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
11 resultados
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- Trends in perioperative practices of high-risk surgical patients over a 10-year interval(2023) GOMES, Brenno Cardoso; LOBO, Suzana Margareth Ajeje; MALBOUISSON, Luiz Marcelo Sa; CHAVES, Renato Carneiro de Freitas; CORREA, Thiago Domingos; AMENDOLA, Cristina Prata; SILVA JUNIOR, Joao Manoel; BraSIS Res GrpIntroductionIn Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart.MethodsThe patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards.ResultsAfter matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery.ConclusionIn this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
conferenceObject A PRAGMATIC MULTI-CENTRE TRIAL ON INTRAOPERATIVE FLUID MANAGEMENT USING PULSE PRESSURE VARIATION IN HIGH-RISK PATIENTS(2014) MALBOUISSON, L. M. S.; SILVA JR., J. M.; CARMONA, M. J. C.; ASSUNCAO, M. C. S.; VALIATTI, J. L.; LOPES, M. R.; SIMOES, C. M.; MICHARD, E.; AULER JR., J. O. C.conferenceObject Meropenem extended infusion versus intermittent infusion against nosocomial MIC 4 mg/L strains to guarantee drug effectiveness by PK/PD approach in burn patients at the earlier period of septic shock(2021) MORALES JR., R.; KUPA, L. V. K.; VIANNA, K. B.; GARCIA, C. M.; SANTOS, V. J.; CAMPOS, E. V.; SILVA JR., J. M.; SILVA JR., E. M.; OLIVEIRA, T. C.; GOMEZ, D. S.; SANTOS, S. R. C. J.- Analgesic efficacy of erector spinae plane block versus paravertebral block in lung surgeries-A non-inferiority randomised controlled trial(2024) ANDRADE FILHO, Pedro Hilton de; PEREIRA, Victor Egypto; SOUSA, Daniel da Escossia Melo; COSTA, Ladyer da Gama; NUNES, Yuri Pinto; TAGLIALEGNA, Giovani; PAULA-GARCIA, Waynice Neiva de; SILVA, Joao ManoelBackground: Pain management plays an essential role in postoperative recovery after lung surgeries. The Erector Spinae Plane Block (ESPB) is a widely used regional anaesthesia technique; however, few clinical trials have compared this block to active control in thoracic surgeries. This study evaluated the non-inferiority of the analgesia provided by ESPB when compared to paravertebral block ( PVB) in lung surgeries. Methods: Randomised, active-controlled, blinded for patients and assessors, noninferiority trial. Patients who underwent unilateral lung surgeries were divided into two groups according to the regional anaesthesia technique-continuous ESPB or PVB at the T5 level. The primary outcome was to assess pain using a numerical rating scale (NRS) with a test of the interaction of three measures over 24 h postoperatively. An NRS score >= 7 was considered analgesia failure, and the prespecified non-inferiority margin was 10%. Results: In the interim analysis that terminated this study, 120 participants were enrolled. ESPB patients reported higher mean NRS general values over 24 h, 4.6 +/- 3.2 in the ESPB group versus 3.9 +/- 2.9 in the PVB group, with a difference of -0.67 (-15.2%) and 95%CI: -1.29 to -0.05 (p =.02), demonstrating not non-inferiority. In addition, the ESPB group presented higher NRS failure of analgesia over 24 h (p <.01) and required more postoperative opioids (p =.01 over 24 h). There was no difference in patient satisfaction between groups. Conclusion: This trial demonstrated that a continuous erector spinae plane block was not non-inferior to a continuous paravertebral block for analgesia after lung surgery but resulted in higher levels of postoperative pain and opioid consumption.
