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
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- 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.
- SAPS 3 score as a predictive factor for postoperative referral to intensive care unit(2016) SILVA JR., Joao M.; ROCHA, Helder Marcus Costa; KATAYAMA, Henrique Tadashi; DIAS, Leandro Ferreira; PAULA, Mateus Barros de; ANDRAUS, Leusi Magda Romano; SILVA, Jose Maria Correa; MALBOUISSON, Luiz Marcelo SaBackground: Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. However, some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this. Methods: The study included patients undergoing intermediate-risk surgery with preoperative indication for ICU but who were taken to the ward postoperatively, because they appeared to be responding well. However, they required late ICU admission. ICU care and preoperative SAPS 3 score were evaluated. Palliative surgeries and patients readmitted to ICU were excluded. Results: The study included 100 patients, 27 % of whom had late postoperative admission to the ICU. The preoperative SAPS 3 score was higher (45.4 +/- 7.8 vs. 35.9 +/- 7.4, P < 0.001) in patients who required delayed admission to the ICU postoperatively. Furthermore, they had undergone longer surgery (4.2 +/- 1.9 vs. 2.7 +/- 1.5 h, P < 0.001), and a greater proportion were gastrointestinal surgeries (14.8 vs. 5.5 %, P = 0.03) and intraoperative transfusion (18.5 vs. 5.5 % P = 0.04). In multivariate analysis, preoperative SAPS 3 and surgery duration independently predicted postoperative ICU admission, respectively (OR 1.25; 95 % CI 1.1-1.4 and OR 3.33; 95 % CI 1.7-6.3). Conclusion: The identification of high-risk surgical patients is essential for proper treatment; time of surgery and preoperative SAPS 3 seem to provide a useful indication of risk and may help better to characterize patients undergoing intermediate-risk surgery that demand ICU care.
- SAPS 3 score as a predictive factor for postoperative referral to intensive care unit (vol 6, pg 42, 2016)(2016) SILVA JR., Joao M.; ROCHA, Helder Marcus Costa; KATAYAMA, Henrique Tadashi; DIAS, Leandro Ferreira; PAULA, Mateus Barros de; ANDRAUS, Leusi Magda Romano; SILVA, Jose Maria Correa; MALBOUISSON, Luiz Marcelo Sa