PEDRO CARUSO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
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- Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout(2020) MATOS, Liane Brescovici Nunes de; FUMIS, Renata Rego Lins; NASSAR JUNIOR, Antonio Paulo; LACERDA, Fabio Holanda; CARUSO, PedroObjective: To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors. Background: There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied. Methods: Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory. Results: Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02). Conclusions: Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.
- Coexistent HIV infection is not associated with increased in-hospital mortality in critically ill patients with cancer(2020) CARVALHO, Fabricio Rodrigues Torres de; HO, Yeh-Li; JOELSONS, Daniel; NETO, Ary Serpa; CARUSO, Pedro
conferenceObject - Selected oncological patients may even restart cancer treatment after in-hospital cardiac arrest(2020) VANE, Matheus F.; PEREIRA, Sergio M.; NASSAR JUNIOR, Antonio Paulo; RANZANI, Otavio T.; CARUSO, Pedro
- Procalcitonin Clearance at 24, 48, 72, and 96 Hours and Mortality in Patients With Cancer and Sepsis: A Retrospective Cohort Study(2020) JR, Antonio Paulo Nassar; NASSIF, Beatriz Nicolau; SANTOS, Daniel Vitorio Veiga dos; CARUSO, PedroIntroduction: Previous studies have evaluated procalcitonin clearance (PCTc) as a marker of sepsis severity but at different time points and cutoffs. We aimed to assess the predictive performance of PCTc at different time points of sepsis management in patients with cancer. Methods: This retrospective cohort study included patients with cancer admitted to an intensive care unit between 2013 and 2016. We calculated PCTc at 24, 48, 72, and 96 hours after admission. Its predictive performance for hospital and 90-day mortality was analyzed with receiver operating characteristic curves and areas under the curves (AUCs). Sensitivity and specificity were calculated for different time points using different cutoffs. Results: We included 301 patients. Areas under the curves ranged from 0.62 for PCTc at 24 hours to 0.68 for PCTc at 72 and 96 hours for hospital mortality prediction, and from 0.61 for PCTc at 24 hours to 0.68 for PCTc at 72 hours for 90-day mortality prediction. For hospital mortality prediction, PCTc at 72 hours <= 80% showed the best sensitivity (96.0%; 95% confidence interval [CI]: 90.8%-98.7%), and PCTc at 96 hours <= 50% showed the best specificity (70.7%; 95% CI: 54.5%-83.9%). Conclusions: Procalcitonin clearance at 24, 48, 72, and 96 hours poorly predicted hospital and 90-day mortality. Therefore, daily PCT measurement should not be used to predict mortality for patients with cancer and sepsis.
- Impact of a respiratory ICU rotation on resident knowledge and confidence in managing mechanical ventilation(2020) HAYASHI, Fatima Kiyoko; AYRES, Pedro Paulo Marino Rodrigues; MORAIS, Anna Miethke; SOUSA, Mayson Laercio de Araujo; BARBAS, Carmen Silvia Valente; COSTA, Eduardo Leite Vieira; CARUSO, Pedro; FERREIRA, Juliana CarvalhoObjective: To develop and apply a competency-based test to assess learning among internal medicine residents during a respiratory ICU rotation at a university hospital. Methods: We developed a test comprising 19 multiple-choice questions regarding knowledge of mechanical ventilation (MV) and 4 self-assessment questions regarding the degree of confidence in the management of MV. The test was applied on the first and last day of a 30-day respiratory ICU rotation (pre-rotation and post-rotation, respectively). During the rotation, the residents had lectures, underwent simulator training, and shadowed physicians on daily bedside rounds focused on teaching MV management. Results: Fifty residents completed the test at both time points. The mean score increased from 6.9 +/- 1.2 (pre-rotation) to 8.6 +/- 0.8 (post-rotation; p < 0.001). On questions regarding the approach to hypoxemia, the recognition of patient-ventilator asynchrony, and the recognition of risk factors for extubation failure, the post-rotation scores were significantly higher than the pre-rotation scores. Confidence in airway management increased from 6% before the rotation to 22% after the rotation (p = 0.02), whereas confidence in making the initial MV settings increased from 31% to 96% (p < 0.001) and confidence in adjusting the ventilator modes increased from 23% to 77% (p < 0.001). Conclusions: We developed a competency-based test to assess knowledge of MV among residents before and after an rotation in a respiratory ICU. Resident performance increased significantly after the rotation, as did their confidence in caring for patients on MV.
