MARCELO BRITTO PASSOS AMATO

(Fonte: Lattes)
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Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
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 3 Citação(ões) na Scopus
    Plano de análise estatística para o Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). Ensaio controlado randomizado
    (2017) DAMIANI, Lucas Petri; BERWANGER, Otavio; PAISANI, Denise; LARANJEIRA, Ligia Nasi; SUZUMURA, Erica Aranha; AMATO, Marcelo Britto Passos; CARVALHO, Carlos Roberto Ribeiro; CAVALCANTI, Alexandre Biasi
    ABSTRACT Background: The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy). Objective: To describe the data management process and statistical analysis plan. Methods: The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes. Conclusion: According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results. Trial registration: ClinicalTrials.gov number, NCT01374022.
  • conferenceObject
    Changes in Regional Lung Perfusion Along Time and with Different Lung Volume During Mechanical Ventilation of Supine Healthy Swine
    (2020) TUCCI, M. R.; RIBEIRO, B. M.; VICTOR JUNIOR, M.; MELO, J. R.; BERALDO, M.; MORAIS, C. C.; NAKAMURA, M. A.; GOMES, S.; LIMA, C.; ALCALA, G. C.; AMATO, M. B.
  • article 0 Citação(ões) na Scopus
    Quantitative analysis of pulmonary perfusion with dual-energy CT angiography: comparison of two quantification methods in patients with pulmonary embolism
    (2023) LEE, Hye Ju; WANDERLEY, Mark; RUBIN, Vivian Cardinal da Silva; ALCALA, Glasiele Cristina; COSTA, Eduardo Leite Vieira; PARGA, Jose Rodrigues; AMATO, Marcelo Britto Passos
    The study aimed to evaluate a quantification method of pulmonary perfusion with Dual-Energy CT Angiography (DE-CTA) normalized by lung density in the prediction of outcome in acute pulmonary embolism (PE). In this prospective study with CTA scans acquired with different breathing protocols, two perfusion parameters were calculated: %PBV (relative value of PBV, expressed per unit volume) and PBVm (PBV normalized by lung density, expressed per unit mass). DE-CTA parameters were correlated with simplified pulmonary embolism severity index (sPESI) and with outcome groups, alone and in combinationwith tomographic right-to-left ventricular ratios (RV/LV). PBVm showed significant correlation with sPESI. PBVm presented higher accuracy than %PBV In the prediction of ICU admission or death in patients with PE, with the best performance when combined with RV/LV volumetric ratio.
  • article 103 Citação(ões) na Scopus
    Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS
    (2021) GRIECO, Domenico Luca; MAGGIORE, Salvatore Maurizio; ROCA, Oriol; SPINELLI, Elena; PATEL, Bhakti K.; THILLE, Arnaud W.; V, Carmen Silvia Barbas; ACILU, Marina Garcia de; CUTULI, Salvatore Lucio; BONGIOVANNI, Filippo; AMATO, Marcelo; FRAT, Jean-Pierre; MAURI, Tommaso; KRESS, John P.; MANCEBO, Jordi; ANTONELLI, Massimo
    The role of non-invasive respiratory support (high-flow nasal oxygen and noninvasive ventilation) in the management of acute hypoxemic respiratory failure and acute respiratory distress syndrome is debated. The oxygenation improvement coupled with lung and diaphragm protection produced by non-invasive support may help to avoid endotracheal intubation, which prevents the complications of sedation and invasive mechanical ventilation. However, spontaneous breathing in patients with lung injury carries the risk that vigorous inspiratory effort, combined or not with mechanical increases in inspiratory airway pressure, produces high transpulmonary pressure swings and local lung overstretch. This ultimately results in additional lung damage (patient self-inflicted lung injury), so that patients intubated after a trial of noninvasive support are burdened by increased mortality. Reducing inspiratory effort by high-flow nasal oxygen or delivery of sustained positive end-expiratory pressure through the helmet interface may reduce these risks. In this physiology-to-bedside review, we provide an updated overview about the role of noninvasive respiratory support strategies as early treatment of hypoxemic respiratory failure in the intensive care unit. Noninvasive strategies appear safe and effective in mild-to-moderate hypoxemia (PaO2/FiO(2) > 150 mmHg), while they can yield delayed intubation with increased mortality in a significant proportion of moderate-to-severe (PaO2/FiO(2) <= 150 mmHg) cases. High-flow nasal oxygen and helmet noninvasive ventilation represent the most promising techniques for first-line treatment of severe patients. However, no conclusive evidence allows to recommend a single approach over the others in case of moderate-to-severe hypoxemia. During any treatment, strict physiological monitoring remains of paramount importance to promptly detect the need for endotracheal intubation and not delay protective ventilation.
