VINICIUS TORSANI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
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.- Regional ventilation of patients with hemidiaphragm paralysis by electrical impedance tomography(2015) PEREIRA, Mayra Caleffi; TORSANI, Vinicius; APANAVICIUS, Andre; FERREIRA, Jeferson George; IAMONTI, Vinicius C.; AMATO, Marcelo Britto Passos; CARVALHO, Carlos Roberto Ribeiro de; ALBUQUERQUE, Andre Luis Pereira de; CARUSO, Pedro
- Global and Regional Respiratory Mechanics During Robotic-Assisted Laparoscopic Surgery: A Randomized Study(2019) BRANDAO, Julio C.; LESSA, Marcos A.; MOTTA-RIBEIRO, Gabriel; HASHIMOTO, Soshi; PAULA, Luis Felipe; TORSANI, Vinicius; LE, Linh; BAO, Xiaodong; EIKERMANN, Matthias; DAHL, Douglas M.; DENG, Hao; TABATABAEI, Shahin; AMATO, Marcelo B. P.; MELO, Marcos F. VidalBACKGROUND: Pneumoperitoneum and nonphysiological positioning required for robotic surgery increase cardiopulmonary risk because of the use of larger airway pressures (Paws) to maintain tidal volume (Vt). However, the quantitative partitioning of respiratory mechanics and transpulmonary pressure (Pl) during robotic surgery is not well described. We tested the following hypothesis: (1) the components of driving pressure (transpulmonary and chest wall components) increase in a parallel fashion at robotic surgical stages (Trendelenburg and robot docking); and (2) deep, when compared to routine (moderate), neuromuscular blockade modifies those changes in Pls as well as in regional respiratory mechanics. METHODS: We studied 35 American Society of Anesthesiologists (ASA) I-II patients undergoing elective robotic surgery. Airway and esophageal balloon pressures and respiratory flows were measured to calculate respiratory mechanics. Regional lung aeration and ventilation was assessed with electrical impedance tomography and level of neuromuscular blockade with acceleromyography. During robotic surgical stages, 2 crossover randomized groups (conditions) of neuromuscular relaxation were studied: Moderate (1 twitch in the train-of-four stimulation) and Deep (1-2 twitches in the posttetanic count). RESULTS: Pneumoperitoneum was associated with increases in driving pressure, tidal changes in Pl, and esophageal pressure (Pes). Steep Trendelenburg position during robot docking was associated with further worsening of the respiratory mechanics. The fraction of driving pressures that partitioned to the lungs decreased from baseline (63% +/- 15%) to Trendelenburg position (49% +/- 14%, P < .001), due to a larger increase in chest wall elastance (Ecw; 12.7 +/- 7.6 cm H2O center dot L-1) than in lung elastance (El; 4.3 +/- 5.0 cm H2O center dot L-1, P < .001). Consequently, from baseline to Trendelenburg, the component of Paw affecting the chest wall increased by 6.6 +/- 3.1 cm H2O, while Pls increased by only 3.4 +/- 3.1 cm H2O (P < .001). Pl and driving pressures were larger at surgery end than at baseline and were accompanied by dorsal aeration loss. Deep neuromuscular blockade did not change respiratory mechanics, regional aeration and ventilation, and hemodynamics. CONCLUSIONS: In robotic surgery with pneumoperitoneum, changes in ventilatory driving pressures during Trendelenburg and robot docking are distributed less to the lungs than to the chest wall as compared to routine mechanical ventilation for supine patients. This effect of robotic surgery derives from substantially larger increases in Ecw than Els and reduces the risk of excessive Pls. Deep neuromuscular blockade does not meaningfully change global or regional lung mechanics.
