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
23 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 23
- Diaphragmatic dysfunction evaluated by ultrasound correlates with dyspnea, exercise and quality of life in interstitial lung disease(2016) SANTANA, Pauliane; CARDENAS, Leticia; FERREIRA, Jeferson; IAMONTI, Vinicius; RAMOS, Ozires; JAEGER, Thomas; ALBUQUERQUE, Andre; CARVALHO, Carlos; CARUSO, Pedro
conferenceObject Diaphragmatic dysfunction in interstitial lung disease: An ultrasonography study(2014) SANTANA, Pauliane Vieira; PRINA, Elena; PLETSCH, Renata; FERREIRA, Jeferson; PEREIRA, Mayra Caleff; US, Andre Apanav; TREVISAN, Patricia; ALBUQUERQUE, Andre P.; CARVALHO, Carlos Roberto R.; CARUSO, Pedro- Comparison of thoracoabdominal synchrony using two methods in healthy subjects, chronic obstructive and interstitial lung disease(2016) PEREIRA, Mayra Caleffi; FERREIRA, Jeferson; IAMONTI, Vinicius; TREVISAN, Patricia; APANAVICIUS, Andre; SANTANA, Pauliane; CARDENAS, Leticia; CARVALHO, Carlos Roberto Ribeiro de; CARUSO, Pedro; ALBUQUERQUE, Andre Luis Pereira de
- Fragility index and fragility quotient in randomized clinical trials(2023) GARCIA, Marcos Vinicius Fernandes; FERREIRA, Juliana Carvalho; CARUSO, Pedro
- Renal Replacement Therapy in Patients With Acute Decompensated Pulmonary Hypertension Admitted to the Intensive Care Unit(2022) GARCIA, Marcos; SOUZA, Rogerio; CARUSO, PedroBackground: 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.
- In-hospital mortality and one-year survival of critically ill patients with cancer colonized or not with carbapenem-resistant gram-negative bacteria or vancomycin-resistant enterococci: an observational study(2023) NASSAR JUNIOR, Antonio Paulo; MISSIER, Giulia Medola Del; PRACA, Ana Paula Agnolon; SILVA, Ivan Leonardo Avelino Franca e; CARUSO, PedroBackgroundPatients with cancer are at risk of multidrug-resistant bacteria colonization, but association of colonization with in-hospital mortality and one-year survival has not been established in critically ill patients with cancer.MethodsUsing logistic and Cox-regression analyses adjusted for confounders, in adult patients admitted at intensive care unit (ICU) with active cancer, we evaluate the association of colonization by carbapenem-resistant Gram-negative bacteria or vancomycin-resistant enterococci with in-hospital mortality and one-year survival.ResultsWe included 714 patients and among them 140 were colonized (19.6%). Colonized patients more frequently came from ward, had longer hospital length of stay before ICU admission, had unplanned ICU admission, had worse performance status, higher predicted mortality upon ICU admission, and more hematological malignancies than patients without colonization. None of the patients presented conversion of colonization to infection by the same bacteria during hospital stay, but 20.7% presented conversion to infection after hospital discharge. Colonized patients had a higher in-hospital mortality compared to patients without colonization (44.3 vs. 33.4%; p < 0.01), but adjusting for confounders, colonization was not associated with in-hospital mortality [Odds ratio = 1.03 (0.77-1.99)]. Additionally, adjusting for confounders, colonization was not associated with one-year survival [Hazard ratio = 1.10 (0.87-1.40)].ConclusionsAdult critically ill patients with active cancer and colonized by carbapenem-resistant Gram-negative bacteria or vancomycin-resistant enterococci active cancer have a worse health status compared to patients without colonization. However, adjusting for confounders, colonization by carbapenem-resistant Gram-negative bacteria or vancomycin-resistant enterococci are not associated with in-hospital mortality and one-year survival.
