LEDA TOMIKO YAMADA DA SILVEIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina
SVFOFITO-62, Hospital Universitário
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
SVFOFITO-62, Hospital Universitário
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Functional status of patients readmitted to ICU(2013) SILVEIRA, Leda T. Y.; SILVA, Janete M.; MAFRA, Jose M. S.; RAMOS, Michele C. S.; TANAKA, Clarice; FU, Carolina- RECRUITMENT MANEUVER MIGHT BE AN OPTION FOR PATIENTS WITH HYPOXEMIA AND ATELECTASIS Reply(2019) MIURA, Mieko Claudia; CARVALHO, Carlos Roberto Ribeiro de; SILVEIRA, Leda Tomiko Yamada da; REGENGA, Marisa de Moraes; DAMIANI, Lucas Petri; FU, Carolina
- The effects of recruitment maneuver during noninvasive ventilation after coronary bypass grafting: A randomized trial(2018) MIURA, Mieko Claudia; CARVALHO, Carlos Roberto Ribeiro de; SILVEIRA, Leda Tomiko Yamada da; REGENGA, Marisa de Moraes; DAMIANI, Lucas Petri; FU, CarolinaObjective: Pulmonary impairment is a common complication after coronary artery bypass graft procedure and may be prevented or treated by noninvasive ventilation. Recruitment maneuvers include sustained airway pressure with high levels of positive end-expiratory pressure in patients with hypoxemia, favoring homogeneous pulmonary ventilation and oxygenation. This study aimed to evaluate whether noninvasive ventilation with recruitment maneuver could safely improve oxygenation in patients with atelectasis and hypoxemia who underwent a coronary artery bypass grafting procedure. Methods: Thirty-four patients admitted to our intensive care unit undergoing mechanical ventilation after surgery, with ratio of arterial oxygen partial pressure to fraction of inspired oxygen < 300 and radiologic atelectasis score >= 2, were included. The control group consisted of 16 randomized patients and the recruitment group consisted of 18 patients. After extubation, noninvasive ventilation was applied for 30 minutes 3 times a day with positive end-expiratory pressure of 8 cm H2O. The recruitment group received recruitment maneuver with positive end-expiratory pressure of 15 cm H2O and 20 cm H2O for 2 minutes each during noninvasive ventilation. We analyzed the arterial oxygen partial pressure in room air, radiologic atelectasis score, hemodynamic stability, and adverse events from extubation until discharge. Results: Arterial oxygen partial pressure increased 12.6% +/- 6.8 % in the control group and 23.3 % +/- 8.5 % in the recruitment group (P < .001). The radiologic atelectasis score was completely improved for 94.4% of the recruitment group with no adverse events, whereas 87.5 % of the control group presented some atelectasis (P < .001). Conclusions: Noninvasive ventilation with recruitment maneuvers is safe, improves oxygenation, and reduces atelectasis in patients undergoing coronary artery bypass.
- Decline in functional status after intensive care unit discharge is associated with ICU readmission: a prospective cohort study(2019) SILVEIRA, Leda Tomiko Yamada da; SILVA, Janete Maria da; TANAKA, Clarice; FU, CarolinaObjectives To compare the functional status at intensive care unit (ICU) discharge of patients who were later readmitted to the ICU and patients discharged home and to verify whether a decline in functional status is associated with ICU readmission. Design Prospective cohort study. Setting ICU at a tertiary teaching hospital. Participants Patients admitted to the ICU, >= 18 years old, submitted to invasive mechanical ventilation (IMV), and discharged to the ward. Interventions Functional assessment at ICU discharge. Discharge Group (DG) (patients discharged home) and Readmission Group (RG) (patients who returned to the ICU) were compared with Mann-Whitney and Chi-square or Exact Fisher tests. Multiple logistic regression verified association. Main outcome measures Barthel Index, key pinch strength, clinical and demographic data. Results Patients in the readmission group presented lower Barthel Index [Median 40 (IQR 20-75) vs 60 (33-83), P= 0.033], greater relative variation (pre and post ICU) of the Barthel Index (P = 0.04), lower key pinch strength [3.4 (1.8-4.5) vs 4.5 (2.7-6.8) kg.f, P = 0.006] and higher APACHE II [18 (12-22) vs 15 (11-20), P = 0.027]. Multiple regression found that the relative variation of the Barthel Index was independently associated with ICU readmission (P <0.001), as well as higher APACHE II (P=0.020), shorter IMV duration (P <0.001) and ICU admission without clear diagnosis (P= 0.020). The Hosmer-Lemeshow test indicated good adjustment of the model (P= 0.99). Conclusion Readmitted patients presented poorer functional status and lower pinch strength. Relative variation of the Barthel Index was associated with ICU readmission despite other factors, as was higher APACHE II, shorter IMV duration and admission without clear diagnosis.
