FELIPE YU MATSUSHITA
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Early fluid overload is associated with mortality and prolonged mechanical ventilation in extremely low birth weight infants(2020) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; FERRARO, Alexandre Archanjo; CARVALHO, Werther Brunow deRecent studies revealed that fluid overload is associated with higher mortality in critically ill children and adults. This study aimed to evaluate the association between fluid overload in the first 3 days of life and mortality in extremely low birth weight infants. This single-center retrospective cohort study included two hundred nineteen newborns with birth weight less than 1000 g who were admitted to the neonatal intensive care between January 2012 and December 2017. Overall mortality was 32.4%, the median gestational age was 27.3 (26.1-29.4) weeks, and birth weight was 770 (610-900) grams. In the group with severe fluid overload, we found a higher rate of deaths (72.2%); mean airway pressure was significantly higher and with longer invasive mechanical ventilation necessity. Conclusion: Early fluid overload in extremely low birth weight infants is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration in the first 7 days of life.What is Known:center dot Fluid overload is associated with a higher mortality rate and prolonged mechanical ventilation in children and adults.What is New:center dot Fluid overload in the first 72 h of life in an extremely premature infant is associated with higher mortality rate, higher mean airway pressure in invasive mechanically ventilated patients, and longer mechanical ventilation duration the first 7 days of life.
- Identifying clinical phenotypes in extremely low birth weight infants-an unsupervised machine learning approach(2022) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow deThere is increasing evidence that patient heterogeneity significantly hinders advancement in clinical trials and individualized care. This study aimed to identify distinct phenotypes in extremely low birth weight infants. We performed an agglomerative hierarchical clustering on principal components. Cluster validation was performed by cluster stability assessment with bootstrapping method. A total of 215 newborns (median gestational age 27 (26-29) weeks) were included in the final analysis. Six clusters with different clinical and laboratory characteristics were identified: the ""Mature"" (Cluster 1; n= 60, 27.9%), the mechanically ventilated with ""adequate ventilation"" (Cluster 2; n=40, 18.6%), the mechanically ventilated with ""poor ventilation"" (Cluster 3; n=39, 18.1%), the ""extremely immature"" (Cluster 4; n= 39, 18.1%%), the neonates requiring ""Intensive Resuscitation"" in the delivery room (Cluster 5; n=20, 9.3%), and the ""Early septic"" group (Cluster 6; n= 17, 7.9%). In-hospital mortality rates were 11.7%, 25%, 56.4%, 61.5%, 45%, and 52.9%, while severe intraventricular hemorrhage rates were 1.7%, 5.3%, 29.7%, 47.2%, 44.4%, and 28.6% in clusters 1, 2, 3, 4, 5, and 6, respectively (p<0.001). Conclusion: Our cluster analysis in extremely preterm infants was able to characterize six distinct phenotypes. Future research should explore how better phenotypic characterization of neonates might improve care and prognosis.
- Neonatal Hypotension: What Is the Efficacy of Each Anti-Hypotensive Intervention? A Systematic Review(2019) MATSUSHITA, F.Y.; KREBS, V.L.J.; CARVALHO, W.B. dePurpose of review: There is no consensus in the treatment of hemodynamic instability in the preterm newborn. Blood pressure is one of the few measurable objective parameters for hemodynamic evaluation in this population. However, little is known about the efficacy of anti-hypotensive treatments in newborns. The objective of this review is to identify and analyze the efficacy of a given anti-hypotensive intervention in improving the hypotensive preterm newborn. Recent findings: With the increase in survival of the preterm newborns, there was an augmentation in the interest for the treatment of hypotension in this population. However, as there are doubts regarding the efficacy in anti-hypotensive treatment, new drugs are being used to reverse the hypotensive state in preterm infants: epinephrine, norepinephrine, vasopressin, and steroids. Summary: We have identified that classically used medications in the treatment of hypotension have little evidence of efficacy in rescuing the preterm infant from the hypotensive state. New therapies are emerging with potential benefits, especially in refractory hypotension such as epinephrine and norepinephrine, but more prospective studies are needed. Literature review should be careful, considering the definition used for hypotension, the time of onset, the intravascular volume status of each patient, and if the drug was used as a first or second line of treatment. © 2019, Springer Nature Switzerland AG.
