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
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- Stress and substance abuse among workers during the COVID-19 pandemic in an intensive care unit: A cross-sectional study(2022) PESTANA, Diego Vinicius Santinelli; RAGLIONE, Dante; DALFIOR JUNIOR, Luiz; LIBERATTI, Caroline de Souza Pereira; BRAGA, Elisangela Camargo; EZEQUIEL, Vitor Augusto de Lima; ALVES, Adriana da Silva; MAURO, Juliana Gil; DIAS, Jose Omar de Araujo; MOREIRA, Paulo Thadeu Fantinato; MADUREIRA, Bruno Del Bianco; PAIVA, Lilian Petroni; LUCENA, Bruno Melo Nobrega de; SILVA JUNIOR, Joao Manoel; MALBOUISSON, Luiz Marcelo SaObjective Professionals working in intensive care units (ICUs) during the COVID-19 pandemic have been exposed to stressful situations and increased workload. The association between symptoms of traumatic stress disorders, substance abuse and personal/occupational characteristics of Brazilian COVID-19-ICU workers is still to be addressed. Our aim was to evaluate the prevalence of those conditions and to find if those associations exist. Methods In this observational, single-center, cross-sectional study, all professionals working in a COVID-19 ICU were invited to fill an anonymous form containing screening tools for traumatic stress disorders and substance abuse, and a section with questions regarding personal and occupational information. Results Three hundred seventy-six ICU professionals participated. Direct exposure to patients infected by COVID-19, history of relatives infected by COVID-19, and sex (female) were significantly associated with signs and symptoms of traumatic stress disorders. 76.5% of the participants had scores compatible with a diagnosis of traumatic stress disorders. Moreover, the prevalence of scores suggestive of Tobacco and Alcohol abuse were 11.7% and 24.7%, respectively. Conclusion ICU workers had significantly elevated scores on both screening forms. Providing psychosocial support to ICU professionals may prevent future problems with traumatic stress disorders or substance abuse.
bookPart O paciente cirúrgico de alto risco(2022) SILVA JR., João Manoel- The effects of vasopressors with and without dobutamine on haemodynamics, metabolism and gut injury during endotoxic shock in rabbits. A controlled study(2022) OLIVEIRA, Neymar E. de; GANDOLFI, Joelma V.; CONTRIM, Liga M.; PEREIRA, Roseli Aparecida Matheus; FERNANDES, Loraine D. O.; JR, Joao Manoel Silva; GOMES, Brenno C.; SORIANO, Francisco Garcia; LOBO, Suzana M.Background: Vasopressors increase arterial pressure but they may have deleterious effects on mesenteric blood flow. We aimed to evaluate the response of gut biomarkers and superior mesenteric blood flow to different vasopressors with and without dobutamine. Methods: Thirty New Zealand rabbits were included and randomly allocated to 5 groups: group A - sham group; group B - norepinephrine; group C - norepinephrine plus dobutamine; group D - vasopressin; and group E - vasopressin plus dobutamine. Mean arterial pressure (MAP) target was greater than 60 mmHg. Endotoxic shock was induced by intra venous injection of lipopolysaccharide (LPS) in four of the five groups. Aortic blood flow (Q(ao)), superior mesenteric artery flow (Q(SM)A) and lactate were measured after LPS injection. Enterocyte damage was evaluated by measurements of serum citrulline and intestinal fatty acid-binding protein (I-FABP) after 4 h. Results: The largest reduction in Q(ao) occurred in group D (64 +/- 17.3 to 38 +/- 7.5 mL min-1; P = 0.04). Q(SMA) also declined significantly in groups D and E and remained lower than in the other groups over 4 h (group D - baseline: 65 +/- 31; 1 h: 37 +/- 10; 2 h: 38 +/- 10; 3 h: 46 +/- 26; and 4 h: 48 +/- 15 mL min-1; P < 0.005; group E - baseline: 73 +/- 14; 1 h: 28 +/- 4.0; 2 h: 37 +/- 6.4; 3 h: 40 +/- 11; and 4 h: 48 +/- 11; P < 0.005; all in mL min-1). Serum citrulline was significantly lower in groups D (P = 0.014) and E (P = 0.019) in comparison to group A. The fluid administration regimen was similar in all groups. Conclusions: Vasopressin seems to negatively impact gut enterocyte function during endotoxic shock despite the association of an inodilator and adequate fluid replacement.
- Intraoperative fluid balance and cardiac surgery-associated acute kidney injury: a multicenter prospective study(2022) PALOMBA, Henrique; TREML, Ricardo E.; CALDONAZO, Tulio; KATAYAMA, Henrique T.; GOMES, Brenno C.; MALBOUISSON, Luiz M.S.; SILVA JUNIOR, João ManoelAbstract Background Recent data suggest the regime of fluid therapy intraoperatively in patients undergoing major surgeries may interfere in patient outcomes. The development of postoperative Acute Kidney Injury (AKI) has been associated with both Restrictive Fluid Balance (RFB) and Liberal Fluid Balance (LFB) during non-cardiac surgery. In patients undergoing cardiac surgery, this influence remains unclear. The study objective was to evaluate the relationship between intraoperative RFB vs. LFB and the incidence of Cardiac-Surgery-Associated AKI (CSA-AKI) and major postoperative outcomes in patients undergoing on-pump Coronary Artery Bypass Grafting (CABG). Methods This prospective, multicenter, observational cohort study was set at two high-complexity university hospitals in Brazil. Adult patients who required postoperative intensive care after undergoing elective on-pump CABG were allocated to two groups according to their intraoperative fluid strategy (RFB or LFB) with no intervention. Results The primary endpoint was CSA-AKI. The secondary outcomes were in-hospital mortality, cardiovascular complications, ICU Length of Stay (ICU-LOS), and Hospital LOS (H-LOS). After propensity score matching, 180 patients remained in each group. There was no difference in risk of CSA-AKI between the two groups (RR = 1.15; 95% CI, 0.85-1.56, p= 0.36). The in-hospital mortality, H-LOS and cardiovascular complications were higher in the LFB group. ICU-LOS was not significantly different between the two groups. ROCcurve analysis determined a fluid balance above 2500 mL to accurately predict in-hospital mortality. Conclusion Patients undergoing on-pump CABG with LFB when compared with patients with RFB present similar CSA-AKI rates and ICU-LOS, but higher in-hospital mortality, cardiovascular complications, and H-LOS.