conferenceObject Peep Titration In Severe Acute Respiratory Distress Syndrome: Different Physiological Consequences When Guided By Electrical Impedance Tomography Versus Esophageal Pressure(2017) ROLDAN, R.; LIMA, C.; YOSHIDA, T.; SANTIAGO, R. R. D. S.; GOMES, S.; TUCCI, M. R.; BERALDO, M. A.; COSTA, E. L. V.; TORSANI, V.; NAKAMURA, M. A. M.; CARVALHO, C. R. R.; AMATO, M. B. P.- Spontaneous Effort During Mechanical Ventilation: Maximal Injury With Less Positive End-Expiratory Pressure(2016) YOSHIDA, Takeshi; ROLDAN, Rollin; BERALDO, Marcelo A.; TORSANI, Vinicius; GOMES, Susimeire; SANTIS, Roberta R. De; COSTA, Eduardo L. V.; TUCCI, Mauro R.; LIMA, Raul G.; KAVANAGH, Brian P.; AMATO, Marcelo B. P.Objectives: We recently described how spontaneous effort during mechanical ventilation can cause ""pendelluft,"" that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury. We hypothesize that higher positive end-expiratory pressure levels decrease the propensity to pendelluft and that with lower positive end-expiratory pressure levels, pendelluft is associated with improved gas exchange but increased tidal recruitment. Design: Crossover design. Setting: University animal research laboratory. Subjects: Anesthetized landrace pigs. Interventions: Surfactant depletion was achieved by saline lavage in anesthetized pigs, and ventilator-induced lung injury was produced by ventilation with high tidal volume and low positive end-expiratory pressure. Ventilation was continued in each of four conditions: positive end-expiratory pressure (low or optimized positive end-expiratory pressure after recruitment) and spontaneous breathing (present or absent). Tidal recruitment was assessed using dynamic CT and regional ventilation/perfusion using electric impedance tomography. Esophageal pressure was measured using an esophageal balloon manometer. Measurements and Results: Among the four conditions, spontaneous breathing at low positive end-expiratory pressure not only caused the largest degree of pendelluft, which was associated with improved ventilation/perfusion matching and oxygenation, but also generated the greatest tidal recruitment. At low positive end-expiratory pressure, paralysis worsened oxygenation but reduced tidal recruitment. Optimized positive end-expiratory pressure decreased the magnitude of spontaneous efforts (measured by esophageal pressure) despite using less sedation, from -5.6 +/- 1.3 to -2.0 +/- 0.7 cm H2O, while concomitantly reducing pendelluft and tidal recruitment. No pendelluft was observed in the absence of spontaneous effort. Conclusions: Spontaneous effort at low positive end-expiratory pressure improved oxygenation but promoted tidal recruitment associated with pendelluft. Optimized positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.
conferenceObject Transpulmonary Pressure Based On Absolute Esophageal Pressure Measurement Predicts Morphological Changes Of Lung Parenchyma In An Experimental Animal Model(2016) FUMAGALLI, J.; ZHANG, C.; TORSANI, V.; PIRRONE, M.; GOMEZ, S.; SANTIS, S. De; TUCCI, M.; RAMOS, O.; LIMA, C.; BENTO, G.; BERRA, L.; KACMAREK, R.; AMATO, M. B. P.- Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD(2020) PINTO, Thiago Fernandes; XAVIER, Rafaella Fagundes; LUNARDI, Adriana Claudia; SILVA, Cibele Cristine Berto Marques da; MORIYA, Henrique Takachi; VITORASSO, Renato Lima; TORSANI, Vinicius; AMATO, Marcelo Brito Passos; STELMACH, Rafael; SALGE, Joao Marcos; CARVALHO-PINTO, Regina Maria; CARVALHO, Celso R. F.Subjects with severe and very severe chronic obstructive pulmonary disease (COPD) present thoracoabdominal asynchrony (TAA) that reduces ventilatory efficiency and exercise capacity. However, no therapeutic intervention has focused on reducing TAA. The purpose of this study was to evaluate the effects of elastic tape (ET) on thoracoabdominal mechanics, dyspnea symptoms, exercise capacity, and physical activity level in nonobese male subjects with severe-to-very severe COPD. This crossover, randomized trial included nonobese males with severe to very severe COPD. ET was placed on the chest wall and abdomen to reduce TAA. Subjects were evaluated at three hospital visits, each 7 days apart. At visit 1, thoracoabdominal kinematic and pulmonary ventilation were evaluated by optoelectronic plethysmography and electrical impedance tomography, respectively, both at rest and during isoload exercise testing. At visit 2, a cardiopulmonary exercise test (CPET; 10 W/min) was performed until exhaustion. Between the visits, subjects used a physical activity monitor (PAM) (at least 5 days of measurement; 10 h/day). At visit 3, all the tests were repeated in the opposite order of the previous randomization. During the isoload exercise, subjects with ET presented lower tidal and minute volumes (P = 0.01) and reduced TAA (P = 0.02) and dyspnea (P = 0.04). During the CPET, subjects with ET presented an increase in peak oxygen consumption (V)over dotO(2peak); L/min and mL.kg(-1).min(-1); P = 0.01), test duration (P = 0.009), and maximal load (P = 0.03). Moderate and vigorous physical activity (MVPA), which was evaluated by the PAM, was also increased in subjects with ET (P = 0.01). ET reduced TAA and dyspnea and increased exercise capacity and the duration of MVPA in nonobese male subjects with severe-to-very severe COPD NEW & NOTEWORTHY Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.