- Living better or living longer? Perceptions of patients and health care professionals in oncology(2015) TOLOI, Diego de Araujo; CRITCHI, Gabriela; MANGABEIRA, Andrea; MATSUSHITA, Felipe; RIECHELMANN, Rachel P.; HOFF, Paulo M.; SAAD, Everardo D.Background: Cancer can influence the views of patients on treatment goals and make them different from those of health care professionals (HCPs). It is crucial to understand patient expectations regarding cancer treatment. Methods: We performed a cross-sectional survey of patients with cancer and HCPs to evaluate their perceptions about treatment priorities and to analyse variables that might influence their opinions. To identify treatment choices, we interviewed all participants using a structured questionnaire with fictitious case vignettes. Results: We enrolled a total of 230 participants, including 144 patients and 86 HCPs (35 nurses, 21 physicians, 30 others). Treatment priority between survival time (28.5% for patients vs. 8.1% for HCP) and quality of life (45.8% vs. 87.2%) differed significantly, with the remaining participants stating they were uncertain or unwilling to respond, or providing invalid responses (P < 0.01). In logistic regression, prioritising survival time was more frequent in patients, adjusting for age and gender (odds ratio (OR) = 3.95; P < 0.01). The view that the physician alone should be responsible for treatment choices was more frequent among patients than HCPs (18.8 vs. 5.8%; P = 0.01). Conclusions: In Brazil, our results suggest that survival time is more important for patients with cancer than for HCPs, whereas quality of life is more important for HCPs than for patients with cancer, who place great emphasis on physicians as decision-makers. Given that Brazilian patients often rely on physicians for decisions, the potential impact of different priorities between survival time and quality of life when patients and HCPs are compared is unknown.
- Artificial intelligence and machine learning in pediatrics and neonatology healthcare(2022) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow de
- Association between ventilatory settings and pneumothorax in extremely preterm neonates(2021) MATSUSHITA, Felipe Y.; KREBS, Vera L. J.; CARVALHO, Werther B. deOBJECTIVES: Pneumothorax is a catastrophic event associated with high morbidity and mortality, and it is relatively common in neonates. This study aimed to investigate the association between ventilatory parameters and the risk of developing pneumothorax in extremely low birth weight neonates. METHODS: This single-center retrospective cohort study analyzed 257 extremely low birth weight neonates admitted to a neonatal intensive care unit between January 2012 and December 2017. A comparison was carried out to evaluate the highest value of positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), and driving pressure (DP) in the first 7 days of life between neonates who developed pneumothorax and those who did not. The primary outcome was pneumothorax with chest drainage necessity in the first 7 days of life. A matched control group was created in order to adjust for cofounders associated with pneumothorax (CRIB II score, birth weight, and gestational age). RESULTS: There was no statistically significant difference in PEEP, PIP, and DP values in the first 7 days of life between extremely low birth weight neonates who had pneumothorax with chest drainage necessity and those who did not have pneumothorax, even after adjusting for potential cofounders. CONCLUSIONS: Pressure-related ventilatory settings in mechanically ventilated extremely low birth weight neonates are not associated with a higher risk of pneumothorax in the first 7 days of life.
