PEDRO CARUSO

(Fonte: Lattes)
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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: MARCOS VINICIUS FERNANDES GARCIA ×

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Agora exibindo 1 - 10 de 11
  • article 7 Citação(ões) na Scopus
    Outcomes and prognostic factors of decompensated pulmonary hypertension in the intensive care unit
    (2021) GARCIA, Marcos Vinicius Fernandes; SOUZA, Rogerio; COSTA, Eduardo Leite Vieira; FERNANDES, Caio Julio Cesar Santos; JARDIM, Carlos Viana Poyares; CARUSO, Pedro
    Background: Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay. Methods: Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality. Results: 73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU. Conclusions: High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%.
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    Echocardiographic Predictors of Mortality in Acute Decompensated Pulmonary Hypertension in the ICU
    (2019) MACEDO, B. R.; GARCIA, M.; SOUZA, R.; CARUSO, P.
  • article
    Renal Replacement Therapy in Patients With Acute Decompensated Pulmonary Hypertension Admitted to the Intensive Care Unit
    (2022) GARCIA, Marcos; SOUZA, Rogerio; CARUSO, Pedro
    Background: Pulmonary arterial hypertension and chronic thromboemholic pulmonary hypertension (PH) are characterized hemodynamically by pre-capillary PH. Acute worsening of systemic congestion and/or reduced right ventricular flow output in patients with pre-capillary PH characterizes an episode of acute decompensated PH. Acute kidney injury (AKI) is a common complication in this population and those patients frequently use renal replacement therapy (RRT). Predictors and timing for RRT in acute decompensated PH are unknown and mortality of patients who require this therapy is high. We hypothesize that AKI and hypervolemia are associated with use of RRT during episodes of acute decompensated PH in patients with pre-capillary PH requiring intensive care unit (ICU) admission. Aim: Explore variables associated with RRT use, develop a decision tree model to predict use of RRT in acute decompensated PH and analyze ICU, in-hospital and 90-days mortality in this population. Materials and methods: Multicenter retrospective cohort study including patients with pulmonary arterial hypertension and chronic thromboembolic PH with unplanned admission in the ICU for acute decompensated PH. Acute decompensated PH was defined by acute right ventricular failure leading to low cardiac output and elevated right ventricle filling pressures. We employed two multivariable logistic regression models using directed acyclic graphs to identify confounders. Unadjusted and adjusted odds ratios and 95% confidence intervals were used to measure the association between variables and RRT use. Results: Some 73 patients were included, 16.4% (n=12) of patients required RRT during ICU stay. In the univariate analysis, right atrial pressure (RAP) on last right heart catheterization, and creatinine upon ICU admission were associated with use of RRT and were included in the multivariable model and in the decision tree model. The decision tree model based on RAP and creatinine showed sensitivity of 58.3% and specificity of 100% with area under the receiver operating characteristic curve of 0.81 for predicting RRT use in the ICU. In-hospital mortality and 90-days mortality of patients who used RRT were higher than in patients that did not use RRT (75.0% vs. 34.4%, p < 0.01 and 83.3% vs. 42.6%, p = 0.01, respectively). Conclusion: The decision tree model based on creatinine upon admission and RAP, which is a surrogate of hypervolemia, can identify patients at risk for RRT. Increased ICU, in-hospital, and 90-days mortality were observed in patients with acute decompensated PH who used RRT in the ICU.
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  • article 0 Citação(ões) na Scopus
  • article 10 Citação(ões) na Scopus
    Implementation of Tele-ICU during the COVID-19 pandemic
    (2021) MACEDO, Bruno Rocha de; GARCIA, Marcos Vinicius Fernandes; GARCIA, Michelle Louvaes; VOLPE, Marcia; SOUSA, Mayson Laercio de Araujo; AMARAL, Talita Freitas; GUTIERREZ, Marco Antonio; BARBOSA, Antonio Pires; SCUDELLER, Paula Gobi; CARUSO, Pedro; CARVALHO, Carlos Roberto Ribeiro
    Objective: To describe the implementation of a Tele-ICU program during the COVID-19 pandemic, as well as to describe and analyze the results of the first four months of operation of the program. Methods: This was a descriptive observational study of the implementation of a Tele-ICU program, followed by a retrospective analysis of clinical data of patients with COVID-19 admitted to ICUs between April and July of 2020. Results: The Tele-ICU program was implemented over a four-week period and proved to be feasible during the pandemic. Participants were trained remotely, and the program had an evidence-based design, the objective being to standardize care for patients with COVID-19. More than 100,000 views were recorded on the free online platforms and the mobile application. During the study period, the cases of 326 patients with COVID-19 were evaluated through the program. The median age was 60 years (IQR, 49-68 years). There was a predominance of males (56%). There was also a high prevalence of hypertension (49.1%) and diabetes mellitus (38.4%). At ICU admission, 83.7% of patients were on invasive mechanical ventilation, with a median PaO2/FiO(2) ratio < 150. It was possible to use lung-protective ventilation in 75% of the patients. Overall, in-hospital mortality was 68%, and ICU mortality was 65%. Conclusions: Our Tele-ICU program provided multidisciplinary training to health care professionals and clinical follow-up for hundreds of critically ill patients. This public health care network initiative was unprecedented and proved to be feasible during the COVID-19 pandemic, encouraging the creation of similar projects that combine evidence-based practices, training, and Tele-ICU.
  • article 0 Citação(ões) na Scopus
  • article 1 Citação(ões) na Scopus
  • article 0 Citação(ões) na Scopus