- More than patient benefit: taking a broader view of ICU admission decisions(2023) BATTEN, Jason N.; CARUSO, Pedro; METAXA, Victoria
- Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients(2023) SILVA, Carla Marchini Dias; GERMANO, Janaina Naiara; COSTA, Anna Karolyne de Araujo; GENNARI, Giovanna Alves; CARUSO, Pedro; JR, Antonio Paulo NassarWe aimed to evaluate the characteristics, resource use and outcomes of critically ill patients with cancer according to appropriateness of ICU admission. This was a retrospective cohort study of patients with cancer admitted to ICU from January 2017 to December 2018. Patients were classified as appropriate, potentially inappropriate, or inappropriate for ICU admission according to the Society of Critical Care Medicine guidelines. The primary outcome was ICU length of stay (LOS). Secondary outcomes were one-year, ICU, and hospital mortality, hospital LOS and utilization of ICU organ support. We used logistic regression and competing risk models accounting for relevant confounders in primary outcome analyses. From 6700 admitted patients, 5803 (86.6%) were classified as appropriate, 683 (10.2%) as potentially inappropriate and 214 (3.2%) as inappropriate for ICU admission. Potentially inappropriate and inappropriate ICU admissions had lower likelihood of being discharged from the ICU than patients with appropriate ICU admission (sHR 0.55, 95% CI 0.49-0.61 and sHR 0.65, 95% CI 0.53-0.81, respectively), and were associated with higher 1-year mortality (OR 6.39, 95% CI 5.60-7.29 and OR 11.12, 95% CI 8.33-14.83, respectively). Among patients with appropriate, potentially inappropriate, and inappropriate ICU admissions, ICU mortality was 4.8%, 32.6% and 35.0%, and in-hospital mortality was 12.2%, 71.6% and 81.3%, respectively (p < 0.01). Use of organ support was more common and longer among patients with potentially inappropriate ICU admission. The findings of our study suggest that inappropriateness for ICU admission among patients with cancer was associated with higher resource use in ICU and higher one-year mortality among ICU survivors.
- Reply to: ""Mortality and prognostic factors in connective tissue disease-associated pulmonary arterial hypertension patients complicated with right heart failure""(2023) GARCIA, Marcos Vinicius Fernandes; SOUZA, Rogerio; CARUSO, Pedro
- Cancer-Related Characteristics Associated With Invasive Mechanical Ventilation or In-Hospital Mortality in Patients With COVID-19 Admitted to ICU: A Cohort Multicenter Study(2021) CARUSO, Pedro; TESTA, Renato Scarsi; FREITAS, Isabel Cristina Lima; PRACA, Ana Paula Agnolon; OKAMOTO, Valdelis Novis; SANTANA, Pauliane Vieira; COSTA, Ramon Teixeira; KAWASAKI, Alexandre Melo; FUMIS, Renata Rego Lins; ILLANES, Wilber Antonio Pino; COSTA, Eduardo Leite Vieira; MIDEGA, Thais Dias; CORREA, Thiago Domingos; CARVALHO, Fabricio Rodrigo Torres de; FERREIRA, Juliana CarvalhoBackgroundCoexistence of cancer and COVID-19 is associated with worse outcomes. However, the studies on cancer-related characteristics associated with worse COVID-19 outcomes have shown controversial results. The objective of the study was to evaluate cancer-related characteristics associated with invasive mechanical ventilation use or in-hospital mortality in patients with COVID-19 admitted to intensive care unit (ICU). MethodsWe designed a cohort multicenter study including adults with active cancer admitted to ICU due to COVID-19. Seven cancer-related characteristics (cancer status, type of cancer, metastasis occurrence, recent chemotherapy, recent immunotherapy, lung tumor, and performance status) were introduced in a multilevel logistic regression model as first-level variables and hospital was introduced as second-level variable (random effect). Confounders were identified using directed acyclic graphs. ResultsWe included 274 patients. Required to undergo invasive mechanical ventilation were 176 patients (64.2%) and none of the cancer-related characteristics were associated with mechanical ventilation use. Approximately 155 patients died in hospital (56.6%) and poor performance status, measured with the Eastern Cooperative Oncology Group (ECOG) score was associated with increased in-hospital mortality, with odds ratio = 3.54 (1.60-7.88, 95% CI) for ECOG =2 and odds ratio = 3.40 (1.60-7.22, 95% CI) for ECOG = 3 to 4. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with in-hospital mortality. ConclusionsIn patients with active cancer and COVID-19 admitted to ICU, poor performance status was associated with in-hospital mortality but not with mechanical ventilation use. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with invasive mechanical ventilation use or in-hospital mortality.
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