JOAQUIM EDSON VIEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
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
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- Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study(2020) TONELOTTO, Bruno; PEREIRA, Sergio Martins; TUCCI, Mauro Roberto; VAZ, Diogo Florenzano; VIEIRA, Joaquim Edson; MALBOUISSON, Luiz Marcelo; GAY, Frederick; SIMOES, Claudia Marquez; CARMONA, Maria Jose Carvalho; MONSEL, Antoine; AMATO, Marcelo Brito; ROUBY, Jean-Jacques; JR, Jose Otavio Costa AulerIntroduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention. Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4 cmH(2)O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data. Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4 cmH(2)O to 10 (8, 13) at PEEP 20 cmH(2)O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p = 0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947. Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention.
conferenceObject Positive End-Expiratory Pressure (peep) Titration Using Electrical Impedance Tomography (eit) In Laparoscopic Surgery: Before Or During Pneumoperitoneum?(2017) PEREIRA, S. M.; TUCCI, M. R.; TONELOTTO, B. F. F.; SIMOES, C. M.; MORAIS, C. C. A.; POMPEO, M. S.; KAY, F. U.; CARVALHO, C. R. R.; VIEIRA, J. E.; AMATO, M. B. P.- 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.
- Individual Positive End-expiratory Pressure Settings Optimize Intraoperative Mechanical Ventilation and Reduce Postoperative Atelectasis(2018) PEREIRA, Sergio M.; TUCCI, Mauro R.; MORAIS, Caio C. A.; SIMOES, Claudia M.; TONELOTTO, Bruno F. F.; POMPEO, Michel S.; KAY, Fernando U.; PELOSI, Paolo; VIEIRA, Joaquim E.; AMATO, Marcelo B. P.Background: Intraoperative lung-protective ventilation has been recommended to reduce postoperative pulmonary complications after abdominal surgery. Although the protective role of a more physiologic tidal volume has been established, the added protection afforded by positive end-expiratory pressure (PEEP) remains uncertain. The authors hypothesized that a low fixed PEEP might not fit all patients and that an individually titrated PEEP during anesthesia might improve lung function during and after surgery. Methods: Forty patients were studied in the operating room (20 laparoscopic and 20 open-abdominal). They underwent elective abdominal surgery and were randomized to institutional PEEP (4 cm H2O) or electrical impedance tomography-guided PEEP (applied after recruitment maneuvers and targeted at minimizing lung collapse and hyperdistension, simultaneously). Patients were extubated without changing selected PEEP or fractional inspired oxygen tension while under anesthesia and submitted to chest computed tomography after extubation. Our primary goal was to individually identify the electrical impedance tomography-guided PEEP value producing the best compromise of lung collapse and hyperdistention. Results: Electrical impedance tomography-guided PEEP varied markedly across individuals (median, 12 cm H2O; range, 6 to 16 cm H2O; 95% CI, 10-14). Compared with PEEP of 4 cm H2O, patients randomized to the electrical impedance tomography-guided strategy had less postoperative atelectasis (6.2 +/- 4.1 vs. 10.8 +/- 7.1% of lung tissue mass; P = 0.017) and lower intraoperative driving pressures (mean values during surgery of 8.0 +/- 1.7 vs. 11.6 +/- 3.8 cm H2O; P < 0.001). The electrical impedance tomography-guided PEEP arm had higher intraoperative oxygenation (435 +/- 62 vs. 266 +/- 76 mmHg for laparoscopic group; P < 0.001), while presenting equivalent hemodynamics (mean arterial pressure during surgery of 80 +/- 14 vs. 78 +/- 15 mmHg; P = 0.821). Conclusions: PEEP requirements vary widely among patients receiving protective tidal volumes during anesthesia for abdominal surgery. Individualized PEEP settings could reduce postoperative atelectasis (measured by computed tomography) while improving intraoperative oxygenation and driving pressures, causing minimum side effects.
- Individualizing Intraoperative Ventilation: Reply(2019) TUCCI, Mauro R.; PEREIRA, Sergio M.; VIEIRA, Joaquim E.; AMATO, Marcelo B. P.