MAURO ROBERTO TUCCI

(Fonte: Lattes)
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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    The Use of the Oxygenation Stretch Index to Predict Outcomes in Mechanically Ventilated PatientsWith COVID-19 ARDS
    (2023) ROLDAN, Rollin; BARRIGA, Fernando; VILLAMONTE, Renan; ROMANI, Franco; TUCCI, Mauro; GONZALES, Arturo; WONG, Paolo; ZAGACETA, Jorge; BROCHARD, Laurent
    BACKGROUND: In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID- 19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (Delta P). METHODS: This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. RESULTS: Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, DP, and composite variables were tested: oxygenation stretch index (P-aO2 /F-IO2 divided by Delta P) and Delta P 3 4 + breathing frequency (f) (Delta P 3 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, Delta P, PaO2 /FIO2, Delta P 3 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, Delta P >= 14, P-aO2 / F-IO2 >= 152 mm Hg, Delta P x 4 + f >= 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. CONCLUSIONS: The oxygenation stretch index, which combines P-aO2 /F-IO2 and DP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
  • article 0 Citação(ões) na Scopus
    Intraoperative individualization of positive-end-expiratory pressure through electrical impedance tomography or esophageal pressure assessment: a systematic review and meta-analysis of randomized controlled trials
    (2024) ESPOSITO, Teresa; FREGONESE, Martina; MORETTINI, Giulio; CARBONI, Paloma; TARDIOLI, Cecilia; MESSINA, Antonio; VASCHETTO, Rosanna; CORTE, Francesco Della; VETRUGNO, Luigi; NAVALESI, Paolo; ROBERTIS, Edoardo De; AZZOLINA, Danila; PIRIYAPATSOM, Annop; TUCCI, Mauro R.; WRIGGE, Hermann; SIMON, Philipp; BIGNAMI, Elena; MAGGIORE, Salvatore M.; SIMONTE, Rachele; CAMMAROTA, Gianmaria
    Purpose This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment (intervention) vs. PEEP not tailored on EIT or Pes (control), in patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach.Methods PUBMED (R), EMBASE (R), and Cochrane Controlled Clinical trials register were searched for observational studies and RCTs from inception to the end of August 2022. Inclusion criteria were: RCTs comparing PEEP titrated on EIT/Pes assessment vs. PEEP not individualized on EIT/Pes and reporting intraoperative PaO2/FiO(2). Two authors independently extracted data from the enrolled investigations. Data are reported as mean difference and 95% confidence interval (CI).Results Six RCTs were included for a total of 240 patients undergoing general anesthesia for surgery, of whom 117 subjects in the intervention group and 123 subjects in the control group. The intraoperative mean PaO2/FiO(2) was 69.6 (95%CI 32.-106.4 ) mmHg higher in the intervention group as compared with the control group with 81.4% between-study heterogeneity (p < 0.01). However, at meta-regression, the between-study heterogeneity diminished to 44.96% when data were moderated for body mass index (estimate 3.45, 95%CI 0.78-6.11, p = 0.011).Conclusions In patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach, PEEP personalized by EIT or Pes allowed the achievement of a better intraoperative oxygenation compared to PEEP not individualized through EIT or Pes.