CARLOS ROBERTO RIBEIRO DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina - Líder
94 resultados
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Agora exibindo 1 - 10 de 94
- 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 BiasiABSTRACT 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.
- Lung ultrasound in the evaluation of pleural effusion(2014) PRINA, Elena; TORRES, Antoni; CARVALHO, Carlos Roberto Ribeiro
article 0 Citação(ões) na Scopus Avaliação dos artigos de pneumologia publicados em periódicos brasileiros além do Jornal Brasileiro de Pneumologia(2011) BALDI, Bruno Guedes; CARVALHO, Carlos Roberto RibeiroIn Brazil, research on pulmonology has become increasingly more visible in recent years. In addition to the Brazilian Journal of Pulmonology, other journals have contributed to that by publishing relevant articles in this area. The objective of this article was to briefly report the most relevant studies on pulmonology that were published in other important Brazilian journals between 2009 and 2010. Altogether, there were 56 articles related to the various subareas that compose the field of respiratory diseases.article 37 Citação(ões) na Scopus Doxycycline use in patients with lymphangioleiomyomatosis: safety and efficacy in metalloproteinase blockade(2011) PIMENTA, Suzana Pinheiro; BALDI, Bruno Guedes; ACENCIO, Milena Marques Pagliarelli; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto RibeiroObjective: Lymphangioleiomyomatosis (LAM) is characterized by lung cysts, whose development is associated with matrix metalloproteinase (MMP) hyperactivity, principally that of MMP-2 and MMP-9. Our objective was to compare LAM patients and controls in terms of the levels of these MMPs, as well as to determine the safety and efficacy of treatment with doxycycline, a potent MMP inhibitor. Methods: Prospective clinical study involving female LAM patients who received doxycycline (100 mg/day) for six months. Urine and blood samples were collected for the quantification of MMP-2 and MMP-9 before and after the treatment period. Samples from 10 healthy women were also collected. Results: Of the 41 LAM patients who started the treatment, 34 completed the protocol. Serum and urinary MMP-9 levels were significantly lower in the controls than in the LAM patients (p < 0.0001). Comparing pre- and post-treatment values, we found that the median level of MMP-9 in serum decreased from 919 ng/mL to 871 ng/mL (p = 0.05), whereas that of MMP-9 in urine decreased from 11,558 pg/mL to 7,315 pg/mL (p = 0.10). After treatment, the median level of MMP-2 in serum was significantly lower (p = 0.04) and urinary MMP-2 levels were undetectable. Nausea, diarrhea, and epigastric pain were the most prevalent adverse affects and were often self-limiting. There was only one case in which the patient discontinued the treatment because of side effects. Conclusions: We have demonstrated, for the first time, a decrease in serum and urine levels of MMPs in LAM patients treated with doxycycline, which proved to be a safe medication, with mild and well-tolerated side effects.- Mechanisms of Exercise Limitation and Prevalence of Pulmonary Hypertension in Pulmonary Langerhans Cell Histiocytosis(2020) HEIDEN, Glaucia Itamaro; SOBRAL, Juliana Barbosa; FREITAS, Carolina Salim Goncalves; ALBUQUERQUE, Andre Luis Pereira de; SALGE, Joao Marcos; KAIRALLA, Ronaldo Adib; FERNANDES, Caio Julio Cesar dos Santos; CARVALHO, Carlos Roberto Ribeiro; SOUZA, Rogerio; BALDI, Bruno GuedesBACKGROUND: Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH). RESEARCH QUESTION: What are the mechanisms of exercise limitation, the exercise capacity , and the prevalence of dynamic hyperinflation (DH) and PH in PLCH? STUDY DESIGN AND METHODS: In a cross-sectional study, patients with PLCH underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography. Those patients with lung diffusing capacity for carbon monoxide (D-LCO) < 40% predicted and/or transthoracic echocardiogram with tricuspid regurgitation velocity > 2.5 m/s and/or with indirect PH signs underwent right heart catheterization. RESULTS: Thirty-five patients were included (68% women; mean age, 47 +/- 11 years). Ventilatory and cardiocirculatory limitations, impairment suggestive of PH, and impaired gas exchange occurred in 88%, 67%, 29%, and 88% of patients, respectively. The limitation was multifactorial in 71%, exercise capacity was reduced in 71%, and DH occurred in 68% of patients. FEV1 and D-LCO were 64 +/- 22% predicted and 56 +/- 21% predicted. Reduction in D-LCO, an obstructive pattern, and air trapping occurred in 80%, 77%, and 37% of patients. FEV1 and D-LCO were good predictors of exercise capacity. The prevalence of PH was 41%, predominantly with a precapillary pattern, and mean pulmonary artery pressure correlated best with FEV1 and tricuspid regurgitation velocity. INTERPRETATION: PH is frequent and exercise impairment is common and multifactorial in PLCH. The most prevalent mechanisms are ventilatory, cardiocirculatory, and suggestive of PH limitations.
