WERTHER BRUNOW DE CARVALHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation(2023) LUGLIO, Michele; CARVALHO, Werther B. de; TANNURI, Uenis; TANNURI, Ana Cristina A.; MATSURA, Rodrigo Hideki; FRANCA, Gardenia Morais; DELGADO, Artur F.BackgroundSodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric patients undergoing liver transplantation are at risk of developing various electrolyte and biochemical abnormalities, with an impact on their postoperative outcomes.ObjectiveTo analyze the impacts of serum sodium and chloride levels on prognosis of Pediatric Liver Transplant receptors.MethodsThis was a retrospective analytical observational study performed in a single transplant reference center in Sao Paulo, Brazil. Included patients were pediatric patients who underwent liver transplantation between January 2015 and July 2019. Statistical regression analysis and General Estimating Equations analysis were performed to evaluate the impacts of sodium and chloride disturbances on the development of acute renal failure and mortality.ResultsA total of 143 patients were included in this study. The main diagnosis was Biliary Atresia (62.9%). Twenty-seven patients died (18.9%), and graft dysfunction was the main cause of death (29.6%). The only variable individually associated with 28-days mortality was PIM-3 score (HR 1.59, CI 95% 1.165-2.177, p = 0.004). Forty-one patients (28.6%) developed moderate or severe AKI. PIM-3 score (OR 3.052, 95% CI 1.56-5.97, p = 0.001), hypernatremia (OR 3.49, 95% CI 1.32-9.23, p = 0.012), and hyponatremia (OR 4.24, 95% CI 1.52-11.85, p = 0.006) were independently associated with the development of moderate/severe AKI.ConclusionsIn pediatric patients after liver transplantation, PIM-3 score, and abnormal serum sodium levels were correlated with AKI development.
- Selecting the Best Mortality Risk Scoring Systems in a PICU: A Difficult Decision(2013) ZANATTA, Graziela de A. C.; CARVALHO, Werther B.; DELGADO, Artur F.
- Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians(2014) GASPAR, Heloisa A.; MORHY, Samira S.; LIANZA, Alessandro C.; CARVALHO, Werther B. de; ANDRADE, Jose L.; PRADO, Rogerio R. do; SCHVARTSMAN, Claudio; DELGADO, Artur F.Background: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/ emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/ cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographers. The evaluations occurred after 8, 16 and 24 practical examinations. Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p = 0.004). The means of the differences between the students' and echocardiographers' measurements of the EF and CI were 7% and 0.56 L/min/m(2), respectively, after the third stage of training. Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians' technical skills and the care of critically ill patients.
- Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock(2018) BERMUDES, Ana Carolina G.; CARVALHO, Werther B. de; ZAMBERLAN, Patricia; MURAMOTO, Giovana; MARANHAO, Raul C.; DELGADO, Artur F.Objectives: Limited knowledge exists regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome. The aim of this study was to evaluate the relationship between the intensity of the inflammatory response and changes in the lipid profiles of critically ill pediatric patients admitted to a pediatric intensive care unit (PICU) with severe sepsis/septic shock. Methods: This was a prospective and observational study at a 15-bed PICU at a public university hospital. We analyzed the lipid profiles of 40 patients with severe sepsis/septic shock admitted to the PICU on the first and seventh days of hospitalization. C-reactive protein was used as a marker for systemic inflammation. Forty-two pediatric patients seen in the emergency department and without systemic inflammatory response syndrome were used to provide control values. Results: On day 1 of admission to the PICU, the patients had significantly lower levels of total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) as well as higher concentrations of triacylglycerols compared with the control group. There was a significant increase in the TC, HDL, LDL, and apolipoprotein levels from day 1 to day 7 of the study. Conclusions: During severe sepsis/septic shock, we found lower serum levels of lipoproteins and apolipoproteins, and these were negatively correlated with C-reactive protein. As the inflammatory response improved, the levels of TC, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation.
- Zinc Deficiency in Systemic Inflammatory Response Syndrome: Cause or Consequence?(2013) GASPAR, Heloisa Amaral; BARRETO, Ana Carolina; CARVALHO, Werther B.; DELGADO, Artur F.
- Iatrogenic pneumothorax: What can we do?(2015) PERON, Karma R.; TAMINATO, Monica; SANTOS, Maria Lucia B. M. dos; DELGADO, Artur F.; CARVALHO, Werther B. de
- Opioid tapering and weaning protocols in pediatric critical care units: a systematic review(2018) BICHAFF, Pedro; SETANI, Karina T.; MOTTA, Emiliana H. G.; DELGADO, Artur F.; CARVALHO, Werther B.; LUGLIO, MicheleOBJECTIVE: Opioid abstinence syndrome is common in the pediatric intensive care environment because sedation is often needed during the children's treatment. There is no specific guideline regarding the management of these patients; and lately, methadone is an important drug for the prevention of abstinence symptoms during the weaning of opioids. This study gathers the available research to establish the initial dose of methadone, the rate of taper and tools to recognize this syndrome and act promptly. METHODS: A systematic review was made from data of four different databases. Forty-nine articles of observational and experimental studies were selected based on the inclusion criteria (critical pediatric patients in acute use of opioids) and exclusion criteria (previous chronic use of opioids, other medications). The data regarding specific themes were separated in sections: initial dose of methadone, use of protocols in clinical practice, abstinence scales and adjuvant drugs. RESULTS: The articles showed a great heterogeneity of ways to calculate the initial dose of methadone. The pediatric intensive care units of the study had different weaning protocols, with a lower incidence of abstinence when a pre-defined sequence of tapering was used. The Withdrawal Assessment Tool - 1 was the most used scale for tapering the opioids, with good sensitivity and specificity for signs and symptoms. CONCLUSION: There is still little evidence of other medications that can help prevent the abstinence syndrome of opioids. This study tries to promote a better practice during opioid weaning.
- Dysnatremia After Neurosurgery: Which Is the Main Marker?(2015) FANTE, Alice L.; MAIA, Josiane C. S.; CARVALHO, Werther Brunow de; DELGADO, Artur F.
- Author's response re. ""Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock""(2019) BERMUDES, Ana Carolina G.; DELGADO, Artur F.; CARVALHO, Werther B. de
- What Is the Best Weight to Obtain Protective Mechanical Ventilation?(2019) SOUZA, Leonardo C. V. F. de; DELGADO, Artur F.; CARVALHO, Werther Brunow de