ROSANA ELY NAKAMURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
3 resultados
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- Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial(2017) BERGAMIN, Fabricio S.; ALMEIDA, Juliano P.; LANDONI, Giovanni; GALAS, Filomena R. B. G.; FUKUSHIMA, Julia T.; FOMINSKIY, Evgeny; PARK, Clarice H. L.; OSAWA, Eduardo A.; DIZ, Maria P. E.; OLIVEIRA, Gisele Q.; FRANCO, Rafael A.; NAKAMURA, Rosana E.; ALMEIDA, Elisangela M.; ABDALA, Edson; FREIRE, Maristela P.; FILHO, Roberto K.; AULER JR., Jose Otavio C.; HAJJAR, Ludhmila A.Objective: To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock. Design: Single center, randomized, double-blind controlled trial. Setting: Teaching hospital. Patients: Adult cancer patients with septic shock in the first 6 hours of ICU admission. Interventions: Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay. Measurements and Main Results: Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0-3] vs 0 [0-2] unit; p<0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53-1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53-0.97; p = 0.03). Conclusions: We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.
article 0 Citação(ões) na Scopus Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery: The VANCS Randomized Controlled Trial (vol 126, pg 85, 2017)(2017) HAJJAR, L. A.; VINCENT, J. L.; GALAS, Barbosa Gomes F. R.; RHODES, A.; LANDONI, G.; OSAWA, E. A.; MELO, R. R.; SUNDIN, M. R.; GRANDE, S. M.; GAIOTTO, F. A.; POMERANTZEFF, P. M.; DALLAN, L. O.; FRANCO, R. A.; NAKAMURA, R. E.; LISBOA, L. A.; ALMEIDA, J. P. de; GERENT, A. M.; SOUZA, D. H.; GAIANE, M. A.; FUKUSHIMA, J. T.; PARK, C. L.; ZAMBOLIM, C.; FERREIRA, Rocha G. S.; STRABELLI, T. M.; FERNANDES, F. L.; CAMARA, L.; ZEFERINO, S.; SANTOS, V. G.; PICCIONI, M. A.; JATENE, F. B.; AULER JR., Costa J. O.; FILHO, R. K.- Vasopressin versus Norepinephrine in Patients with Vasoplegic Shock after Cardiac Surgery The VANCS Randomized Controlled Trial(2017) HAJJAR, Ludhmila Abrahao; VINCENT, Jean Louis; GALAS, Filomena Regina Barbosa Gomes; RHODES, Andrew; LANDONI, Giovanni; OSAWA, Eduardo Atsushi; MELO, Renato Rosa; SUNDIN, Marcia Rodrigues; GRANDE, Solimar Miranda; GAIOTTO, Fabio A.; POMERANTZEFF, Pablo Maria; DALLAN, Luis Oliveira; FRANCO, Rafael Alves; NAKAMURA, Rosana Ely; LISBOA, Luiz Augusto; ALMEDIA, Juliano Pinheiro de; GERENT, Aline Muller; SOUZA, Dayenne Hianae; GAIANE, Maria Alice; FUKUSHIMA, Julia Tizue; PARK, Clarice Lee; ZAMBOLIM, Cristiane; FERREIRA, Graziela Santos Rocha; STRABELLI, Tania Mara; FERNANDES, Felipe Lourenco; CAMARA, Ligia; ZEFERINO, Suely; SANTOS, Valter Garcia; PICCIONI, Marilde Albuquerque; JATENE, Fabio Biscegli; AULER JR., Jose Otavio Costa; KALIL FILHO, RobertoBackground: Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome. Methods: This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l.min(-1).m(-2)) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 mu g/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days. Results: A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction. Conclusions: The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.