PAULO FERNANDO GUIMARAES M M TIERNO

Índice h a partir de 2011
7
Projetos de Pesquisa
Unidades Organizacionais
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico

Filtros

Limpar filtros

Configurações

Resultados de Busca

Agora exibindo 1 - 10 de 26
  • article 107 Citação(ões) na Scopus
    Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study
    (2013) AZEVEDO, Luciano C. P.; PARK, Marcelo; SALLUH, Jorge I. F.; REA-NETO, Alvaro; SOUZA-DANTAS, Vicente C.; VARASCHIN, Pedro; OLIVEIRA, Mirella C.; TIERNO, Paulo Fernando G. M. M.; DAL-PIZZOL, Felipe; SILVA, Ulysses V. A.; KNIBEL, Marcos; NASSAR JR., Antonio P.; ALVES, Rossine A.; FERREIRA, Juliana C.; TEIXEIRA, Cassiano; REZENDE, Valeria; MARTINEZ, Amadeu; LUCIANO, Paula M.; SCHETTINO, Guilherme; SOARES, Marcio
    Introduction: Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU). Methods: In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure. Results: Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30). Conclusions: Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting.
  • bookPart
    Tratamento de hipercalemia aguda
    (2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe Matheus
  • bookPart
    Protocolo de indicações e critérios de UTI
    (2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe Matheus
  • bookPart
    Padronização de diluição de soluções endovenosas utilizadas no centro cirúrgico
    (2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe Matheus
  • bookPart
    Monitorização
    (2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe Matheus
  • bookPart
    Intubação orotraqueal
    (2017) DARCIE, Ana Letícia Fornazieri; RAMALHO, Alan Saito; TIERNO, Paulo Fernando Guimarães Marzocchi
  • bookPart
    Cricotireoidostomia
    (2017) SOUSA, Braian Lucas Aguiar; OGATA, Fiama Kuroda; OKUMA, Jéssica Kazumi; BRESCIA, Marília D'Elboux Guimarães; TIERNO, Paulo Fernando Guimarães Marzocchi; HOJAIJ, Flávio Carneiro
  • article 9 Citação(ões) na Scopus
    Computed tomography angiography accuracy in brain death diagnosis
    (2020) BRASIL, Sergio; BOR-SENG-SHU, Edson; DE-LIMA-OLIVEIRA, Marcelo; TACCONE, Fabio Silvio; GATTAS, Gabriel; NUNES, Douglas Mendes; OLIVEIRA, Raphael A. Gomes de; TOMAZINI, Bruno Martins; TIERNO, Paulo Fernando; BECKER, Rafael Akira; BASSI, Estevao; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson da Silva; TEIXEIRA, Manoel Jacobsen; NOGUEIRA, Ricardo de Carvalho
    OBJECTIVE The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest. METHODS A unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score <= 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally. RESULTS A total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS. CONCLUSIONS CTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.
  • article 39 Citação(ões) na Scopus
    Transfusion requirements after head trauma: a randomized feasibility controlled trial
    (2019) GOBATTO, Andre L. N.; LINK, Milena A.; SOLLA, Davi J.; BASSI, Estevao; TIERNO, Paulo F.; PAIVA, Wellingson; TACCONE, Fabio S.; MALBOUISSON, Luiz M.
    BackgroundAnemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined.MethodsAll eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a restrictive (hemoglobin transfusion threshold of 7g/dL), or a liberal (threshold 9g/dL) transfusion strategy. The transfusion strategy was continued for up to 14days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome.ResultsA total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.41.0 and 9.31.3 (p<0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p=0.02). There was negative correlation (r=-0.265, p<0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p<0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p=0.048) and the liberal group tended to have a better neurological status at 6months (p=0.06).Conclusions The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group.Trial registration ClinicalTrials.gov, NCT02203292. Registered on 29 July 2014.
  • bookPart
    O paciente com trauma na UTI
    (2015) MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimaraes Morando Marzocchi; FERREIRA, César Biselli; MALBOUISSON, Luis Marcelo de Sá