JOAO MANOEL DA SILVA JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Individualised vancomycin doses for paediatric burn patients to achieve PK/PD targets(2013) GOMEZ, David S.; CAMPOS, Edvaldo V.; AZEVEDO, Rodrigo P. de; SILVA- JR., Joao Manoel da; FERREIRA, Marcus C.; SANCHES-GIRAUD, Cristina; SILVA- JR., Carlindo Vieira; SANTOS, Silvia R. C. J.Background: The objective of the study was to investigate vancomycin dose adjustment in pediatric burn patients by evaluating trough drug concentrations and the pharmacokinetic and pharmacodynamic (PK/PD) correlation. Methods: Study subjects included 13 patients who were 6.0 years old, 25 kg (median). with normal renal function. These had at least a 30% total burn surface area and inhalation injury were present in 7/13 patients. The patients were investigated prospectively. Plasma monitoring and PK assessments were performed by serial blood sample collections (30 sets). Only 0.2 mL of each plasma sample was required for our plasma measurements, which were made by high performance liquid chromatography. The vancomycin PK/PD target was set at AUC(0-24)(ss)/MIC > 400. Results: Trough values less than 10 mu g/mL were obtained in 16/30 sets (53%) as a consequence of increased plasma clearance and the apparent volume of distribution. The daily dose was subsequently increased from 43.4 +/- 9.0 mg/kg (mean +/- SD) to 98.0 +/- 17.9 mg/kg, p < 0.05. The PK/PD target was reached for pathogens with 0.5 mg/L, 1 mg/L, 2 mg/L and 4 mg/L MIC in 93.3% (28/30), 66.7% (20/30), 33.3% (10/30) and 3.3% (1/30) of the sets, respectively. Conclusions: To more rapidly achieve the PK/PD targets in pediatric burn patients with normal renal function, an initial dose of approximately 90-100 mg/kg/day is recommended; however, this higher dosage regimen should be further evaluated in this population in terms of efficacy and toxicity as well as in terms of achieving pharmacodynamic goals.
- The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study(2013) SILVA JR., Joao M.; OLIVEIRA, Amanda Maria Ribas Rosa de; NOGUEIRA, Fernando Augusto Mendes; VIANNA, Pedro Monferrari Monteiro; PEREIRA FILHO, Marcos Cruz; DIAS, Leandro Ferreira; MAIA, Vivian Paz Leao; NEUCAMP, Cesar de Souza; AMENDOLA, Cristina Prata; CARMONA, Maria Jose Carvalho; MALBOUISSON, Luiz M. SaIntroduction: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. Methods: We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. Results: The study included 479 patients. Mean age was 61.2 +/- 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 +/- 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P < 0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P < 0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P < 0.001), cardiovascular (63.2% vs. 39.6%, P < 0.001) and respiratory complications (34.3% vs. 11.6%, P < 0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). Conclusions: Patients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.
- Risk Factors for Perioperative Complications in Endoscopic Surgery with Irrigation(2013) SILVA JR., Joao Manoel; BARROS, Maria Alice; CHAHDA, Mena Aur L.; SANTOS, Igor Martins; MARUBAYASHI, Lauro Yoiti; MALBOUISSON, Luiz Marcelo SaBackground and objectives: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. Method: A cohort study of six months duration. Patients aged >= 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. Results: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively). When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048), serum sodium (OR = 0.962), and volume of irrigation fluid administered during surgery (OR = 1.001) were independent variables. Conclusion: The incidence of serious complications in endoscopic surgeries is high. Serum sodium at the end of the operation, amount of irrigation fluid, and age were strong independent factors associated with the problem. Thus, these factors must be taken into account in these surgeries.
- Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics(2013) SILVA JR., Joao Manoel; SANTOS, Sigrid De Sousa dosIntroduction: Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. Methods: A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU). Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6, interleukin-10 and TNF-alpha. Outcome measures were in-hospital and six-month mortality. Results: The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008). The main foci of infection in HIV-positive patients were pulmonary and abdominal (p = 0.001). Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4%) and Gram-positive cocci (36.4%) (p = 0.001). CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p = 0.005, and 1.19 vs. 4.06 ng/mL p = 0.04, respectively), with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p = 0.005), with moderate accuracy for predicting death (area under receiver-operating characteristic curve = 0.74). In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p = 0.03, and 58.3 vs. 27.3% p = 0.02, respectively). Conclusions: The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and inflammatory characteristics.