PEDRO CARUSO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
Agora exibindo 1 - 7 de 7
- ICU Architectural Design Affects the Delirium Prevalence: A Comparison Between Single-Bed and Multibed Rooms(2014) CARUSO, Pedro; GUARDIAN, Lilian; TIENGO, Tatiane; SANTOS, Lucio Souza dos; MEDEIROS JUNIOR, PedroObjectives: Delirium risk factors are related to the patients' acute and chronic clinical condition, treatment, and environment. The environmental risk factors are essentially determined by the ICU architectural design. Although there are countless architectural variations among the ICUs, all can be classified as single-or multibed rooms. Our objectives were to compare the ICU delirium prevalence and characteristics (coma/delirium-free days, first day in delirium, and delirium motoric subtypes) of critically ill patients admitted in single-or multibed rooms. Design: Retrospective. Setting: ICU of a teaching oncologic hospital with 31 beds. Twenty-three beds distributed in one multibed room with 13 beds and other with 10 beds. Eight beds distributed in single-bed rooms. Patients: All adult patients admitted from February to November 2011. Interventions: None. Measurements and Main Results: We evaluated 1,587 patients and included 1,253 patients. Patients' characteristics at ICU admission and their outcomes along the ICU stay were not different between patients admitted in single-or multibed rooms. One hundred sixty-three patients (13.0%) had delirium, and the prevalence was significantly lower in patients admitted in single-bed rooms (6.8% x 15.1%; p < 0.01). This lower prevalence occurred in patients admitted due to a medical (11.0% x 25.6%; p < 0.01) or postoperative (5.0% x 11.4%; p < 0.01) reason. However, the coma/ delirium-free days, the first day in delirium, and the delirium motoric subtypes were not different between the single-and multibed rooms. The risk factors associated with delirium were admission in multibed rooms (odds ratio, 4.03; 95% CI, 2.13-7.62), older age, ICU-acquired infection, and higher Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment score. Conclusions: Critically ill patients admitted in single-bed rooms have a lower prevalence of delirium than those admitted in multibed rooms. However, coma/delirium-free days, first day in delirium, and motoric subtypes were not different.
- Accuracy of Invasive and Noninvasive Parameters for Diagnosing Ventilatory Overassistance During Pressure Support Ventilation*(2018) PLETSCH-ASSUNCAO, Renata; PEREIRA, Mayra Caleffi; FERREIRA, Jeferson George; CARDENAS, Leticia Zumpano; ALBUQUERQUE, Andre Luis Pereira de; CARVALHO, Carlos Roberto Ribeiro de; CARUSO, PedroObjective: Evaluate the accuracy of criteria for diagnosing pressure overassistance during pressure support ventilation. Design: Prospective clinical study. Setting: Medical-surgical ICU. Patients: Adults under mechanical ventilation for 48 hours or more using pressure support ventilation and without any sedative for 6 hours or more. Overassistance was defined as the occurrence of work of breathing less than 0.3 J/L or 10% or more of ineffective inspiratory effort. Two alternative overassistance definitions were based on the occurrence of inspiratory esophageal pressure-time product of less than 50 cm H2O s/min or esophageal occlusion pressure of less than 1.5 cm H2O. Interventions: The pressure support was set to 20 cm H2O and decreased in 3-cm H2O steps down to 2 cm H2O. Measurements and Main Results: The following parameters were evaluated to diagnose overassistance: respiratory rate, tidal volume, minute ventilation, peripheral arterial oxygen saturation, rapid shallow breathing index, heart rate, mean arterial pressure, change in esophageal pressure during inspiration, and esophageal and airway occlusion pressure. In all definitions, the respiratory rate had the greatest accuracy for diagnosing overassistance (receiver operating characteristic area = 0.92; 0.91 and 0.76 for work of breathing, pressure-time product and esophageal occlusion pressure in definition, respectively) and always with a cutoff of 17 incursions per minute. In all definitions, a respiratory rate of less than or equal to 12 confirmed overassistance (100% specificity), whereas a respiratory rate of greater than or equal to 30 excluded overassistance (100% sensitivity). Conclusion: A respiratory rate of 17 breaths/min is the parameter with the greatest accuracy for diagnosing overassistance. Respiratory rates of less than or equal to 12 or greater than or equal to 30 are useful clinical references to confirm or exclude pressure support overassistance.
