FABIA DINIZ SILVA

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LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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    Knowledge, Attitudes And Practices Among Critical Care Professionals Towards Patient-Ventilator Asynchrony: A Pilot Survey
    (2017) SOUSA, M. L. A.; FELTRIM, M. I. Z.; DINIZ-SILVA, F.; HAYASHI, F. K.; CARVALHO, C. R. R.; FERREIRA, J. C.
  • article 0 Citação(ões) na Scopus
    Comparison between technical parameters recommended by regulatory agencies and relevant institutions for ventilatory therapy equipment used in patients with COVID-19
    (2021) SOUZA, D. B. de; FRONDANA, F. V.; SILVA, F. D.
    Background: Patients contaminated with the new coronavirus, SARS-CoV-2, and who develop the severe form of the disease require ventilatory support to maintain adequate gas exchange. The objective of this systematic review was to establish reference parameters of ventilator therapy used in the various levels of severity of adult patients affected by COVID-19 to assist health professionals and hospital managers who will purchase this equipment. Methods: It used four databases: Medline, Cochrane Central, Scielo, and Pubmed. Restrictions applied as to the language, restricted to English, and to the patient’s profile, only adults affected by SARS-CoV-2. The review process was carried out by three independent reviewers using the PRISMA-P method. Results: Nineteen articles were included, in addition to the recommendations of the Brazilian Association of Intensive Care Medicine (Brazil), Federal Commission for Protection against Health Risks (Mexico), Medicines and Healthcare Products Regulatory Agency (UK), Pan American Health Organization, and World Health Organization. The types of ventilatory therapies found in the articles eligible for this study were continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), and invasive mechanical ventilation (IMV). For each ventilatory therapy, the parameters presented in the article and the recommendations of regulatory agencies and relevant institutions were compared and analyzed. Conclusion: It was possible to suggest a relationship between the respiratory support strategy adopted by the clinical team and the clinical conditions of the patient infected with SARS-CoV-2. The included studies used ventilation modes and parameters within the specifications and recommendations of relevant regulatory agencies and institutions. However, some minor differences were observed in the instruction presented among the agencies more related to the recommended ventilation modes. Further studies are needed. © 2021, Sociedade Brasileira de Engenharia Biomedica.
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  • article 2 Citação(ões) na Scopus
    Performance of Noninvasive Ventilation Masks in a Lung Model of COPD Exacerbation
    (2019) MACEDO, Bruno Rocha de; REGO, Francinni Mambrini Pires; SILVA, Fabia Diniz; PINAFFI, Juliana Valerio; FERREIRA, Juliana Carvalho
    BACKGROUND: Noninvasive ventilation (NIV) reduces intubation and mortality in patients with COPD exacerbation who present with respiratory failure, and the type of mask may affect its success. Our objective was to compare the performance of 3 different NIV masks in a lung model. METHODS: We set the lung simulator mechanics and respiratory rate, and tested a small oronasal mask, a total face mask, and a large oronasal mask. We added CO2 at a constant rate into the system and monitored the end-tidal carbon dioxide. We used a mechanical ventilator to deliver NW in 8 different combinations of inspiratory effort, pressure support, and expiratory positive airway pressure. We measured end-tidal carbon dioxide mask leakage, tidal volume, trigger time, time to achieve 90% of the inspiratory target during inspiration, and excess inspiratory time. RESULTS: We presented the mean +/- SD of the 8 simulated conditions for each mask. The mean +/- SD leakage was higher for the total face mask (51 +/- 6 L/min) than for the small oronasal mask (37 +/- 5 L/min) and for the large oronasal mask (21 +/- 3 L/min), P < .001; but end-tidal carbon dioxide and tidal volume were similar. The mean +/- SD 90% of the inspiratory target during inspiration was faster for the small oronasal mask (585 +/- 49 ms) compared with the large oronasal (647 +/- 107 ms) and total face mask (851 +/- 105 ms), P < .001, all other variables were similar. CONCLUSIONS: In this model, we found that the type of mask had no impact on CO2 washout or on most synchrony variables.
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    Using The Electric Activity Of The Diaphragm (eadi) To Monitor Nppv Unloading After Extubation In A Patient With Severe COPD
    (2014) MIETHKE-MORAIS, A.; DINIZ-SILVA, F.; ALENCAR, A. M.; MORIYA, H. T.; HIROTA, A. S.; CARUSO, P.; COSTA, E. L. V.; CARVALHO, C. R. R.; FERREIRA, J. C.
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    Patient-Ventilator Interaction In Neurally Adjusted Ventilatory Assist (nava) And Pressure Support (psv) During Spontaneous Breathing Trials
    (2014) FERREIRA, J. C.; DINIZ-SILVA, F.; MORIYA, H. T.; ALENCAR, A. M.; AMATO, M. B. P.; CARVALHO, C. R. R.
