ERICA ARANHA SUZUMURA

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LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: MARCELO BRITTO PASSOS AMATO ×

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  • article 92 Citação(ões) na Scopus
    Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: a systematic review and meta-analysis
    (2014) SUZUMURA, Erica Aranha; FIGUEIRO, Mabel; NORMILIO-SILVA, Karina; LARANJEIRA, Ligia; OLIVEIRA, Claudia; BUEHLER, Anna Maria; BUGANO, Diogo; AMATO, Marcelo Britto Passos; CARVALHO, Carlos Roberto Ribeiro; BERWANGER, Otavio; CAVALCANTI, Alexandre Biasi
    To assess the effects of alveolar recruitment maneuvers (ARMs) on clinical outcomes in patients with acute respiratory distress syndrome (ARDS). We conducted a search of the MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (from inception to July 2014) databases for all (i.e. no language restriction) randomized controlled trials (RCTs) evaluating the effects of ARMs versus no ARMs in adults with ARDS. Four teams of two reviewers independently assessed the eligibility of the studies identified during the search and appraised the risk of bias and extracted data from those which were assessed as meeting the inclusion criteria. Data were pooled using the random-effects model. Trial sequential analysis (TSA) was used to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome (in-hospital mortality). The GRADE system was used to rate the quality of evidence. Our database search identified ten RCTs (1,594 patients, 612 events) which satisfied the inclusion criteria. The meta-analysis assessing the effect of ARMs on in-hospital mortality showed a risk ratio (RR) of 0.84 [95 % confidence interval (CI) 0.74-0.95; I (2) = 0 %], although the quality of evidence was considered to be low due to the risk of bias in the included trials and the indirectness of the evidence-that is, ARMs were usually conducted together with other ventilatory interventions which may affect the outcome of interest. There were no differences in the rates of barotrauma (RR 1.11; 95 % CI 0.78-1.57; I (2) = 0 %) or need for rescue therapies (RR 0.76, 95 % CI 0.41-1.40; I (2) = 56 %). Most trials found no difference between groups in terms of duration of mechanical ventilation and length of stay in the intensive care unit and hospital. The TSA showed that the available evidence for the effect of ARMs on in-hospital mortality is precise in the case of a type I error of 5 %, but it is not precise with a type I error of 1 %. Although ARMs may decrease the mortality of patients with ARDS without increasing the risk for major adverse events, current evidence is not definitive. Large-scale ongoing trials addressing this question may provide data better applicable to clinical practice.
  • article 32 Citação(ões) na Scopus
    Understanding recruitment maneuvers
    (2016) SUZUMURA, Erica Aranha; AMATO, Marcelo Britto Passos; CAVALCANTI, Alexandre Biasi
  • article 27 Citação(ões) na Scopus
    Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial
    (2012) CAVALCANTI, Alexandre B.; BERWANGER, Otavio; AMATO, Marcelo B. P.; TALLO, Fernando S.; REZENDE, Ederlon A. C.; TELLES, Jose M. M.; ROMANO, Edson; GUIMARAES, Helio P.; REGENGA, Marisa M.; TAKAHASHI, Luzia N.; TEIXEIRA, Cassiano; OLIVEIRA, Roselaine P.; CARVALHO, Vitor O.; DIAZ-QUIJANO, Fredi A.; CARVALHO, Carlos R. R.; SUZUMURA, Erica A.; KODAMA, Alessandra A.; RIBEIRO, Gisele F. M.; ABREU, Matheus O.; OLIVEIRA, Ivonaldo M.; GUYATT, Gordon; FERGUSON, Niall; WALTER, Stephen; VASCONCELOS, Marcia O. M.; SEGUNDO, Valerio J.; FERRAZ, Iris L.; SILVA, Rosicley S.; OLIVEIRA FILHO, Wilson de; SILVA, Nelson B.; HEIREL, Debora C. B.; TAKATANI, Rodrigo R.; SOUSA NETO, Jefferson A.; NETO, Jeronimo C. B.; ALMEIDA, Samara D.; CHAMY, Gauco; GONCALVES NETO, Graciliano J. L.; DIAS, Alysson P.; SILVA, Rozangela R.; TAVARES, Roberta C.; SOUZA, Marcia L. V. D.; DECIO, Janaina C.; LIMA, Cyntia M. L. S.; FERREIRA NETO, Fleury; OLIVEIRA, Katia R.; DIAS, Polyana P. L. C.; BRANDAO, Andre L. S. B.; RAMOS JR., Joroastro E.; VASCONCELOS, Paula T.; FLORES, Dimitri G.; PINHEIRO FILHO, Gilvan R.; ANDRADE, Isaac G.; MARTINEZ, Amadeu; FRANCA, Gustavo G. P.; MONTEIRO, Livia L.; CORREIA, Emmanuel I. S.; RIBEIRO, Wagner; PEREIRA, Antonio J.; ANDRADE, Wandalvo; LEITE, Petronio A.; FETO, Jose E. Filgueira; HOLANDA, Marcelo A.; AMORIM, Fabio F.; MARGALHO, Silviano B.; DOMINGUES JR., Sergio M.; FERREIRA, Claiton S.; FERREIRA, Cassia M.; RABELO, Livia A.; DUARTE, Juliana N.; LIMA, Fernando B.; KAWAGUCHI, Ines A. L.; ARAUJO NETO, Jose A.; MAIA, Marcelo O.; CORREA, Fabiano G.; RIBEIRO, Rubens A. B.; CASER, Eliana; MOREIRA, Cora L. C. B.; MARCILINO, Antonielen; FALCAO, Jansen G.; JESUS, Karinne R.; TCHERNIAKOVISK, Leo; DUTRA, Victor G.; THOMPSON, Marlus M.; PIRAS, Claudio; GIUBERTI JR., Jonas; SILVA, Albano S.; SANTOS, Jose R. P.; POTRATZ, Jorge L.; PAULA, Ludmila N.; BOZI, Giovana G.; GOMES, Bruno C.; VASSALLO, Paula F.; ROCHA, Edson P.; LIMA, Maria H. B. S.; FERREIRA, Denise M.; GONCALVES, Fernanda A. F.; PEREIRA, Sheila A.; NOBREGA, Marciano S.; CAIXETA, Carlos R.; MORAES, Ana P. P.; CARVALHO, Alexandre G. R.; ALVES, Janine D.; CARVALHO, Frederico B.; MOREIRA, Fabiana B. R.; STARLING, Claudia M.; COUTO, Wivian A. D.; BITENCOURT, Wesley S.; PEIXOTO, Daniela C.; CARVALHO, Ivana L. V.; SILVA, Silvangela G. A.; FELIZARDO, Livia R. S. M.; NASCIMENTO, Francine J. Magalhaes; SANTOS, Priscila J. C. D.; ZANTA, Camila C.; MARTINS, Marcele F.; NAVES, Sergio A.; SILVA, Fabiano D.; LAUBE JR., Gilberto; GALVAO, Endi L.; SOUSA, Marcelo F.; SOUZA, Marcia M. F.; CARVALHO, Fernanda L. G.; BERGO, Ricardo R.; REZENDE, Claudnei M.; TAMAZATO, Edys Y.; SARAT JR., Saturnino Campo; ALMEIDA, Patricia S.; GORSKI, Anthony G.; MATSUI, Mirna; EBERHART NETO, Ervin; NOMOTO, Silmara H.; LIMA, Zildamara B.; INAGAKI, Alexandre S.; GIL, Fernando S. U.; ARAUJO, Mario F. A.; OLIVEIRA, Aline E.; CORREA, Tiago A.; MENDONCA, Angela; REIS, Helder; CARNEIRO, Saul