conferenceObject Evaluation Of Bronchial Anastomosis Stenosis After Lung Transplantation With Electrical Impedance Tomography: A Case Report(2014) CAMARGO, P. C. L. B. D.; AFONSO JR., J. E.; COSTA, A. N.; CARRARO, R. M.; CAMPOS, S. V.; ABDALLA, L. G.; FERNANDES, L. M.; SAMANO, M. N.; TORSANI, V.; PEGO-FERNANDES, P. M.; AMATO, M. B. D. P.- Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity(2017) FUMAGALLI, Jacopo; BERRA, Lorenzo; ZHANG, Changsheng; PIRRONE, Massimiliano; SANTIAGO, Roberta R. De Santis; GOMES, Susimeire; MAGNI, Federico; SANTOS, Glaucia A. B. dos; BENNETT, Desmond; TORSANI, Vinicius; FISHER, Daniel; MORAIS, Caio; AMATO, Marcelo B. P.; KACMAREK, Robert M.Objectives: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. Design: Prospective, crossover, nonrandomized interventional study. Setting: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (Sao Paulo, Brazil). Patients/Subjects: Critically ill obese patients with acute respiratory failure and anesthetized swine. Interventions: Clinical data from 16 mechanically ventilated critically ill obese patients were analyzed. An animal model of obesity with reversible atelectasis was developed by placing fluid filled bags on the abdomen to describe changes of lung mechanics, lung morphology, and pulmonary hemodynamics in 10 swine. Measurements and Main Results: In obese patients (body mass index, 48 +/- 11 kg/m(2)), 21.7 +/- 3.7 cm H2O of positive end-expiratory pressure resulted in the lowest elastance of the respiratory system (18.6 +/- 6.1 cm H2O/L) after a recruitment maneuver and decremental positive end-expiratory pressure and corresponded to a positive (2.1 +/- 2.2 cm H2O) end-expiratory transpulmonary pressure. Ventilation at lowest elastance positive end-expiratory pressure preceded by a recruitment maneuver restored end-expiratory lung volume (30.4 +/- 9.1 mL/kg ideal body weight) and oxygenation (273.4 +/- 72.1 mm Hg). In the swine model, lung collapse and intratidal recruitment/derecruitment occurred when the positive end-expiratory transpulmonary pressure decreased below 2-4 cm H2O. After the development of atelectasis, a decremental positive end-expiratory pressure trial preceded by lung recruitment identified the positive end-expiratory pressure level (17.4 +/- 2.1 cm H2O) needed to restore poorly and nonaerated lung tissue, reestablishing lung elastance and oxygenation while avoiding increased pulmonary vascular resistance. Conclusions: In obesity, low-to-negative values of transpulmonary pressure predict lung collapse and intratidal recruitment/derecruitment. A decremental positive end-expiratory pressure trial preceded by a recruitment maneuver reverses atelectasis, improves lung mechanics, distribution of ventilation and oxygenation, and does not increase pulmonary vascular resistance.
conferenceObject Distribution Of Ventilatory By Electrical Impedance Tomography During Breath Staking And Expiratory Positive Airway Pressure(2014) MORAIS, C. A.; RATTES, C.; CAMPOS, S. L.; BRANDAO, D. C.; BANDEIRA, M. C. D. P.; GONCALVES, T. F.; TORSANI, V.; AMATO, M. B. P.; ANDRADE, A. Dornelas De