OTAVIO TAVARES RANZANI
Projetos de Pesquisa
Unidades Organizacionais
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
24 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 24
- Prompt admission to the ICU: an instrument to improve mortality for deteriorating ward patients(2018) LANGE, Theis; SKRIFVARS, Markus; RANZANI, Otavio T.
- Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline(2022) MOLLER, Morten H.; ALHAZZANI, Waleed; LEWIS, Kimberley; BELLEY-COTE, Emilie; GRANHOLM, Anders; CENTOFANTI, John; MCINTYRE, William B.; SPENCE, Jessica; DUHAILIB, Zainab Al; NEEDHAM, Dale M.; EVANS, Laura; BLASER, Annika Reintam; PISANI, Margaret A.; D'ARAGON, Frederick; SHANKAR-HARI, Manu; ALSHAHRANI, Mohammed; CITERIO, Giuseppe; ARORA, Rakesh C.; MEHTA, Sangeeta; GIRARD, Timothy D.; RANZANI, Otavio T.; HAMMOND, Naomi; DEVLIN, John W.; SHEHABI, Yahya; PANDHARIPANDE, Pratik; OSTERMANN, MarliesPurpose The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) was to formulate evidence-based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU). Methods We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web-based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients' values and preferences, costs and resources, feasibility, acceptability, and research priorities. Results The ICM-RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: ""In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia"". Conclusion This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.
- Randomized, multicenter trial of lateral Trendelenburg versus semirecumbent body position for the prevention of ventilator-associated pneumonia(2017) BASSI, Gianluigi Li; PANIGADA, Mauro; RANZANI, Otavio T.; ZANELLA, Alberto; BERRA, Lorenzo; CRESSONI, Massimo; PARRINI, Vieri; KANDIL, Hassan; SALATI, Giovanni; SELVAGGI, Paola; AMATU, Alessandro; SANZ-MONCOSI, Miquel; BIAGIONI, Emanuela; TAGLIAFERRI, Fernanda; FURIA, Mirella; MERCURIO, Giovanna; COSTA, Antonietta; MANCA, Tullio; LINDAU, Simone; BABEL, Jaksa; CAVANA, Marco; CHIURAZZI, Chiara; MARTI, Joan-Daniel; CONSONNI, Dario; GATTINONI, Luciano; PESENTI, Antonio; WIENER-KRONISH, Janine; BRUSCHI, Cecilia; BALLOTTA, Andrea; SALSI, Pierpaolo; LIVIGNI, Sergio; IOTTI, Giorgio; FERNANDEZ, Javier; GIRARDIS, Massimo; BARBAGALLO, Maria; MOISE, Gabriella; ANTONELLI, Massimo; CASPANI, Maria Luisa; VEZZANI, Antonella; MEYBOHM, Patrick; GASPAROVIC, Vladimir; GEAT, Edoardo; AMATO, Marcelo; NIEDERMAN, Michael; KOLOBOW, Theodor; TORRES, AntoniPurpose: The lateral Trendelenburg position (LTP) may hinder the primary pathophysiologic mechanism of ventilator-associated pneumonia (VAP). We investigated whether placing patients in the LTP would reduce the incidence of VAP in comparison with the semirecumbent position (SRP). Methods: This was a randomized, multicenter, controlled study in invasively ventilated critically ill patients. Two pre-planned interim analyses were performed. Patients were randomized to be placed in the LTP or the SRP. The primary outcome, assessed by intention-to-treat analysis, was incidence of microbiologically confirmed VAP. Major secondary outcomes included mortality, duration of mechanical ventilation, and intensive care unit length of stay. Results: At the second interim analysis, the trial was stopped because of low incidence of VAP, lack of benefit in secondary outcomes, and occurrence of adverse events. A total of 194 patients in the LTP group and 201 in the SRP group were included in the final intention-to-treat analysis. The incidence of microbiologically confirmed VAP was 0.5% (1/194) and 4.0% (8/201) in LTP and SRP patients, respectively (relative risk 0.13, 95% CI 0.02-1.03, p = 0.04). The 28-day mortality was 30.9% (60/194) and 26.4% (53/201) in LTP and SRP patients, respectively (relative risk 1.17, 95% CI 0.86-1.60, p = 0.32). Likewise, no differences were found in other secondary outcomes. Six serious adverse events were described in LTP patients (p = 0.01 vs. SRP). Conclusions: The LTP slightly decreased the incidence of microbiologically confirmed VAP. Nevertheless, given the early termination of the trial, the low incidence of VAP, and the adverse events associated with the LTP, the study failed to prove any significant benefit. Further clinical investigation is strongly warranted; however, at this time, the LTP cannot be recommended as a VAP preventive measure.
