MARCELO PARK
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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- My (critically ill) patient has only a pneumonia - the risk of oversimplification and the evidence of post-ICU syndrome(2016) BESEN, Bruno Adler Maccagnan Pinheiro; PARK, Marcelo
- Challenges in patients supported with extracorporeal membrane oxygenation in Brazil(2012) MENDES, Pedro Vitale; MOURA, Ewandro; BARBOSA, Edzangela Vasconcelos Santos; HIROTA, Adriana Sayuri; SCORDAMAGLIO, Paulo Rogerio; AJJAR, Fabiana Maria; COSTA, Eduardo Leite Vieira; AZEVEDO, Luciano Cesar Pontes; PARK, Marcelo
- Respiratory failure after lung transplantation: extracorporeal membrane oxygenation as a rescue treatment(2012) PEGO-FERNANDES, Paulo Manuel; HAJJAR, Ludhmila Abrahao; GALAS, Filomena Regina Barbosa Gomes; SAMANO, Marcos Naoyuki; RIBEIRO, Alexandre Kazantzi Fonseca; PARK, Marcelo; SOARES, Rodolfo; OSAWA, Eduardo; JATENE, Fabio Biscegli
- Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support(2014) NUNES, Liane Brescovici; MENDES, Pedro Vitale; HIROTA, Adriana Sayuri; BARBOSA, Edzangela Vasconcelos; MACIEL, Alexandre Toledo; SCHETTINO, Guilherme Pinto Paula; COSTA, Eduardo Leite Vieira; AZEVEDO, Luciano Cesar Pontes; PARK, MarceloOBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1) optimization of extracorporeal membrane oxygenation blood flow; 2) identification of recirculation and cannula repositioning if necessary; 3) optimization of residual lung function and consideration of blood transfusion; 4) diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5) optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.
- Early diagnosis of acute kidney injury in a critically ill patient using a combination of blood and urinary physicochemical parameters(2012) MACIEL, Alexandre Toledo; PARK, Marcelo
- Timing of Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury(2016) BESEN, Bruno Adler Maccagnan Pinheiro; RANZANI, Otavio T.; PARK, Marcelo
- Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in Sao Paulo, Brazil - study protocol(2020) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno A. M. P.; MALBUISSON, Luiz M. S.; TANIGUCHI, Leandro U.; V, Pedro Mendes; V, Eduardo L. Costa; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; JR, Joao M. Silva; CARMONA, Maria Jose C.; CARVALHO, Carlos Roberto RibeiroOBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital's electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials. gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
- Sulfonamide-induced acute eosinophilic pneumonia requiring extracorporeal membrane oxygenation support: a case report(2023) SILVA, Ana Flávia Garcia; MELRO, Lívia Maria Garcia; BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro Vitale; PARK, Marcelo
- First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation(2012) PARK, Marcelo; AZEVEDO, Luciano Cesar Pontes; MENDES, Pedro Vitale; CARVALHO, Carlos Roberto Ribeiro; AMATO, Marcelo Brito Passos; SCHETTINO, Guilherme Paula Pinto; TUCCI, Mauro; MACIEL, Alexandre Toledo; TANIGUCHI, Leandro Utino; BARBOSA, Edzangela Vasconcelos Santos; NARDI, Raquel Oliveira; IGNACIO, Michelle de Nardi; MACHTANS, Claudio Cerqueira; NEVES, Wellington Alves; HIROTA, Adriana Sayuri; COSTA, Eduardo Leite VieiraOBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
- Effects of arterial oxygen tension and cardiac output on venous saturation: a mathematical modeling approach(2012) ZAMPIERI, Fernando Godinho; PARK, Marcelo; AZEVEDO, Luciano Cesar Pontes; AMATO, Marcelo Britto Passos; COSTA, Eduardo Leite VieiraOBJECTIVES: Hemodynamic support is aimed at providing adequate O-2 delivery to the tissues; most interventions target O-2 delivery increase. Mixed venous O-2 saturation is a frequently used parameter to evaluate the adequacy of O-2 delivery. METHODS: We describe a mathematical model to compare the effects of increasing O-2 delivery on venous oxygen saturation through increases in the inspired O-2 fraction versus increases in cardiac output. The model was created based on the lungs, which were divided into shunted and non-shunted areas, and on seven peripheral compartments, each with normal values of perfusion, optimal oxygen consumption, and critical O-2 extraction rate. O-2 delivery was increased by changing the inspired fraction of oxygen from 0.21 to 1.0 in steps of 0.1 under conditions of low (2.0 L.min(-1)) or normal (6.5 L.min(-1)) cardiac output. The same O-2 delivery values were also obtained by maintaining a fixed O-2 inspired fraction value of 0.21 while changing cardiac output. RESULTS: Venous oxygen saturation was higher when produced through increases in inspired O-2 fraction versus increases in cardiac output, even at the same O-2 delivery and consumption values. Specifically, at high inspired O-2 fractions, the measured O-2 saturation values failed to detect conditions of low oxygen supply. CONCLUSIONS: The mode of O-2 delivery optimization, specifically increases in the fraction of inspired oxygen versus increases in cardiac output, can compromise the capability of the ""venous O-2 saturation"" parameter to measure the adequacy of oxygen supply. Consequently, venous saturation at high inspired O-2 fractions should be interpreted with caution.