R.; CASTANELO, Carlos; COELHO JR., Edward; AMARAL, Karine A. E. H.; REGO, Leila R. M.; CUNHA, Adenard F. C.; BARRA, Williams F.; CARNEIRO, Mauricio; BATISTA, Roseane A.; ZOGHBI, Karina K.; MACHADO, Nelma J. N.; FERREIRA, Reinaldo; APOENA, Pablo; LEAO, Rosangela M.; MARTINS, Eliauria R.; OLIVEIRA, Marcelo E.; ODIR, Isaura; KLEBER, Wladimy; TAVARES, Daniele; ARAUJO, Marcelo E. U.; BRILHANTE, Yuzeth Nobrega; TAVARES, Daniele C. C.; KLEBER, Wladmy; CARVALHO, Waneska L. N.; WINVELER, Georgia F. P.; CHAGAS FILHO, Aldir; CAVALCANTI, Raphael Ali; GRION, Cintia M. C.; REIS, Andrezza T. J. B.; FESTTI, Josiane; GIMENEZ, Francielli M. P.; LARANGEIRA, Alexandre S.; CARDOSO, Lucienne T. Q.; MEZZAROBA, Ana L.; GIANCURSI, Thiago S.; KAUSS, Ivanil A. M.; DUARTE, Pericles A. D.; TOZO, Tatiane C.; PELISER, Priscila; GERMANO, Almir; GURGEL, Sanderland J. T.; SILVA, Sandra R. B.; KURODA, Cristina M.; HEREK, Andrea; YAMADA, Sergio S.; SCHIAVETTO, Paulo M.; WYSOCKI, Natacha; MATSUBARA, Rosely R.; SALES JR., Joao A. L.; LAPROVITA, Maria P.; PENA, Felipe M.; SA, Alexandre; VIANNA, Arthur; VERDEAL, Juan C.; MARTINS, Gloria A.; SALGADO, Diamantino R.; COELHO, Adalberto M.; COELHO, Milena P. P. M.; MORONG, Aline S.; POQUIRIQUI, Rodolfo M. B.; FERREIRA, Ana P.; LUCENA, Debora N. L.; MARINO, Nathalia F.; MOREIRA, Monique A.; URATANI, Cristiana C. S.; SEVERINO, Marta A.; SILVA, Patricia N.; MEDEIROS, Luciana G.; CHAVES FILHO, Francisco G.; GUIMARAES, Daniela M. Q. S.; REZENDE, Valeria M. C.; CARBONELL, Roberto C. C.; TRINDADE, Renata S.; PELLEGRINI, Jose A. S.; BONIATTI, Marcio M.; SANTOS, Moreno C.; BOLDO, Rodrigo; OLIVEIRA, Vanessa M.; CORREA, Viviane M.; NEDEL, Wagner; SCHAICH, Felipe; TAGLIARI, Luciana; SAVI, Augusto; SCHULZ, Luis F.; MACCARI, Juara G.; SEEGER, Gabriela M.; FOERNGES, Rafael B.; RIEDER, Marcelo M.; BECKER, Daniel A.; BROILO, Fabiano P.; SCHWARZ, Patricia; ALENCASTRO, Andre; BERTO, Paula; BACKES, Fabiane; DIAS, Fernando S.; BLATTNER, Clarissa; MARTINS, Edna T. J.; SCAGLIA, Nris C.; VIEIRA, Silvia R. R.; PRADO, Karen F.; FIALKOW, Lea; FRANKE, Cristiano; VIEIRA, Debora F. V. B.; MORAES, Rafael B.; MARQUES, Leonardo S.; HOPF, Joao L. S.; WAWRZENIAK, Iuri C.; RECH, Tatiana H.; ALBUQUERQUE, Regis B.; GUERREIRO, Marcio O.; TEIXEIRA, Luciano O.; MACEDO, Pedro L.; BAINY, Marina P.; FERREIRA, Edgard V.; MARTINS, Marcio A.; ANDRADE, Luciana A. S.; MACHADO, Fernando O.; BURIGO, Ana C.; PINCELLI, Mariangela; KRETZER, Lara; MAIA, Israel S.; CORDEIRO, Rodrigo B.; WESTPHAL, Glauco; CALDEIRA, Milton; CRAMER, Amanda S.; DADAM, Michelli M.; BARBOSA, Pierry O.; BRILENGER, Caroline O.; HORNER, Marina B. W.; OLIVEIRA, Glauce L.; GERMINIANI, Bruno C.; TEIXEIRA, Cristina; DUARTE, Robson; ASSEF, Maria G. P. L.; ROSSO, Deorgelis; BIGOLIN, Rodrigo; VANZUITA, Raquel; PRADO, Luiz F. A.; OLIVEIRA, Andre L. V.; REIS, Diego L.; MORAIS, Mirene O.; BASTOS, Rafael S.; SANTANA, Hericalizandra S. R.; SILVA, Alline O.; CACAU, Lucas A. P.; ALMEIDA, Marilia S.; CANAVESSI, Hugo Schlebinger; NOGUEIRA, Eduardo