- New steps for the international consolidation of the Brazilian Journal of Pulmonology(2014) CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes; JARDIM, Carlos Viana Poyares; CARUSO, Pedro; SOUZA, Rogerio
bookPart Pneumonia Adquirida na Comunidade(2013) SANTANA, Alfredo Nicodemos da Cruz; MARTINS, Herlon Saraiva; CARVALHO, Carlos Roberto Ribeiro- Driving pressure and long-term outcomes in moderate/severe acute respiratory distress syndrome(2018) TOUFEN JUNIOR, Carlos; SANTIAGO, Roberta R. De Santis; HIROTA, Adriana S.; CARVALHO, Alysson Roncally S.; GOMES, Susimeire; AMATO, Marcelo Brito Passos; CARVALHO, Carlos Roberto RibeiroBackgroundAcute respiratory distress syndrome (ARDS) patients may present impaired in lung function and structure after hospital discharge that may be related to mechanical ventilation strategy. The aim of this study was to evaluate the association between functional and structural lung impairment, N-terminal-peptide type III procollagen (NT-PCP-III) and driving pressure during protective mechanical ventilation. It was a secondary analysis of data from randomized controlled trial that included patients with moderate/severe ARDS with at least one follow-up visit performed. We obtained serial measurements of plasma NT-PCP-III levels. Whole-lung computed tomography analysis and pulmonary function test were performed at 1 and 6months of follow-up. A health-related quality of life survey after 6months was also performed.ResultsThirty-three patients were enrolled, and 21 patients survived after 6months. In extubation day an association between driving pressure and NT-PCP-III was observed. At 1 and 6months forced vital capacity (FVC) was negatively correlated to driving pressure (p<0.01). At 6months driving pressure was associated with lower FVC independently on tidal volume, plateau pressure and baseline static respiratory compliance after adjustments (r(2)=0.51, p=0.02). There was a significant correlation between driving pressure and lung densities and nonaerated/poorly aerated lung volume after 6months. Driving pressure was also related to general health domain of SF-36 at 6months.ConclusionEven in patients ventilated with protective tidal volume, higher driving pressure is associated with worse long-term pulmonary function and structure.
- Colagenose pulmão dominante em pacientes com doença pulmonar intersticial: prevalência, estabilidade funcional e manifestações extratorácicas comuns(2015) PEREIRA, Daniel Antunes Silva; DIAS, Olivia Meira; ALMEIDA, Guilherme Eler de; ARAUJO, Mariana Sponholz; KAWANO-DOURADO, Leticia Barbosa; BALDI, Bruno Guedes; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto RibeiroObjective: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). Methods: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (>= 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CO). Results: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. Conclusions: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria.
- Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases(2012) BALDI, Bruno Guedes; PEREIRA, Carlos Alberto de Castro; RUBIN, Adalberto Sperb; SANTANA, Alfredo Nicodemos da Cruz; COSTA, Andre Nathan; CARVALHO, Carlos Roberto Ribeiro; ALGRANTI, Eduardo; CAPITANI, Eduardo Mello de; BETHLEM, Eduardo Pamplona; COLETTA, Ester Nei Aparecida Martins; ARAKAKI, Jaquelina Sonoe Ota; MARTINEZ, Jose Antonio Baddini; CARVALHO, Jozelio Freire de; STEIDLE, Leila John Marques; ROCHA, Marcelo Jorge Jaco; LIMA, Mariana Silva; SOARES, Maria Raquel; CARAMORI, Marlova Luzzi; AIDE, Miguel Abidon; FERREIRA, Rimarcs Gomes; KAIRALLA, Ronaldo Adib; OLIVEIRA, Rudolf Krawczenko Feitoza de; JEZLER, Sergio; RODRIGUES, Silvia Carla Sousa; PIMENTA, Suzana PinheiroInterstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.