- 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.
conferenceObject Vancomycin dose adjustment against Gram-positive MIC 2 mg/L strains in critically ill adult burn patients by pharmacokinetic-pharmacodynamic approach(2021) MORALES JR., R.; KUPA, L. V. K.; SANTOS, V. J.; ROMANO, P.; OLIVEIRA, E. M.; CAMPOS, E. V.; SILVA JR., J. M.; SILVA JR., E. M.; GOMIDES, A. S.; GOMEZ, D. S.; SANTOS, S. R. C. J.- Measurements of I-FABP and citrulline in the postoperative period of non-cardiac surgeries with gastrointestinal complications: A prospective cohort observational study(2024) AJEJE, Eduarda Tebet; GANDOLFI, Joelma Villafanha; CAVALLARI, Vinicius; SILVA, Joao Manoel; CHAVES, Renato Carneiro de Freitas; BERGER-ESTILITA, Joana; LOBO, Suzana MargarethBackground: Acute Gastrointestinal Injury (AGI) is associated with adverse clinical outcomes, including increased mortality. We aimed to investigate the potential of citrulline and intestinal fatty acid binding protein (I-FABP) as biomarkers for early AGI diagnosis and predicting outcomes in surgical patients. Methods: Prospective cohort study involving patients who underwent non-cardiac surgeries and were admitted to Intensive Care Units. AGI diagnosis was based on specific criteria, and severity was categorised following established guidelines. Statistical analyses were performed to assess the diagnostic accuracy of the biomarkers and their association with outcomes, P significant when <0.05. Results: AGI was identified in 40.3% of patients with varying severity. Mortality rates were significantly higher in the AGI group in the ICU (19.4% vs. 0%, p = 0.001) and hospital (22.6% vs. 2.17%, p = 0.003). Urinary I-FABP levels on days 3 and 7 showed reasonable and good accuracy for AGI diagnosis (AUC 0.732 and 0.813, respectively). Urinary I-FABP levels on days 2 and 3 accurately predict sepsis. Urinary citrulline levels on day one predicted mortality (AUC 0.87) furthermore urinary I-FABP levels on day 2 showed reasonable accuracy (sensitivity 83.3%, specificity 92.4%). Conclusion: Urinary I-FABP and citrulline levels are promising diagnostic and prognostic markers in ICU patients following non-cardiac surgeries.
- Impact of Nutritional Management on Survival of Critically Ill Malnourished Patients with Refeeding Hypophosphatemia(2023) DOCK-NASCIMENTO, Diana Borges; RIBEIRO, Amanda Coelho; JR, Joao Manoel Silva; AGUILAR-NASCIMENTO, Jose Eduardo deBackground. Early nutritional therapy may aggravate hypophosphatemia in critically ill patients.Aim. To investigate the influence of the type nutritional therapy on the survival of critically-ill malnourished patients at refeeding hypophosphatemia risk.Methods. Retrospective cohort study including malnourished, critically-ill adults, ad-mitted from June 2014-December 2017 in an intensive care unit (ICU) at a tertiary hospital. Refeeding hypophosphatemia risk was defined as low serum phosphorus levels ( < 2.5 mg/dL) seen at two timepoints: before the initiation and at day 4 of the nutritional therapy. Patients receiving enteral nutrition (EN) were compared with those receiving supplemental parenteral nutrition (SPN-EN plus parenteral nutrition). Primary outcome was 60 d survival. Secondary endpoint was the incidence of refeeding hypophosphatemia risk.Results. We included 468-321 patients (68.6%) received EN and 147 (31.4%) received SPN. The mortality rate was 36.3% ( n = 170). Refeeding hypophosphatemia risk was found in 116 (24.8%) patients before and in 177 (37.8%) at day 4 of nutritional therapy. The 60 d mean survival probability was greater for patients receiving SPN both before (42.4 vs. 22.4%, p = 0.005) and at day 4 (37.4 vs. 25.8%, p = 0.014) vs. patients receiving EN at the same timepoints. Cox regression showed a hazard ratio of 3.3 and 2.4 for patients at refeeding hypophosphatemia risk before and at day 4 of EN, respectively, compared to the SPN group at the same timepoints.Conclusion. Refeeding hypophosphatemia risk was frequent in malnourished ICU pa-tients and the survival for patients receiving SPN seemed associated with better survival than EN only.(c) 2023 Instituto Mexicano del Seguro Social (IMSS).
- Response to ""Is really a continuous erector spinae plane block inferior to a continuous paravertebral block for pain control following lung surgery?""(2024) ANDRADE FILHO, Pedro Hilton de; SILVA, Joao Manoel