E. F.; PAVIA, Caio L. P.; ARAUJO, Jose F.; LIRA, Jose A.; NIENSTEDT, Esteban C.; SMITH, Thiago C.; ROMANO, Marcelo; BARROS, Dalton; COSTA, Andre F.; TAKAHASHI, Luzia; WERNECK, Vinicius; FARRAN, Jorge; HENRIQUES, Lilian A.; MIURA, Claudia; LOPES, Renato D.; VENDRAME, Leticia S.; SANDRI, Priscila; GALASSI, Marcela S.; TOUFEN JR., Carlos; SANTIAGO, Roberta R. S.; HIROTA, Adriana S.; PARK, Marcelo; AZEVEDO, Luciano C. P.; MALBOUISON, Luiz M.; COSTA, Maristela C.; TANIGUCHI, Leandro; POMPILIO, Carlos E.; BARUZZI, Claudio; ANDRADE, Ana H. V.; TAIRA, Elisabete E.; TAINO, Bruno; OLIVEIRA, Clezio S.; SILVA, Anselmo C.; ISOLA, Alexandre; REZENDE, Ederlon; RODRIGUES, Ricardo G.; RANGEL, Vivian P. L.; LUZZI, Sergio; GIACOMASSI, Ivens W. S.; NASSAR JR., Antonio P.; SOUZA, Ana R.; RAHAL, Luciana; NUNES, Andre L.; GIANNINI, Fabio; MENESCAL, Brena; MORAIS, Jussara E. P.; TOLEDO, Diogo; MORSCH, Rafaela D.; MERLUZZI, Thalita; AMORIM, Denise S.; BASTOS, Ana C. A. G.; SANTOS, Patricia L.; SILVA, Sabrina F.; GALLEGO, Raquel C. N.; SANTOS, Gheisa D.; TUCCI, Mauro; COSTA, Ramon T.; SANTOS, Lucio S.; DEMARZO, Sergio E.; SCHETTINO, Guilherme P. P.; SUZUKI, Vivian C.; PATROCINIO, Ana C. L.; MARTINS, Mariana L.; PASSOS, Denise B. V. G.; CAPPI, Sylas B.; GONCALVES JR., Iran; BORGES, Marcos C.; LOVATO, Wilson; TAVARES, Marcel V.; MORALES, Daniela; MACHADO, Luis A. M. W.; TORRES, Franciele C. C.; GOMES, Tania M.; CERANTOLA, Rodrigo B.; GOIS, Aecio; MARRACCINI, Thiago; MARGARIDA, Kathia; CAVALCANTE, Eulalia; MACHADO, Flavia R.; MAZZA, Bruno F.; SANTANA, Heloisa B. Rossetti; MENDEZ, Vanessa M. F.; XAVIER, Patricia A.; RABELO, Melina V.; SCHIEVANO, Fabiana R.; PINTO, Walkyria A. M.; FRANCISCO, Renata S.; FERREIRA, Elaine M.; SILVA, Dafne C. B.; ARDUINI, Rodrigo G.; ALDRIGHI, Jose R.; AMARO, Andreson F.; CONDE, Katia A. P.; PEREIRA, Cesar A.; TARKIELTAUB, Elcio; OLIVER, Wilson R.; GUADALUPE, Erika G. L.; ACERBI, Paulo S. C.; TOMIZUKA, Carlos I.; OLIVEIRA, Tatiana A.; GEHA, Nadia N.; MECATTI, Giovana C.; PIOVESAN, Maysa Z. R.; SALOMAO, Maria C.; MORENO, Marcelo S.; ORSATTI, Vinicius N.; MIRANDA, Whiniton; RAY, Alexandre; GUERRA, Andre; BAPTISTA FILHO, Mario L. A.; FERREIRA JR., Firmino H.; VIERA FILHO, Edesio; CANZI, Regina A.; GIUBERTI, Adriana F. T.; GARCEZ, Melissa C. M.; PEDRO, A.; SALA, Andrea D.; SUGUITANI, Edmundo O.; KAZUE, Priscila; OLIVEIRA, Luiz R. C.; INFANTINI, Rodrigo M.; CARVALHO, Fabricio R. T.; ANDRADE, Lucia C.; SANTOS, Thiago M.; CARMONA, Cesar V.; FIGUEIREDO, Luciana C.; FALCAO, Antonio; DRAGOSAVAK, Desanka; NOGUEIRA FILHO, Wilson; LUNARDI, Maria C.; LAGO, Roberto; GATTI, Ciro; CHIASSO, Tatiana M.; SANTOS, Grazielle O.; SILVA, Aline C. F.; ARAUJO, Arthur C.; ORNELLAS, Izadora B.; VIEIRA, Vitor M.; HAJJAR, Ludhmila A.; FIGUEIREDO, Adelaide C.; DAMASCENO, Bruna; PIZARRO, Camilo; HINESTROSA, Alfredo; DIAZ-QUIJANO, Fredi A.; GARCIA L., Sandra M. C.; GONZALEZ C., Octavio; DIAZ S., Edgard; RAINERI, Santi M.; CORTEGIANI, Andrea
    Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.