- Validation of questionnaire on the Spiritual Needs Assessment for Patients (SNAP) questionnaire in Brazilian Portuguese(2016) TOLOI, Diego de Araujo; UEMA, Deise; MATSUSHITA, Felipe; ANDRADE, Paulo Antonio da Silva; BRANCO, Tiago Pugliese; CHINO, Fabiana Tomie Becker de Carvalho; GUERRA, Raquel Bezerra; PFIFFER, Tulio Eduardo Flesch; CHIBA, Toshio; GUINDALINI, Rodrigo Santa Cruz; SULMASY, Daniel P.; RIECHELMANN, Rachel P.Objectives: Spirituality is related to the care and the quality of life of cancer patients. Thus, it is very important to assess their needs. The objective of this study was the translation and cultural adjustment of the Spiritual Needs Assessment for Patients ( SNAP) questionnaire to the Brazilian Portuguese language. Methodology: The translation and cultural adjustment of the SNAP questionnaire involved six stages: backtranslation, revision of backtranslation, translation to the original language and adjustments, pre-test on ten patients, and test and retest with 30 patients after three weeks. Adult patients, with a solid tumour and literate with a minimum of four years schooling were included. For analysis and consistency we used the calculation of the Cronbach alpha coefficient and the Pearson linear correlation. Results: The final questionnaire had some language and content adjustments compared to the original version in English. The correlation analysis of each item with the total score of the questionnaire showed coefficients above 0.99. The calculation of the Cronbach alpha coefficient was 0.9. The calculation of the Pearson linear correlation with the test and retest of the questionnaire was equal to 0.95. Conclusion: The SNAP questionnaire translated into Brazilian Portuguese is adequately reliable and consistent. This instrument allows adequate access to spiritual needs and can help patient care.
- Gray zone: mortality profile of newborns at the limit of viability(2019) CARVALHO, Werther Brunow de; MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada
- Association between Serum Lactate and Morbidity and Mortality in Neonates: A Systematic Review and Meta-Analysis(2023) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow DeObjective: Lactate is a marker of hypoperfusion in critically ill patients. Whether lactate is useful for identifying and stratifying neonates with a higher risk of adverse outcomes remains unknown. This study aimed to investigate the association between lactate and morbidity and mortality in neonates. Methods: A meta-analysis was performed to determine the association between blood lactate levels and outcomes in neonates. Ovid MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched from inception to 1 May 2021. A total of 49 observational studies and 14 data accuracy test studies were included. The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the QUADAS-2 tool for data accuracy test studies. The primary outcome was mortality, while the secondary outcomes included acute kidney injury, necessity for renal replacement therapy, neurological outcomes, respiratory morbidities, hemodynamic instability, and retinopathy of prematurity. Results: Of the 3184 articles screened, 63 studies fulfilled all eligibility criteria, comprising 46,069 neonates. Higher lactate levels are associated with mortality (standard mean difference, -1.09 [95% CI, -1.46 to -0.73]). Using the estimated sensitivity (0.769) and specificity (0.791) and assuming a prevalence of 15% for adverse outcomes (median of prevalence among studies) in a hypothetical cohort of 10,000 neonates, assessing the lactate level alone would miss 346 (3.46%) cases (false negative) and wrongly diagnose 1776 (17.76%) cases (false positive). Conclusions: Higher lactate levels are associated with a greater risk of mortality and morbidities in neonates. However, our results do not support the use of lactate as a screening test to identify adverse outcomes in newborns. Research efforts should focus on analyzing serial lactate measurements, rather than a single measurement.
- Association between fluid overload and mortality in newborns: a systematic review and meta-analysis(2022) MATSUSHITA, Felipe Yu; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow deFluid overload (FO) is associated with higher rates of mortality and morbidity in pediatric and adult populations. The aim of this systematic review and meta-analysis was to investigate the association between FO and mortality in critically ill neonates. Systematic search of Ovid MEDLINE, EMBASE, Cochrane Library, trial registries, and gray literature from inception to January 2021. We included all studies that examined neonates admitted to neonatal intensive care units and described FO and outcomes of interest. We identified 17 observational studies with a total of 4772 critically ill neonates who met the inclusion criteria. FO was associated with higher mortality (OR, 4.95 [95% CI, 2.26-10.87]), and survivors had a lower percentage of FO compared with nonsurvivors (WMD, - 4.33 [95% CI, - 8.34 to - 0.32]). Neonates who did not develop acute kidney injury (AKI) had lower FO compared with AKI patients (WMD, - 2.29 [95% CI, - 4.47 to - 0.10]). Neonates who did not require mechanical ventilation on postnatal day 7 had lower fluid balance (WMD, - 1.54 [95% CI, - 2.21 to - 0.88]). FO is associated with higher mortality, AKI, and need for mechanical ventilation in critically ill neonates in the intensive care unit. Strict control of fluid balance to prevent FO is essential.