohibit protective mechanical ventilation. Instead of using deep sedation and neuromuscular blockade, the authors hypothesized that perineural administration of lidocaine around the phrenic nerve would reduce tidal volume (V-T) and peak transpulmonary pressure in spontaneously breathing patients with acute respiratory distress syndrome. Methods: An established animal model of acute respiratory distress syndrome with six female pigs was used in a proof-of-concept study. The authors then evaluated this technique in nine mechanically ventilated patients under pressure support exhibiting driving pressure greater than 15 cm H2O or V-T greater than 10 ml/kg of predicted body weight. Esophageal and transpulmonary pressures, electrical activity of the diaphragm, and electrical impedance tomography were measured in pigs and patients. Ultrasound imaging and a nerve stimulator were used to identify the phrenic nerve, and perineural lidocaine was administered sequentially around the left and right phrenic nerves. Results: Results are presented as median [interquartile range, 25th to 75th percentiles]. In pigs, V-T decreased from 7.4 ml/kg [7.2 to 8.4] to 5.9 ml/kg [5.5 to 6.6] (P < 0.001), as did peak transpulmonary pressure (25.8 cm H2O [20.2 to 27.2] to 17.7 cm H2O [13.8 to 18.8]; P < 0.001) and driving pressure (28.7 cm H2O [20.4 to 30.8] to 19.4 cm H2O [15.2 to 22.9]; P < 0.001). Ventilation in the most dependent part decreased from 29.3% [26.4 to 29.5] to 20.1% [15.3 to 20.8] (P < 0.001). In patients, V-T decreased (8.2 ml/ kg [7.9 to 11.1] to 6.0 ml/ kg [5.7 to 6.7]; P < 0.001), as did driving pressure (24.7 cm H2O [20.4 to 34.5] to 18.4 cm H2O [16.8 to 20.7]; P < 0.001). Esophageal pressure, peak transpulmonary pressure, and electrical activity of the diaphragm also decreased. Dependent ventilation only slightly decreased from 11.5% [8.5 to 12.6] to 7.9% [5.3 to 8.6] (P = 0.005). Respiratory rate did not vary. Variables recovered 1 to 12.7 h [6.7 to 13.7] after phrenic nerve block. Conclusions: Phrenic nerve block is feasible, lasts around 12 h, and reduces V-T and driving pressure without changing respiratory rate in patients under assisted ventilation.
- Caracterização de pacientes transportados com suporte respiratório e/ou cardiovascular extracorpóreo no Estado de São Paulo − Brasil(2018) LI, Ho Yeh; MENDES, Pedro Vitale; MELRO, Livia Maria Garcia; JOELSONS, Daniel; BESEN, Bruno Adler Maccagnan Pinheiro; COSTA, Eduardo Leite Viera; HIROTA, Adriana Sayuri; BARBOSA, Edzangela Vasconcelos Santos; FORONDA, Flavia Krepel; AZEVEDO, Luciano Cesar Pontes; ROMANO, Thiago Gomes; PARK, MarceloABSTRACT Objective: To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support. Methods: A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database. Results: From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84 (68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 - 82) km was traveled on each rescue mission during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three (2 - 3) physicians, and one (0 - 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis. Conclusions: Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.