  • article 94 Citação(ões) na Scopus
    Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial
    (2013) ORNICO, Susana R.; LOBO, Suzana M.; SANCHES, Helder S.; DEBERALDINI, Maristela; TOFOLI, Luciane T.; VIDAL, Ana M.; SCHETTINO, Guilherme P.; AMATO, Marcelo B.; CARVALHO, Carlos R.; BARBAS, Carmen S.
    Introduction: Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF). Methods: A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours, and 24 hours after extubation, reintubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay, and hospital mortality. Results: Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cm H2O, positive end-expiratory pressure (PEEP) of 5 cm H2O, oxygen inspiratory fraction (FiO(2)) <= 40%, arterial oxygen saturation (SaO(2)) >= 90%, and ratio of respiratory rate and tidal volume in liters (f/TV) < 105. Comparing the 20 patients (NIV) with the 18 patients (OM) that finished the study 48 hours after extubation, the rate of reintubation in NIV group was 5% and 39% in OM group (P = 0.016). Relative risk for reintubation was 0.13 (CI = 0.017 to 0.946). Absolute risk reduction for reintubation showed a decrease of 33.9%, and analysis of the number needed to treat was three. No difference was found in the length of ICU stay (P = 0.681). Hospital mortality was zero in NIV group and 22.2% in OM group (P = 0.041). Conclusions: In this study population, NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group.
  • article 8 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus
    Positive End-Expiratory Pressure, Pleural Pressure, and Regional Compliance during Pronation: An Experimental Study (vol 203, pg 1266, 2021)
    (2021) KATIRA, B. H.; OSADA, K.; ENGELBERTS, D.; BASTIA, L.; DAMIANI, L. F.; LI, X.; CHEN, H.; YOSHIDA, T.; AMATO, M. B. P.; FERGUSON, N. D.; POST, M.; KAVANAGH, B. P.; BROCHARD, L. J.