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    Variability Of Neurally-Adjusted Ventilatory Assist (nava) Compared To Pressure Support Ventilation (psv) During The Weaning Phase Of Mechanical Ventilation
    (2013) FERREIRA, J. C.; SILVA, F. D.; MORIYA, H. T.; ALENCAR, A. M.; AMATO, M. B. P.; CARVALHO, C. R. R.
  • article 40 Citação(ões) na Scopus
    Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial
    (2017) FERREIRA, Juliana C.; DINIZ-SILVA, Fabia; MORIYA, Henrique T.; ALENCAR, Adriano M.; AMATO, Marcelo B. P.; CARVALHO, Carlos R. R.
    Background: Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs. Methods: We conducted a crossover trial in the ICU of a university hospital in Brazil and included mechanically ventilated patients considered ready to undergo an SBT on the day of the study. Patients underwent two SBTs in randomized order: 30 min in PSV of 5 cmH(2)O or NAVA titrated to generate equivalent peak airway pressure (Paw), with a positive end-expiratory pressure of 5 cmH(2)O. The ICU team, blinded to ventilatory mode, evaluated whether patients passed each SBT. We captured flow, Paw and electrical activity of the diaphragm (EAdi) from the ventilator and used it to calculate respiratory rate (RR), tidal volume (VT), and EAdi. Detection of asynchrony events used waveform analysis and we calculated the asynchrony index as the number of asynchrony events divided by the number of neural cycles. Results: We included 20 patients in the study. All patients passed the SBT in PSV, and three failed the SBT in NAVA. Five patients were reintubated and the extubation failure rate was 25% (95% CI 9-49%). Respiratory parameters were similar in the two modes: VT = 6.1 (5.5-6.5) mL/Kg in NAVA vs. 5.5 (4.8-6.1) mL/Kg in PSV (p = 0.076) and RR = 27 (17-30) rpm in NAVA vs. 26 (20-30) rpm in PSV, p = 0.55. NAVA reduced AI, with a median of 11.5% (4.2-19.7) compared to 24.3% (6.3-34.3) in PSV (p = 0.033). Conclusions: NAVA reduces patient-ventilator asynchrony index and generates a respiratory pattern similar to PSV during SBTs. Patients considered ready for mechanical ventilation liberation may be submitted to an SBT in NAVA using the same objective criteria used for SBTs in PSV.
  • article 12 Citação(ões) na Scopus
    Neurally adjusted ventilatory assist vs. pressure support to deliver protective mechanical ventilation in patients with acute respiratory distress syndrome: a randomized crossover trial
    (2020) DINIZ-SILVA, Fabia; MORIYA, Henrique T.; ALENCAR, Adriano M.; AMATO, Marcelo B. P.; CARVALHO, Carlos R. R.; FERREIRA, Juliana C.
    Background Protective mechanical ventilation is recommended for patients with acute respiratory distress syndrome (ARDS), but it usually requires controlled ventilation and sedation. Using neurally adjusted ventilatory assist (NAVA) or pressure support ventilation (PSV) could have additional benefits, including the use of lower sedative doses, improved patient-ventilator interaction and shortened duration of mechanical ventilation. We designed a pilot study to assess the feasibility of keeping tidal volume (V-T) at protective levels with NAVA and PSV in patients with ARDS. Methods We conducted a prospective randomized crossover trial in five ICUs from a university hospital in Brazil and included patients with ARDS transitioning from controlled ventilation to partial ventilatory support. NAVA and PSV were applied in random order, for 15 min each, followed by 3 h in NAVA. Flow, peak airway pressure (Paw) and electrical activity of the diaphragm (EAdi) were captured from the ventilator, and a software (Matlab, Mathworks, USA), automatically detected inspiratory efforts and calculated respiratory rate (RR) and V-T. Asynchrony events detection was based on waveform analysis. Results We randomized 20 patients, but the protocol was interrupted for five (25%) patients for whom we were unable to maintain V-T below 6.5 mL/kg in PSV due to strong inspiratory efforts and for one patient for whom we could not detect EAdi signal. For the 14 patients who completed the protocol, V-T was 5.8 +/- 1.1 mL/kg for NAVA and 5.6 +/- 1.0 mL/kg for PSV (p = 0.455) and there were no differences in RR (24 +/- 7 for NAVA and 23 +/- 7 for PSV, p = 0.661). Paw was greater in NAVA (21 +/- 3 cmH(2)O) than in PSV (19 +/- 3 cmH(2)O, p = 0.001). Most patients were under continuous sedation during the study. NAVA reduced triggering delay compared to PSV (p = 0.020) and the median asynchrony Index was 0.7% (0-2.7) in PSV and 0% (0-2.2) in NAVA (p = 0.6835). Conclusions It was feasible to keep V-T in protective levels with NAVA and PSV for 75% of the patients. NAVA resulted in similar V-T, RR and Paw compared to PSV. Our findings suggest that partial ventilatory assistance with NAVA and PSV is feasible as a protective ventilation strategy in selected ARDS patients under continuous sedation. Trial registration ClinicalTrials.gov (NCT01519258). Registered 26 January 2012, https://clinicaltrials.gov/ct2/show/NCT01519258