- Is this critically ill patient elderly or too old?(2017) ROBERT, R.; SKRIFVARS, M. B.; RANZANI, O. T.
- Pulmonary infections complicating ARDS(2020) LUYT, Charles-Edouard; BOUADMA, Lila; MORRIS, Andrew Conway; DHANANI, Jayesh A.; KOLLEF, Marin; LIPMAN, Jeffrey; MARTIN-LOECHES, Ignacio; NSEIR, Saad; RANZANI, Otavio T.; ROQUILLY, Antoine; SCHMIDT, Matthieu; TORRES, Antoni; TIMSIT, Jean-FrancoisPulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option.
- Recalibrating our prediction models in the ICU: time to move from the abacus to the computer(2014) PIRRACCHIO, Romain; RANZANI, Otavio T.
- How objective is the observed mortality following critical care?(2013) CAPUZZO, Maurizia; RANZANI, Otavio T.
- Focus on better care and ethics: Are medical ethics lagging behind the development of new medical technologies?(2020) EINAV, Sharon; RANZANI, Otavio T.
- Optimising aerosolized therapies in critically ill patients(2022) DHANANI, Jayesh; TANIGUCHI, Leandro U.; RANZANI, Otavio T.
- Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study(2014) NORITOMI, Danilo Teixeira; RANZANI, Otavio T.; MONTEIRO, Mariana Barbosa; FERREIRA, Elaine Maria; SANTOS, Sergio Ricardo; LEIBEL, Fernando; MACHADO, Flavia RibeiroPurpose: To evaluate whether a multifaceted, centrally coordinated quality improvement program in a network of hospitals can increase compliance with the resuscitation bundle and improve clinical and economic outcomes in an emerging country setting. Methods: This was a pre- and post-intervention study in ten private hospitals (1,650 beds) in Brazil (from May 2010 to January 2012), enrolling 2,120 patients with severe sepsis or septic shock. The program used a multifaceted approach: screening strategies, multidisciplinary educational sessions, case management, and continuous performance assessment. The network administration and an external consultant provided performance feedback and benchmarking within the network. The primary outcome was compliance with the resuscitation bundle. The secondary outcomes were hospital mortality, hospital and ICU length of stay, quality-adjusted life year (QALY) gain, and cost-effectiveness. Results: The proportion of patients who received all the required items for the resuscitation bundle improved from 13 % [95 % confidence interval (CI) 8-18 %] at baseline to 62 % (95 % CI 54-69 %) in the last trimester (p < 0.001). Hospital mortality decreased from 55 % (95 % CI 48-62 %) to 26 % (95 % CI 19-32 %, p < 0.001). Full compliance with the resuscitation bundle was associated with lower risk of hospital mortality (propensity weighted corrected risk ratio 0.74; 95 % CI 0.56-0.94, p = 0.02). There was a reduction in the total cost per patient from 29.3 (95 % CI 23.9-35.4) to 17.5 (95 % CI 14.3-21.1) thousand US dollars from baseline to the last 3 months (mean difference -11,815; 95 % CI -18,604 to -5,338). The mean QALY increased from 2.63 (95 % CI 2.15-3.14) to 4.06 (95 % CI 3.58-4.57). For each QALY, the full compliance saves US$5,383. Conclusions: A multifaceted approach to severe sepsis and septic shock patients in an emerging country setting led to high compliance with the resuscitation bundle. The intervention was cost-effective and associated with a reduction in mortality.
- «
- 1 (current)
- 2
- 3
- »