- Effect of therapeutic Swedish massage on anxiety level and vital signs of Intensive Care Unit patients(2017) SILVA, Tatiana Alves da; SCHUJMANN, Debora Stripari; SILVEIRA, Leda Tomiko Yamada da; CAROMANO, Fatima Aparecida; FU, CarolinaObjective: To evaluate how Swedish massage affects the level of anxiety and vital signs of Intensive Care Unit (ICU) patients. Methods: Quasi-experimental study. Inclusion criteria: ICU patients, 18-50 years old, cooperative, respiratory and hemodynamic stable, not under invasive mechanical ventilation. Exclusion criteria: allergic to massage oil, vascular or orthopedic post-operative, skin lesions, thrombosis, fractures. A 30-min Swedish massage was applied once. Variables: arterial pressure, heart rate, respiratory rate, S-STAI questionnaire. Timing of evaluation: pre-massage, immediately post-massage, 30 min post-massage. Comparison: T-test, corrected by Bonferroni method, level of significance of 5%, confidence interval of 95%. Results: 48 patients included, 30 (62.5%) female, mean age 55.46 (15.70) years old. Mean S-STAI pre-massage: 42.51 (9.48); immediately post-massage: 29.34 (6.37); 30 min post-massage: 32.62 (8.56), p < 0.001 for all comparison. Mean vital signs achieved statistical significance between pre-massage and immediately post-massage. Conclusion: Swedish massage reduced anxiety of ICU patients immediately and 30 min post-massage. Vital signs were reduced immediately post-massage.
conferenceObject Postoperative pulmonary complications are associated to higher ICU cost(2013) ROTTA, Bruna Peruzzo; SILVA, Janete Maria da; PADOVANI, Caue; SILVEIRA, Leda Tomiko Yamada da; MARCELO, Jose; FU, Carolina; TANAKA, Clarice- Resposta para: Ventilação não invasiva com pressão positiva pós-extubação: características e desfechos na prática clínica(2016) YAMAUCHI, Liria Yuri; FIGUEIROA, Maise; SILVEIRA, Leda Tomiko Yamada da; TRAVAGLIA, Teresa Cristina Francischetto; BERNARDES, Sidnei; FU, Carolina
- Ventilação não invasiva com pressão positiva pós-extubação: características e desfechos na prática clínica(2015) YAMAUCHI, Liria Yuri; FIGUEIROA, Maise; SILVEIRA, Leda Tomiko Yamada da; TRAVAGLIA, Teresa Cristina Francischetto; BERNARDES, Sidnei; FU, CarolinaObjective: To describe postextubation noninvasive positive pressure ventilation use in intensive care unit clinical practice and to identify factors associated with noninvasive positive pressure ventilation failure.Methods:This prospective cohort study included patients aged ≥ 18 years consecutively admitted to the intensive care unit who required noninvasive positive pressure ventilation within 48 hours of extubation. The primary outcome was noninvasive positive pressure ventilation failure.Results:We included 174 patients in the study. The overall noninvasive positive pressure ventilation use rate was 15%. Among the patients who used noninvasive positive pressure ventilation, 44% used it after extubation. The failure rate of noninvasive positive pressure ventilation was 34%. The overall mean ± SD age was 56 ± 18 years, and 55% of participants were male. Demographics; baseline pH, PaCO2 and HCO3; and type of equipment used were similar between groups. All of the noninvasive positive pressure ventilation final parameters were higher in the noninvasive positive pressure ventilation failure group [inspiratory positive airway pressure: 15.0 versus 13.7cmH2O (p = 0.015), expiratory positive airway pressure: 10.0 versus 8.9cmH2O (p = 0.027), and FiO2: 41 versus 33% (p = 0.014)]. The mean intensive care unit length of stay was longer (24 versus 13 days), p < 0.001, and the intensive care unit mortality rate was higher (55 versus 10%), p < 0.001 in the noninvasive positive pressure ventilation failure group. After fitting, the logistic regression model allowed us to state that patients with inspiratory positive airway pressure ≥ 13.5cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure compared with individuals with inspiratory positive airway pressure < 13.5 (OR = 3.02, 95%CI = 1.01 - 10.52, p value = 0.040).Conclusion:The noninvasive positive pressure ventilation failure group had a longer intensive care unit length of stay and a higher mortality rate. Logistic regression analysis identified that patients with inspiratory positive airway pressure ≥ 13.5cmH2O on the last day of noninvasive positive pressure ventilation support are three times more likely to experience noninvasive positive pressure ventilation failure.
bookPart Trauma(2016) FU, Carolina; SCHUJMANN, Debora Stripari; SILVEIRA, Leda Tomiko Yamada da- Assessing functional status after intensive care unit stay: the Barthel Index and the Katz Index(2018) SILVEIRA, Leda Tomiko Yamada Da; SILVA, Janete Maria Da; SOLER, Julia Maria Pavan; SUN, Carolina Yea Ling; TANAKA, Clarice; FU, CarolinaObjective: To assess the functional status of post-ICU patients using the Barthel Index (BI) and the Katz Index (KI) and to assess which is more suitable for this population. Design: Retrospective longitudinal study. Setting: Public tertiary hospital in Sao Paulo (Brazil). Participants: Patients aged >= 18 years old, admitted to ICU, who were treated with mechanical ventilation (MV) >= 24 h and were discharged to ward. Exclusion criteria: Inability to answer the BI and the KI; limiting neurological or orthopaedic conditions; ICU stay >= 90 days. Patients transferred to or from other hospitals or who died in the wards were not analysed. Intervention: BI and KI were scored pre-ICU and post-ICU and the variation was calculated. Main Outcome Measures: BI and KI scores were compared using analysis based on item response theory (IRT), using degree of difficulty and discriminating items as parameters. Results: Median age was 52 years old, median APACHE II score was 15. Median ICU stay was 11 days and median MV duration was 4 days. BI variation was 44% and KI variation was 55%. In IRT analysis, BI considered a larger number of items with different levels of difficulty. Conclusion: Both the BI and the KI revealed significant deterioration of functional status after ICU discharge. The IRT analysis suggested that the Barthel Index might be a better scale than the Katz Index for the assessment of functional status of patients discharged from ICU, since it presented better discrimination of the ability to carry out the tasks.