CARLOS ROBERTO RIBEIRO DE CARVALHO

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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

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Assunto: Medicine, General & Internal ×

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Agora exibindo 1 - 10 de 27
  • article 1 Citação(ões) na Scopus
    Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome Reply
    (2018) CAVALCANTI, Alexandre Biasi; AMATO, Marcelo Britto Passos; CARVALHO, Carlos Roberto Ribeiro de
  • article 1716 Citação(ões) na Scopus
    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.)
  • article 6 Citação(ões) na Scopus
    Association between pulmonary artery to aorta diameter ratio with pulmonary hypertension and outcomes in diffuse cystic lung diseases
    (2021) BALDI, Bruno Guedes; FERNANDES, Caio Julio Cesar dos Santos; HEIDEN, Glaucia Itamaro; FREITAS, Carolina Salim Goncalves; SOBRAL, Juliana Barbosa; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto Ribeiro; SOUZA, Rogerio
    To investigate the importance of pulmonary vascular measurements on computed tomography (CT) in predicting pulmonary hypertension (PH) and worse outcomes in diffuse cystic lung diseases (DCLDs). We conducted a cross-sectional study of patients with DCLDs. Patients underwent pulmonary function tests, a six-minute walk test (6MWT), chest CT, transthoracic echocardiography, and right heart catheterization. Pulmonary artery (PA) diameter and PA-ascending aorta ratio (PA-Ao ratio) were obtained from CT. Mean pulmonary artery pressure (mPAP) from right heart catheterization was correlated with tomographic, functional, and echocardiographic variables. The association between the PA-Ao ratio with outcomes was determined by Kaplan-Meier curves. Thirty-four patients were included (18 with pulmonary Langerhans cell histiocytosis and 16 with lymphangioleiomyomatosis, mean age 46 +/- 9 years). Forced expiratory volume in the first second and lung diffusing capacity for carbon monoxide were 47 +/- 20% and 38 +/- 21% predicted, respectively. PA diameter and PA-Ao ratio were 29 +/- 6 mm and 0.95 +/- 0.24, respectively. PA-Ao ratio > 1 occurred in 38.2% of patients. PA-Ao ratio was a good predictor of PH. mPAP correlated best with PA-Ao ratio, PA diameter, oxygen desaturation during six-minute walk test, and echocardiographic variables. Patients with PA-Ao ratio > 1 had greater mPAP, and a higher risk of death or lung transplantation (log-rank, P < .001) than those with PA-Ao ratio <= 1. The PA-Ao ratio measured on CT scan has a potential role as a non-invasive tool to predict the presence of PH and as a prognostic parameter in patients with DCLDs.
  • article 37 Citação(ões) na Scopus
    Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1) virus infection
    (2011) TOUFEN JR., Carlos; COSTA, Eduardo Leite V.; HIROTA, Adriana Sayuri; LI, Ho Yeh; AMATO, Marcelo Brito Passos; CARVALHO, Carlos Roberto Ribeiro
    BACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.
  • article 5 Citação(ões) na Scopus
    Immunoglobulin G4-related systemic sclerosing disease in a patient with sclerosing cholangitis, inflammatory pseudotumors of the lung and multiple radiological patterns: a case report
    (2011) DIAS, Olivia Meira; KAWASSAKI, Alexandre de Melo; HAGA, Hironori; CUKIER, Alberto; CARVALHO, Carlos Roberto Ribeiro
  • article 10 Citação(ões) na Scopus
    Shortening ventilatory support with a protocol based on daily extubation screening and noninvasive ventilation in selected patients
    (2011) NERY, Patricia; PASTORE, Laerte; CARVALHO, Carlos Roberto Ribeiro; SCHETTINO, Guilherme
    BACKGROUND: Prolonged invasive mechanical ventilation and reintubation are associated with adverse outcomes and increased mortality. Daily screening to identify patients able to breathe without support is recommended to reduce the length of mechanical ventilation. Noninvasive positive-pressure ventilation has been proposed as a technique to shorten the time that patients remain on invasive ventilation. METHODS: We conducted a before-and-after study to evaluate the efficacy of an intervention that combined daily screening with the use of noninvasive ventilation immediately after extubation in selected patients. The population consisted of patients who had been intubated for at least 2 days. RESULTS: The baseline characteristics were similar between the groups. The intervention group had a lower length of invasive ventilation (6 [4;9] vs. 7 [4;11.5] days, p = 0.04) and total (invasive plus noninvasive) ventilator support (7 [4;11] vs. 9 [6;8], p = 0.01). Similar reintubation rates within 72 hours were observed for both groups. In addition, a lower ICU mortality was found in the intervention group (10.8% vs. 24.3%, p = 0.03), with a higher cumulative survival probability at 60 days (p = 0.05). Multivariate analysis showed that the intervention was an independent factor associated with survival (RR: 2.77; CI 1.14-6.65; p = 0.03), whereas the opposite was found for reintubation at 72 hours (RR: 0.27; CI 0.11-0.65; p = 0.01). CONCLUSION: The intervention reduced the length of invasive ventilation and total ventilatory support without increasing the risk of reintubation and was identified as an independent factor associated with survival.
  • article 4 Citação(ões) na Scopus
    Protocol for Functional Assessment of Adults and Older Adults after Hospitalization for COVID-19
    (2021) GODOY, Caroline Gil de; SILVA, Erika Christina Gouveia e; OLIVEIRA, Danielle Brancolini de; GAMBETA, Amislaine Cristina; SILVA, Elizabeth Mendes da; CAMPOS, Camila Machado de; SCHMITT, Ana Carolina Basso; CARVALHO, Celso R. F.; FU, Carolina; TANAKA, Clarice; NAKAGAWA, Naomi Kondo; TOUFEN JUNIOR, Carlos; CARVALHO, Carlos Roberto Ribeiro de; HILL, Keith; POMPEU, Jose Eduardo
  • article 24 Citação(ões) na Scopus
    Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil
    (2021) BUSATTO, Geraldo Filho; ARAUJO, Adriana Ladeira de; DUARTE, Alberto Jose da Silva; LEVIN, Anna Sara; GUEDES, Bruno Fukelmann; KALLAS, Esper Georges; PINNA, Fabio Rezende; SOUZA, Heraldo Possolo de; SILVA, Katia Regina da; SAWAMURA, Marcio Valente Yamada; SEELAENDER, Marilia; IMAMURA, Marta; GARCIA, Michelle Louvaes; FORLENZA, Orestes Vicente; NITRINI, Ricardo; DAMIANO, Rodolfo Furlan; ROCHA, Vanderson Geraldo; BATISTTELLA, Linamara Rizzo; CARVALHO, Carlos Roberto Ribeiro de
    Introduction COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity. Methods and analyses We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo). All eligible subjects will be consecutively invited to undergo a 1-2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6-9 months and 12-15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics. Ethics and dissemination All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples.
  • article 4 Citação(ões) na Scopus
    Chronic lung lesions in COVID-19 survivors: predictive clinical model
    (2022) CARVALHO, Carlos Roberto Ribeiro; CHATE, Rodrigo Caruso; SAWAMURA, Marcio Valente Yamada; GARCIA, Michelle Louvaes; LAMAS, Celina Almeida; CARDENAS, Diego Armando Cardona; LIMA, Daniel Mario; SCUDELLER, Paula Gobi; SALGE, Joao Marcos; NOMURA, Cesar Higa; GUTIERREZ, Marco Antonio
    Objective This study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection. Design This prospective cohort study included COVID-19 survivors hospitalised between 30 March 2020 and 31 August 2020 followed-up 6 months after hospital discharge. The pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO(2)), spirometry (forced vital capacity (FVC)) and chest X-ray (CXR) during an in-person consultation. Patients with abnormalities in at least one of these parameters underwent chest CT. mMRC scale, SpO(2), FVC and CXR findings were used to build a machine learning model for lung lesion detection on CT. Setting A tertiary hospital in Sao Paulo, Brazil. Participants 749 eligible RT-PCR-confirmed SARS-CoV-2-infected patients aged >= 18 years. Primary outcome measure A predictive clinical model for lung lesion detection on chest CT. Results There were 470 patients (63%) that had at least one sign of pulmonary involvement and were eligible for CT. Almost half of them (48%) had significant pulmonary abnormalities, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis and architectural distortion. The machine learning model, including the results of 257 patients with complete data on mMRC, SpO(2), FVC, CXR and CT, accurately detected pulmonary lesions by the joint data of CXR, mMRC scale, SpO(2) and FVC (sensitivity, 0.85 +/- 0.08; specificity, 0.70 +/- 0.06; F1-score, 0.79 +/- 0.06 and area under the curve, 0.80 +/- 0.07). Conclusion A predictive clinical model based on CXR, mMRC, oximetry and spirometry data can accurately screen patients with lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries for early detection of COVID-19 sequelae.
  • article 15 Citação(ões) na Scopus
    Use of telemedicine to combat the COVID-19 pandemic in Brazil
    (2020) CARVALHO, Carlos Roberto Ribeiro; SCUDELLER, Paula Gobi; RABELLO, Guilherme; GUTIERREZ, Marco Antonio; JATENE, Fabio Biscegli