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
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline(2020) ROCHWERG, Bram; EINAV, Sharon; CHAUDHURI, Dipayan; MANCEBO, Jordi; MAURI, Tommaso; HELVIZ, Yigal; GOLIGHER, Ewan C.; JABER, Samir; RICARD, Jean-Damien; RITTAYAMAI, Nuttapol; ROCA, Oriol; ANTONELLI, Massimo; MAGGIORE, Salvatore Maurizio; DEMOULE, Alexandre; HODGSON, Carol L.; MERCAT, Alain; WILCOX, M. Elizabeth; GRANTON, David; WANG, Dominic; AZOULAY, Elie; OUANES-BESBES, Lamia; CINNELLA, Gilda; RAUSEO, Michela; CARVALHO, Carlos; DESSAP-MEKONTSO, Armand; FRASER, John; FRAT, Jean-Pierre; GOMERSALL, Charles; GRASSELLI, Giacomo; HERNANDEZ, Gonzalo; JOG, Sameer; PESENTI, Antonio; RIVIELLO, Elisabeth D.; SLUTSKY, Arthur S.; STAPLETON, Renee D.; TALMOR, Daniel; THILLE, Arnaud W.; BROCHARD, Laurent; BURNS, Karen E. A.Purpose High flow nasal cannula (HFNC) is a relatively recent respiratory support technique which delivers high flow, heated and humidified controlled concentration of oxygen via the nasal route. Recently, its use has increased for a variety of clinical indications. To guide clinical practice, we developed evidence-based recommendations regarding use of HFNC in various clinical settings. Methods We formed a guideline panel composed of clinicians, methodologists and experts in respiratory medicine. Using GRADE, the panel developed recommendations for four actionable questions. Results The guideline panel made a strong recommendation for HFNC in hypoxemic respiratory failure compared to conventional oxygen therapy (COT) (moderate certainty), a conditional recommendation for HFNC following extubation (moderate certainty), no recommendation regarding HFNC in the peri-intubation period (moderate certainty), and a conditional recommendation for postoperative HFNC in high risk and/or obese patients following cardiac or thoracic surgery (moderate certainty). Conclusions This clinical practice guideline synthesizes current best-evidence into four recommendations for HFNC use in patients with hypoxemic respiratory failure, following extubation, in the peri-intubation period, and postoperatively for bedside clinicians.
- Driving Pressure and Survival in the Acute Respiratory Distress Syndrome(2015) AMATO, Marcelo B. P.; MEADE, Maureen O.; SLUTSKY, Arthur S.; BROCHARD, Laurent; COSTA, Eduardo L. V.; SCHOENFELD, David A.; STEWART, Thomas E.; BRIEL, Matthias; TALMOR, Daniel; MERCAT, Alain; RICHARD, Jean-Christophe M.; CARVALHO, Carlos R. R.; BROWER, Roy G.BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V-T), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C-RS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (Delta P=V-T/C-RS), in which V-T is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than V-T or PEEP in patients who are not actively breathing. METHODS Using a statistical tool known as multilevel mediation analysis to analyze individual data from 3562 patients with ARDS enrolled in nine previously reported randomized trials, we examined Delta P as an independent variable associated with survival. In the mediation analysis, we estimated the isolated effects of changes in Delta P resulting from randomized ventilator settings while minimizing confounding due to the baseline severity of lung disease. RESULTS Among ventilation variables, Delta P was most strongly associated with survival. A 1-SD increment in Delta P (approximately 7 cm of water) was associated with increased mortality (relative risk, 1.41; 95% confidence interval [CI], 1.31 to 1.51; P<0.001), even in patients receiving ""protective"" plateau pressures and V-T (relative risk, 1.36; 95% CI, 1.17 to 1.58; P<0.001). Individual changes in V-T or PEEP after randomization were not independently associated with survival; they were associated only if they were among the changes that led to reductions in Delta P (mediation effects of Delta P, P=0.004 and P=0.001, respectively). CONCLUSIONS We found that Delta P was the ventilation variable that best stratified risk. Decreases in Delta P owing to changes in ventilator settings were strongly associated with increased survival. (Funded by Fundacao de Amparo e Pesquisa do Estado de Sao Paulo and others.)
conferenceObject Fibrotic-Like CT Alterations in COVID-19: Distinct Patterns of Temporal Evolution(2022) KAWANO-DOURADO, L.; ENGHELMAYER, J. I.; PATEL, D. C.; FITTIPALDI, R.; JARDIM, A.; PUKA, J.; VIECELI, T.; GIRARD, J. Loso; SAMOLSKI, D.; GASER, A.; CARVALHO, C. R.; DEBRAY, M.; CRESTANI, B.; BORIE, R.- COVID-19 in Lymphangioleiomyomatosis An International Study of Outcomes and Impact of Mechanistic Target of Rapamycin Inhibition(2022) BALDI, Bruno Guedes; RADZIKOWSKA, Elzbieta; COTTIN, Vincent; DILLING, Daniel F.; ATAYA, Ali; CARVALHO, Carlos Roberto Ribeiro; HARARI, Sergio; KOSLOW, Matthew; GRUTTERS, Jan C.; INOUE, Yoshikazu; GUPTA, Nishant; JOHNSON, Simon R.
- Ventilatory Variables and Mechanical Power in Patients with Acute Respiratory Distress Syndrome(2021) V, Eduardo L. Costa; SLUTSKY, Arthur S.; BROCHARD, Laurent J.; BROWER, Roy; SERPA-NETO, Ary; CAVALCANTI, Alexandre B.; MERCAT, Alain; MEADE, Maureen; MORAIS, Caio C. A.; GOLIGHER, Ewan; CARVALHO, Carlos R. R.; AMATO, Marcelo B. P.Rationale: Mortality in acute respiratory distress syndrome (ARDS) has decreased after the adoption of lung-protective strategies. Lower VT, lower driving pressure (DP), lower respiratory rates (RR), and higher end-expiratory pressure have all been suggested as key components of lung protection strategies. A unifying theoretical explanation has been proposed that attributes lung injury to the energy transfer rate (mechanical power) from the ventilator to the patient, calculated froma combination of several ventilator variables. Objectives: To assess the impact of mechanical power on mortality in patients with ARDS as compared with that of primary ventilator variables such as the DP, VT, and RR. Methods: We obtained data on ventilatory variables and mechanical power from a pooled database of patients with ARDS who had participated in six randomized clinical trials of protective mechanical ventilation and one large observational cohort of patients with ARDS. The primary outcome was mortality at 28 days or 60 days. Measurements and Main Results: We included 4,549 patients (38% women; mean age, 55 +/- 23 yr). The average mechanical power was 0.32 +/- 0.14 J . min(-1) . kg(-1) of predicted body weight, the Delta P was 15.0 +/- 5.8 cm H2O, and the RR was 25.7 +/- 7.4 breaths/min. The driving pressure, RR, and mechanical power were significant predictors of mortality in adjusted analyses. The impact of the Delta P on mortality was four times as large as that of the RR. Conclusions: Mechanical power was associated with mortality during controlled mechanical ventilation in ARDS, but a simpler model using only the DP and RR was equivalent.