JOAO MANOEL DA SILVA JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- Ventilation practices in burn patients-an international prospective observational cohort study(2021) GLAS, Gerie J.; HORN, Janneke; HOLLMANN, Markus W.; PRECKEL, Benedikt; COLPAERT, Kirsten; MALBRAIN, Manu; NETO, Ary Serpa; ASEHNOUNE, Karim; ABREU, Marcello Gamma de; MARTIN-LOECHES, Ignacio; PELOSI, Paolo; SJOBERG, Folke; BINNEKADE, Jan M.; CLEFFKEN, Berry; JUFFERMANS, Nicole P.; KNAPE, Paul; LOEF, Bert G.; MACKIE, David P.; ENKHBAATAR, Perenlei; DEPETRIS, Nadia; PERNER, Anders; HERRERO, Eva; CACHAFEIRO, Lucia; JESCHKE, Marc; LIPMAN, Jeffrey; LEGRAND, Matthieu; HORTER, Johannes; LAVRENTIEVA, Athina; KAZEMI, Alex; GUTTORMSEN, Anne Berit; HUSS, Frederik; KOL, Mark; WONG, Helen; STARR, Therese; CROP, Luc De; OLIVEIRA FILHO, Wilson de; SILVA JUNIOR, Joao Manoel; GRION, Cintia M. C.; BURNETT, Marjorie; MONDRUP, Frederik; RAVAT, Francois; FONTAINE, Mathieu; FLOCH, Renan Le; JEANNE, Mathieu; BACUS, Morgane; CHAUSSARD, Maite; LEHNHARDT, Marcus; MIKHAIL, Bassem Daniel; GILLE, Jochen; SHARKEY, Aidan; TROMMEL, Nicole; REIDINGA, Auke C.; VIELEERS, Nadine; TILSLEY, Anna; ONARHEIM, Henning; BOUZA, Maria Teresa; AGRIFOGLIO, Alexander; FREDEN, Filip; PALMIERI, Tina; PAINTING, Lynda E.; SCHULTZ, Marcus J.Background: It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from it. This study aimed to determine ventilation practices in burn intensive care units (ICUs) and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28 (VFD-28). Methods: This is an international prospective observational cohort study including adult burn patients requiring mechanical ventilation. Low tidal volume (V-T) was defined as V-T <= 8 mL/kg predicted body weight (PBW). Levels of positive end-expiratory pressure (PEEP) and maximum airway pressures were collected. The association between V-T and VFD-28 was analyzed using a competing risk model. Ventilation settings were presented for all patients, focusing on the first day of ventilation. We also compared ventilation settings between patients with and without inhalation trauma. Results: A total of 160 patients from 28 ICUs in 16 countries were included. Low V-T was used in 74% of patients, median V-T size was 7.3 [interquartile range (IQR) 6.2-8.3] mL/kg PBW and did not differ between patients with and without inhalation trauma (p= 0.58). Median VFD-28 was 17 (IQR 0-26), without a difference between ventilation with low or high V-T (p= 0.98). All patients were ventilated with PEEP levels >= 5 cmH(2)O; 80% of patients had maximum airway pressures <30 cmH(2)O. Conclusion: In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients, irrespective of the presence of inhalation trauma. Use of low V-T was not associated with a reduction in VFD-28.
- Outcomes comparison between the first and the subsequent SARS-CoV-2 waves - a systematic review and meta-analysis(2023) CALDONAZO, Tulio; TREML, Ricardo E.; VIANNA, Felipe S. L.; TASOUDIS, Panagiotis; KIROV, Hristo; MUKHARYAMOV, Murat; DOENST, Torsten; JR, Joao M. SilvaBackground: In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves.Methods: Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia.Results: A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences.Conclusions: The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in -hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator-associated pneumonia.