- Procalcitonin Clearance and Prognosis in Sepsis: Are There Really an Optimal Cutoff and Time Interval?(2017) VITORIO, Daniel; NASSAR JR., Antonio Paulo; CARUSO, Pedro
- Outcomes of Cancer Patients Discharged From ICU After a Decision to Forgo Life-Sustaining Therapies(2019) PRACA, Ana P. A.; JR, Antonio P. Nassar; CARUSO, PedroObjectives: Many cancer patients are admitted to an ICU and decisions to forgo life-sustaining therapies are frequent during ICU stay. A significant proportion of these patients are subsequently discharged from ICU, but their outcomes are unknown. Design: Retrospective. Setting: ICU of oncological hospital. Patients: Adult cancer patients admitted to ICU, then with a decision to forgo life-sustaining therapies and that were discharged from ICU. Interventions: None. Measurements and Main Results: Hospital mortality, long-term survival, recommencement of cancer treatment, and ICU readmission were recorded. Hospital mortality predictors were evaluated. The propensity score method was used to test the hypothesis that decision to forgo life-sustaining therapies was independently associated with hospital mortality. Among the 16,998 patients that were admitted to ICU, in 1,369 patients (8.1%) a decision to forgo life-sustaining therapies was made during ICU stay. Among the latter group, 507 were discharged from ICU and were examined in this study. The hospital mortality of this group was 80.1% and was independently predicted according to the occurrence of delirium or acute kidney injury during their ICU stay. Six-month and 12-month survival rates were 3.6% and 0.6%. Sixty-four patients (12.6%) resumed cancer treatment and had a longer survival (p < 0.01). Fifty-two patients (10.3%) were readmitted to ICU and had a longer survival (p < 0.01). The decision to forgo life-sustaining therapies was associated with higher hospital mortality (80.0% vs 26.3%, respectively; p < 0.01) and lower rates of survival (p < 0.01). Conclusions: Approximately 20% of cancer patients discharged from our ICU after a decision to forgo life-sustaining therapies were discharged from hospital. Delirium and acute kidney injury during ICU stay were predictors of hospital mortality. The decision to forgo life-sustaining therapies was independently associated with hospital mortality. Patients readmitted to the ICU and those that resumed cancer treatment had longer survival. Knowledge of these outcomes is important for providing proper therapeutic planning and counseling for patients and their relatives.
- Delirium During Critical Illness and Subsequent Change of Treatment in Patients With Cancer: A Mediation Analysis(2024) VIZZACCHI, Barbara A.; DETTINO, Aldo L. A.; BESEN, Bruno A. M. P.; CARUSO, Pedro; JR, Antonio P. NassarOBJECTIVES: To assess whether delirium during ICU stay is associated with subsequent change in treatment of cancer after discharge.DESIGN: Retrospective cohort study.SETTING: A 50-bed ICU in a dedicated cancer center.PATIENTS: Patients greater than or equal to 18 years old with a previous proposal of cancer treatment (chemotherapy, target therapy, hormone therapy, immunotherapy, radiotherapy, oncologic surgery, and bone marrow transplantation).INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: We considered delirium present if Confusion Assessment Method for the ICU was positive. We assessed the association between delirium and modification of the treatment after discharge. We also performed a mediation analysis to assess both the direct and indirect (i.e., mediated by the development of functional dependence after discharge) of delirium on modification of cancer treatment and whether the modification of cancer treatment was associated with mortality at 1 year. We included 1,134 patients, of whom, 189 (16.7%) had delirium. Delirium was associated with the change in cancer treatment (adjusted odds ratio [OR], 3.80; 95% CI, 2.72-5.35). The association between delirium in ICU and change of treatment was both direct and mediated by the development of functional dependence after discharge. The proportion of the total effect of delirium on change of treatment mediated by the development of functional dependence after discharge was 33.0% (95% CI, 21.7-46.0%). Change in treatment was associated with increased mortality at 1 year (adjusted OR, 2.68; 95% CI, 2.01-3.60).CONCLUSIONS: Patients who had delirium during ICU stay had a higher rate of modification of cancer treatment after discharge. The effect of delirium on change in cancer treatment was only partially mediated by the development of functional dependence after discharge. Change in cancer treatment was associated with increased 1-year mortality.
- Prognostication of Critically Ill Patients With Cancer: A Long Road Ahead(2017) CARUSO, Pedro