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
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- 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.
- Interstitial Emphysema Leading to Pneumomediastinum in a Bone Marrow Transplant Patient(2013) DIAS, Olivia Meira; COELHO, David Lopes Lima Cavalcanti; CARVALHO, Carlos Roberto Ribeiro de
bookPart Pneumonia Adquirida na Comunidade(2013) SANTANA, Alfredo Nicodemos da Cruz; MARTINS, Herlon Saraiva; CARVALHO, Carlos Roberto RibeiroconferenceObject High Resolution Computer Tomography Analysis Of A Cohort Of Mixed Connective Tissue Disease (mctd) Patients: 10 Years Of Follow-Up(2013) KAWANO-DOURADO, L.; DIAS, O. M.; KAY, F.; GRIPP, T.; GOMES, P.; CALEIRO, M.; KAIRALLA, R.; CARVALHO, C. R. R.- Evaluation of manual resuscitators used in ICUs in Brazil(2013) ORTIZ, Tatiana de Arruda; JUNIOR, Germano Forti; VOLPE, Marcia Souza; BERALDO, Marcelo do Amaral; AMATO, Marcelo Britto Passos; CARVALHO, Carlos Roberto Ribeiro; TUCCI, Mauro RobertoObjective: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards. Methods: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (V-T) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria. Results: Expiratory resistance was greater than 6 cmH(2)O. L-1. s(-1) in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH(2)O), and the maximal pressure was 32.0-55.9 cmH(2)O. Mean V-T varied greatly among the MRs tested. The mean V-T values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. in the situations studied, mean V-T was generally lower from the Brazilian-made MRs that had a pressure-limiting valve. Conclusions: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower V-T values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.
conferenceObject Comparing Berlin To Aecc Definition To Predict Mortality In Acute Lung Injury Patients: What Are The Changes?(2013) CASER, E.; CASATI, A.; MATOS, G. F. J.; CARVALHO, C. R. R.; BARBAS, C. S. V.conferenceObject Evaluation and correlations of the extension of pulmonary cysts in lymphangioleiomyomatosis(2013) ARAUJO, Mariana Sponholz; FREITAS, Carolina Salim Goncalves; BALDI, Bruno Guedes; TELES, Gustavo Borges da Silva; PIMENTA, Suzana Pinheiro; PEREIRA, Daniel Antunes Silva; DIAS, Olivia Meira; COSTA, Andre Nathan; KAWANO-DOURADO, Leticia; KAWASSAKI, Alexandre; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto Ribeiro- Doxycycline use in patients with lymphangioleiomyomatosis: biomarkers and pulmonary function response(2013) PIMENTA, Suzana Pinheiro; BALDI, Bruno Guedes; KAIRALLA, Ronald Adib; CARVALHO, Carlos Roberto RibeiroObjective: To assess blockade of matrix metalloproteinase (MMP)-2 and MMP-9, as well as the variation in FEV1, in patients with lymphangioleiomyomatosis (LAM) treated with doxycycline (a known MMP inhibitor) for 12 months. Methods: An open-label, single-arm, interventional clinical trial in which LAM patients received doxycycline (100 mg/day) for 12 months. Patients underwent full pulmonary function testing, a six-minute walk test, and quality of life assessment, as well as blood and urine sampling for quantification of MMP-2, MMP-9, and VEGF-D levels at baseline, as well as at 6 and 12 months after the initiation of doxycycline. Results: Thirty-one LAM patients received doxycycline for 12 months. Although there was effective blockade of urinary MMP-9 and serum MMP-2 after treatment, there were no significant differences between pre-and post-doxycycline serum levels of MMP-9 and VEGF-D. On the basis of their response to doxycycline (as determined by the variation in FEV1), the patients were divided into two groups: the doxycydine-responder (doxy-R) group (n = 13); and the doxycycline-nonresponder (doxy-NR) group (n = 18). The patients with mild spirometric abnormalities responded better to doxycycline. The most common side effects were mild epigastric pain, nausea, and diarrhea. Conclusions: In patients with LAM, doxycydine treatment results in effective MMP blockade, as well as in improved lung function and quality of life in those with less severe disease. However, these benefits do not seem to be related to the MMP blockade, raising the hypothesis that there is a different mechanism of action. (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-6g8yz9 [http://www.ensaiosclinicos.gov.br]).
conferenceObject Comparison of respiratory muscle recruitments between maximal voluntary contraction and strenuous exercise(2013) SANTANA, Pauliane; CARDENAS, Leticia; PLETSCH, Renata; FERREIRA, Jeferson; ORLANDIM, Luiz; ANDRE, Albuquerque; CARLOS, Carvalho; TREVIZAN, Patricia; MALONI, Renan; CARUSO, Pedroarticle 2 Citação(ões) na Scopus O Jornal Brasileiro de Pneumologia e as bases de dados internacionais(2013) CARVALHO, Carlos Roberto Ribeiro