- Effect of restrictive cumulative fluid balance on 28-day survival in invasively ventilated patients with moderate to severe ARDS due to COVID-19(2023) TREML, Ricardo Esper; CALDONAZO, Tulio; HILTON FILHO, Pedro A.; MORI, Andreia L.; CARVALHO, Andre S.; SERRANO, Juliana S. F.; DALL-AGLIO, Pedro A. T.; RADERMACHER, Peter; JR, Joao Silva ManoelThis study aimed to evaluate the effect of two restrictive cumulative fluid balance (CFB) trends on survival and on major clinical outcomes in invasively ventilated patients with moderate to severe respiratory distress syndrome (ARDS) due to SARS-CoV-2. Prospective data collection was conducted on patients in the intensive care unit (ICU) originating from a tertiary university hospital. The primary outcomes were the risk association between the CFB trend during D0 to D7 and 28-day survival. The secondary outcomes were ICU mortality, in-hospital mortality, the need for invasive ventilation at D28, administration of vasoactive drugs at D7, time on invasive ventilation after D7, and length of ICU and hospital stay. 171 patients were enrolled in the study and divided according to their CFB trends during seven days of follow-up using model-based clustering [median CFB negative trend (n = 89) - 279 ml (- 664 to 203) and (n = 82) median CFB positive trend 1362 ml (619-2026)]. The group with CFB negative trend showed a higher chance of surviving 28-day in the ICU (HR: 0.62, 95% CI 0.41-0.94, p = 0.038). Moreover, this group had a reduced length of stay in the ICU, 11 (8-19) days versus 16.5 (9-29) days p = 0.004 and presented lower rates (OR = 0.22; 95% CI 0.09-0.52) of invasive ventilation after 28-days in the ICU. In patients invasively ventilated with moderate to severe ARDS due to COVID-19, the collective who showed a negative trend in the CFB after seven days of invasive ventilation had a higher chance of surviving 28 days in the ICU and lower length of stay in the ICU.
- Response of patients with acute respiratory failure caused by COVID-19 to awake-prone position out-side the intensive care unit based on pulmonary involvement(2021) SILVA JUNIOR, Joao Manoel; TREML, Ricardo Esper; GOLINELLI, Pamela Cristina; SEGUNDO, Miguel Rogerio de Melo Gurgel; MENEZES, Pedro Ferro L.; UMADA, Julilane Daniele de Almeida; ALVES, Ana Paula Santana; NABESHIMA, Renata Peres; CARVALHO, Andre dos Santos; PEREIRA, Talison Silas; SPONTON, Elaine SerafimOBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.
- Intraoperative fluid balance and cardiac surgery-associated acute kidney injury: a multicenter prospective study(2022) PALOMBA, Henrique; TREML, Ricardo E.; CALDONAZO, Tulio; KATAYAMA, Henrique T.; GOMES, Brenno C.; MALBOUISSON, Luiz M.S.; SILVA JUNIOR, João ManoelAbstract Background Recent data suggest the regime of fluid therapy intraoperatively in patients undergoing major surgeries may interfere in patient outcomes. The development of postoperative Acute Kidney Injury (AKI) has been associated with both Restrictive Fluid Balance (RFB) and Liberal Fluid Balance (LFB) during non-cardiac surgery. In patients undergoing cardiac surgery, this influence remains unclear. The study objective was to evaluate the relationship between intraoperative RFB vs. LFB and the incidence of Cardiac-Surgery-Associated AKI (CSA-AKI) and major postoperative outcomes in patients undergoing on-pump Coronary Artery Bypass Grafting (CABG). Methods This prospective, multicenter, observational cohort study was set at two high-complexity university hospitals in Brazil. Adult patients who required postoperative intensive care after undergoing elective on-pump CABG were allocated to two groups according to their intraoperative fluid strategy (RFB or LFB) with no intervention. Results The primary endpoint was CSA-AKI. The secondary outcomes were in-hospital mortality, cardiovascular complications, ICU Length of Stay (ICU-LOS), and Hospital LOS (H-LOS). After propensity score matching, 180 patients remained in each group. There was no difference in risk of CSA-AKI between the two groups (RR = 1.15; 95% CI, 0.85-1.56, p= 0.36). The in-hospital mortality, H-LOS and cardiovascular complications were higher in the LFB group. ICU-LOS was not significantly different between the two groups. ROCcurve analysis determined a fluid balance above 2500 mL to accurately predict in-hospital mortality. Conclusion Patients undergoing on-pump CABG with LFB when compared with patients with RFB present similar CSA-AKI rates and ICU-LOS, but higher in-hospital mortality, cardiovascular complications, and H-LOS.