  • article 71 Citação(ões) na Scopus
    Lung Recruitment Maneuvers for Adult Patients with Acute Respiratory Distress Syndrome A Systematic Review and Meta-Analysis
    (2017) GOLIGHER, Ewan C.; HODGSON, Carol L.; ADHIKARI, Neill K. J.; MEADE, Maureen O.; WUNSCH, Hannah; ULERYK, Elizabeth; GAJIC, Ognjen; AMATO, Marcelo P. B.; FERGUSON, Niall D.; RUBENFELD, Gordon D.; FAN, Eddy
    Rationale: In patients with acute respiratory distress syndrome (ARDS), lung recruitment maneuvers (LRMs) may prevent ventilator-induced lung injury and improve survival. Objectives: To summarize the current evidence in support of the use of LRMs in adult patients with ARDS and to inform the recently published American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline on mechanical ventilation in ARDS. Methods: We conducted a systematic review and meta-analysis of randomized trials comparing mechanical ventilation strategies with and without LRMs. Eligible trials were identified from among previously published systematic reviews and an updated literature search. Data on 28-day mortality, oxygenation, adverse events, and use of rescue therapy were collected, and results were pooled using random effects models weighted by inverse variance. Strength of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Results: We screened 430 citations and previous systematic reviews and found six trials eligible for inclusion (n = 1,423 patients in total). The type of LRM varied widely between trials, and five of the trials involved a cointervention with a higher positive end-expiratory pressure (PEEP) ventilation strategy. Risk of bias was deemed high in one trial. In the primary analysis, the only trial without a cointervention showed that LRMs were associated with reduced mortality (one trial; risk ratio [RR], 0.62; 95% confidence interval [CI], 0.39-0.98; evidence grade = low). Meta-analysis of all six trials also suggested a significant mortality reduction (six trials; RR, 0.81; 95% CI, 0.69-0.95; evidence grade = moderate), and the use of a higher PEEP cointervention did not significantly modify the mortality effect (P = 0.27 for heterogeneity). LRMs were also associated with improved oxygenation after 24 hours (six trials; mean increase, 52 mm Hg; 95% CI, 23-81 mm Hg) and less frequent requirement for rescue therapy (three trials; RR, 0.65; 95% CI, 0.45-0.94). LRMs were not associated with an increased rate of barotrauma (four trials; RR, 0.84; 95% CI, 0.46-1.55). The rate of hemodynamic compromise was not significantly increased with LRMs (three trials; RR, 1.30; 95% CI, 0.92-1.78). Conclusions: Randomized trials suggest that LRMs in combination with a higher PEEP ventilation strategy reduce mortality, but confidence in this finding is limited. Further trials are required to confirm benefit from LRMs in adults with ARDS.
  • article 31 Citação(ões) na Scopus
    Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia
    (2017) BASSI, Gianluigi Li; PANIGADA, Mauro; RANZANI, Otavio T.; ZANELLA, Alberto; BERRA, Lorenzo; CRESSONI, Massimo; PARRINI, Vieri; KANDIL, Hassan; SALATI, Giovanni; SELVAGGI, Paola; AMATU, Alessandro; SANZ-MONCOSI, Miquel; BIAGIONI, Emanuela; TAGLIAFERRI, Fernanda; FURIA, Mirella; MERCURIO, Giovanna; COSTA, Antonietta; MANCA, Tullio; LINDAU, Simone; BABEL, Jaksa; CAVANA, Marco; CHIURAZZI, Chiara; MARTI, Joan-Daniel; CONSONNI, Dario; GATTINONI, Luciano; PESENTI, Antonio; WIENER-KRONISH, Janine; BRUSCHI, Cecilia; BALLOTTA, Andrea; SALSI, Pierpaolo; LIVIGNI, Sergio; IOTTI, Giorgio; FERNANDEZ, Javier; GIRARDIS, Massimo; BARBAGALLO, Maria; MOISE, Gabriella; ANTONELLI, Massimo; CASPANI, Maria Luisa; VEZZANI, Antonella; MEYBOHM, Patrick; GASPAROVIC, Vladimir; GEAT, Edoardo; AMATO, Marcelo; NIEDERMAN, Michael; KOLOBOW, Theodor; TORRES, Antoni
    Purpose: The lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP). Methods: This was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two pre-planned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay. Results: At the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to-treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02-1.03, p = 0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86-1.60, p = 0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (p = 0.01 vs. SRP). Conclusions: The LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted; however, at this time, the LTP cannot be recommended as a VAP preventive measure.
  • conferenceObject
    Neck Electrical Impedance Tomography For Continuous And Non-Invasive Evaluation Of Upper Airway Patency During Sleep
    (2014) PICCIN, V. S.; GENTA, P. R.; CAMARGO, E. L. D. B.; SCHORR, F.; ANDRADE, R. G. S.; TORSANI, V.; SARDINHA, P. S.; GREGORIO, M. G.; CARVALHO, C. R. R.; AMATO, M. B.; LORENZI-FILHO, G.