- Diaphragmatic ultrasound: a review of its methodological aspects and clinical uses(2020) SANTANA, Pauliane Vieira; CARDENAS, Leticia Zumpano; ALBUQUERQUE, André Luis Pereira de; CARVALHO, Carlos Roberto Ribeiro de; CARUSO, PedroABSTRACT The diaphragm is the main muscle of respiration, acting continuously and uninterruptedly to sustain the task of breathing. Diaphragmatic dysfunction can occur secondary to numerous pathological conditions and is usually underdiagnosed in clinical practice because of its nonspecific presentation. Although several techniques have been used in evaluating diaphragmatic function, the diagnosis of diaphragmatic dysfunction is still problematic. Diaphragmatic ultrasound has gained importance because of its many advantages, including the fact that it is noninvasive, does not expose patients to radiation, is widely available, provides immediate results, is highly accurate, and is repeatable at the bedside. Various authors have described ultrasound techniques to assess diaphragmatic excursion and diaphragm thickening in the zone of apposition. Recent studies have proposed standardization of the methods. This article reviews the usefulness of ultrasound for the evaluation of diaphragmatic function, addressing the details of the technique, the main findings, and the clinical applications.
- Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country(2020) NASSAR JUNIOR, Antonio Paulo; TREVISANI, Mariane da Silva; BETTIM, Barbara Beltrame; ZAMPIERI, Fernando Godinho; JR, Jose Albani Carvalho; JR, Amilton Silva; FREITAS, Flavio Geraldo Rezende de; PINTO, Jorge Eduardo da Silva Soares; ROMANO, Edson; RAMOS, Silvia Regina; FARIA, Guilherme Brenande Alves; V, Ulysses Andrade e Silva; SANTOS, Robson Correa; TOMMASI, Edmundo de Oliveira; MORAES, Ana Paula Pierre de; CRUZ, Bruno Azevedo da; BOZZA, Fernando Augusto; CARUSO, Pedro; SALLUH, Jorge Ibrahin Figueira; SOARES, MarcioBackground Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). Methods This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. Results Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). Conclusions Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.
conferenceObject Sofa Score as a Predictor of In-Hospital Mortality After an Unplanned ICU Admission in Inoperable Chronic Thromboembolic Pulmonary Hypertension(2020) GARCIA, M.; SOUZA, R.; CARUSO, P.- Impact of Urgent Chemotherapy in Critically Ill Patients(2020) OLIVEIRA, Maria Cristina Franca de; FERREIRA, Juliana Carvalho; NASSAR JUNIOR, Antonio Paulo; DETTINO, Aldo Lourenco Abbade; CARUSO, PedroObjective: Compare the mortality between critically ill patients who received urgent chemotherapy for a cancer-related life-threatening complication with matched patients (controls) who did not received it. Design: Propensity score-matched retrospective study. Setting: Adult intensive care unit in an oncological hospital. Participants: All adults with solid tumor or hematological malignancies who received at least 1 day of urgent intravenous chemotherapy for a cancer-related life-threatening complication. Using the propensity score method adjusted for 10 variables, patients who received urgent chemotherapy were matched to patients who did not. Interventions: None. Main Outcomes Measures: Intensive care unit and hospital mortality. Results: Forty-seven patients (57% with solid tumors and 43% with hematological malignancies) who received urgent chemotherapy were matched to 94 controls. At intensive care unit admission, patients were similar except that those who received urgent chemotherapy were less likely to have received chemotherapy previously (36% vs 85%; P < .01). The intensive care unit (48.9% vs 23.4%; P < .01) and hospital (76.6% vs 46.8%; P < .01) mortality of the patients who received urgent chemotherapy was higher than the controls. The subgroup analysis showed that the higher mortality was limited to patients with solid tumor. Conclusion: The use of urgent chemotherapy is associated with an increase in the intensive care unit and hospital mortality of unselected critically ill patients with solid tumors but not in patients with hematological malignancies.