- The impact of obesity in hospitalized patients with COVID-19: a retrospective cohort study(2024) CARRA, Fabio Alfano; MELO, Maria Edna de; STUMPF, Matheo A. M.; CERCATO, Cintia; FERNANDES, Ariana E.; MANCINI, Marcio C.; HIROTA, Adriana; KANASIRO, Alberto Kendy; CRESCENZI, Alessandra; FERNANDES, Amanda Coelho; MIETHKE-MORAIS, Anna; BELLINTANI, Arthur Petrillo; CANASIRO, Artur Ribeiro; CARNEIRO, Barbara Vieira; ZANBON, Beatriz Keiko; PINHEIRO, Bernardo; BATISTA, Senna Nogueira; NICOLAO, Bianca Ruiz; BESEN, Bruno Adler Maccagnan Pinheiro; BISELLI, Bruno; MACEDO, Bruno Rocha De; TOLEDO, Caio Machado Gomes De; CARVALHO, Carlos Roberto Ribeiro De; MOL, Caroline Gomes; STIPANICH, Cassio; BUENO, Caue Gasparotto; GARZILLO, Cibele; TANAKA, Clarice; FORTE, Daniel Neves; JOELSONS, Daniel; ROBIRA, Daniele; COSTA, Eduardo Leite Vieira; SILVA JUNIOR, Elson Mendes Da; REGALIO, Fabiane Aliotti; SEGURA, Gabriela Cardoso; LOURO, Giulia Sefrin; MARCELINO, Gustavo Brasil; HO, Yeh-Li; FERREIRA, Isabela Argollo; GOIS, Jeison Oliveira; SILVA-JR, Joao Manoel Da; JUNIOR, Jose Otto Reusing; RIBEIRO, Julia Fray; FERREIRA, Juliana Carvalho; GALLETI, Karine Vusberg; SILVA, Katia Regina; ISENSEE, Larissa Padrao; OLIVEIRA, Larissa Santos; TANIGUCHI, Leandro Utino; LETAIF, Leila Suemi; LIMA, Ligia Trombetta; PARK, Lucas Yongsoo; NETTO, Lucas Chaves; NOBREGA, Luciana Cassimiro; HADDAD, Luciana Bertocco Paiva; HAJJAR, Ludhmila Abrahao; MALBOUISSON, Luiz Marcelo Sa; PANDOLFI, Manuela Cristina Adsuara; PARK, Marcelo; CARMONA, Maria Jose Carvalho; ANDRADE, Maria Castilho Prandini H.; SANTOS, Mariana Moreira; BATELOCHE, Matheus Pereira; SUIAMA, Mayra Akimi; OLIVEIRA, Mayron Faria de; SOUSA, Mayson Laercio; GARCIA, Michelle Louvaes; HUEMER, Natassja; MENDES, Pedro Vitale; LINS, Paulo Ricardo Gessolo; SANTOS, Pedro Gaspar Dos; MOREIRA, Pedro Ferreira Paiva; GUAZZELLI, Renata Mello; REIS, Renato Batista Dos; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta Muriel Longo; PEDRO, Rodolpho Augusto Moura; KONDO, Rodrigo; RACHED, Samia Zahi; FONSECA, Sergio Roberto Silveira Da; BORGES, Thais Sousa; FERREIRA, Thalissa; JUNIOR, Vilson Cobello; SALES, Vivian Vieira Tenorio; FERREIRA, Willaby Serafim CassaBackground Obesity is believed to be a risk factor for COVID-19 and unfavorable outcomes, although data on this remains to be better elucidated.Objective To evaluate the impact of obesity on the endpoints of patients hospitalized due to SARS-CoV-2.Methods This retrospective cohort study evaluated patients hospitalized at a tertiary hospital (Hospital das Cl & iacute;nicas da Faculdade de Medicina da USP) from March to December 2020. Only patients positive for COVID-19 (real-time PCR or serology) were included. Data were collected from medical records and included clinical and demographic information, weight and height, SAPS-3 score, comorbidities, and patient-centered outcomes (mortality, and need for mechanical ventilation, renal replacement therapy, or vasoactive drugs). Patients were divided into categories according to their BMI (underweight, eutrophic, overweight and obesity) for comparison porpoise.Results A total of 2547 patients were included. The mean age was 60.3 years, 56.2% were men, 65.2% were white and the mean BMI was 28.1 kg/m(2). SAPS-3 score was a risk factor for all patient-centered outcomes (HR 1.032 for mortality, OR 1.03 for dialysis, OR 1.07 for vasoactive drug use, and OR 1.08 for intubation, p < 0.05). Male sex increased the risk of death (HR 1.175, p = 0.027) and dialysis (OR 1.64, p < 0.001), and underweight was protective for vasoactive drug use (OR 0.45, p = 0.027) and intubation (OR 0.31, p < 0.003).Conclusion Obesity itself was not an independent factor for worse patient-centered outcomes. Critical clinical state (indirectly evaluated by SAPS-3) appears to be the most important variable related to hard outcomes in patients infected with COVID-19.