LUIZ MARCELO SA MALBOUISSON
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
132 resultados
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- High versus low mean arterial pressure target in liver transplant patients. An open, controlled, single-center, randomized clinical trial - Protocol and methods (LIVER-PAM)(2023) PEDRO, Rodolpho Augusto de Moura; SCHARRANCH, Bruna Carla; ARAÚJO, Lucas de Oliveira; BRANDÃO, Luciana Severo; ANDRADE, Lúcia da Conceição; ANDRAUS, Wellington; D’ALBUQUERQUE, Luís Augusto Carneiro; MALBOUISSON, Luíz Marcelo SáABSTRACT Objective: To explain the rationale and protocol of the methods and analyses to be used in the LIVER-PAM randomized clinical trial, which seeks to understand whether a higher mean arterial pressure is capable of reducing the incidence of renal dysfunction postoperatively after liver transplantation. Methods: LIVER-PAM is an open-label, randomized, controlled, singlecenter clinical trial. Patients randomized to the intervention group will have a mean arterial pressure of 85 - 90mmHg in the initial 24 hours of postoperative management, while patients in the control group will have a mean arterial pressure of 65 - 70mmHg in the same period. A sample of 174 patients will be required to demonstrate a 20% reduction in the absolute incidence of renal dysfunction, with a power of 80% and an alpha of 0.05. Conclusion: If a 20% reduction in the absolute incidence of renal dysfunction in the postoperative period of liver transplantation is achieved with higher target mean arterial pressure in the first 24 hours, this would represent an inexpensive and simple therapy for improving current outcomes in the management of liver transplant patients. ClinicalTrials.gov Registry:NCT05068713
- Evaluation of hemodynamic effects of xenon in dogs undergoing hemorrhagic shock(2013) FRANCESCHI, Ruben C.; MALBOUISSON, Luiz; YOSHINAGA, Eduardo; AULER JR., Jose Otavio Costa; FIGUEIREDO, Luiz Francisco Poli de; CARMONA, Maria Jose C.OBJECTIVES: The anesthetic gas xenon is reported to preserve hemodynamic stability during general anesthesia. However, the effects of the gas during shock are unclear. The objective of this study was to evaluate the effect of Xe on hemodynamic stability and tissue perfusion in a canine model of hemorrhagic shock. METHOD: Twenty-six dogs, mechanically ventilated with a fraction of inspired oxygen of 21% and anesthetized with etomidate and vecuronium, were randomized into Xenon (Xe; n = 13) or Control (C; n = 13) groups. Following hemodynamic monitoring, a pressure-driven shock was induced to reach an arterial pressure of 40 mmHg. Hemodynamic data and blood samples were collected prior to bleeding, immediately after bleeding and 5, 20 and 40 minutes following shock. The Xe group was treated with 79% Xe diluted in ambient air, inhaled for 20 minutes after shock. RESULT: The mean bleeding volume was 44 mL.kg(-1) in the C group and 40 mL.kg(-1) in the Xe group. Hemorrhage promoted a decrease in both the cardiac index (p<0.001) and mean arterial pressure (p<0.001). These changes were associated with an increase in lactate levels and worsening of oxygen transport variables in both groups (p<0.05). Inhalation of xenon did not cause further worsening of hemodynamics or tissue perfusion markers. CONCLUSIONS: Xenon did not alter hemodynamic stability or tissue perfusion in an experimentally controlled hemorrhagic shock model. However, further studies are necessary to validate this drug in other contexts.
- The effects of acute kidney injury in a multicenter cohort of high-risk surgical patients(2021) KATAYAMA, Henrique Tadashi; GOMES, Brenno Cardoso; LOBO, Suzana Margareth Ajeje; CHAVES, Renato Carneiro de Freitas; CORREA, Thiago Domingos; ASSUNCAO, Murillo Santucci Cesar; SERPA NETO, Ary; MALBOUISSON, Luiz Marcelo Sa; SILVA, Joao ManoelBackground and objectives Patients who develop post-operative acute kidney injury (AKI) have a poor prognosis, especially when undergoing high-risk surgery. Therefore, the objective of this study was to evaluate the outcome of patients with AKI acquired after non-cardiac surgery and the possible risk factors for this complication. Methods A multicenter, prospective cohort study with patients admitted to intensive care units (ICUs) after non-cardiac surgery was conducted to assess whether they developed AKI. The patients who developed AKI were then compared to non-AKI patients. Results A total of 29 ICUs participated, of which 904 high-risk surgical patients were involved in the study. The occurrence of AKI in the post-operative period was 15.8%, and the mortality rate of post-operative AKI patients at 28 days was 27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95% CI 1.51-5.62; p = 0.001), and a higher length of ICU and hospital stay (p < 0.001). Independent factors for the risk of developing AKI were pre-operative anemia (OR = 7.01; 95% CI 1.69-29.07), elective surgery (OR = 0.45; 95% CI 0.21-0.97), SAPS 3 (OR = 1.04; 95% CI 1.02-1.06), post-operative vasopressor use (OR = 2.47; 95% CI 1.34-4.55), post-operative infection (OR = 8.82; 95% CI 2.43-32.05) and the need for reoperation (OR= 7.15; 95% CI 2.58-19.79). Conclusion AKI was associated with the risk of death in surgical patients and those with anemia before surgery, who had a higher SAPS 3, needed a post-operative vasopressor, or had a post-operative infection or needed reoperation were more likely to develop AKI post-operatively.
- Prediction of Early TBI Mortality Using a Machine Learning Approach in a LMIC Population(2020) AMORIM, Robson Luis; OLIVEIRA, Louise Makarem; MALBOUISSON, Luis Marcelo; NAGUMO, Marcia Mitie; SIMOES, Marcela; MIRANDA, Leandro; BOR-SENG-SHU, Edson; BEER-FURLAN, Andre; ANDRADE, Almir Ferreira De; RUBIANO, Andres M.; TEIXEIRA, Manoel Jacobsen; KOLIAS, Angelos G.; PAIVA, Wellingson SilvaBackground: In a time when the incidence of severe traumatic brain injury (TBI) is increasing in low- to middle-income countries (LMICs), it is important to understand the behavior of predictive variables in an LMIC's population. There are few previous attempts to generate prediction models for TBI outcomes from local data in LMICs. Our study aim is to design and compare a series of predictive models for mortality on a new cohort in TBI patients in Brazil using Machine Learning. Methods: A prospective registry was set in Sao Paulo, Brazil, enrolling all patients with a diagnosis of TBI that require admission to the intensive care unit. We evaluated the following predictors: gender, age, pupil reactivity at admission, Glasgow Coma Scale (GCS), presence of hypoxia and hypotension, computed tomography findings, trauma severity score, and laboratory results. Results: Overall mortality at 14 days was 22.8%. Models had a high prediction performance, with the best prediction for overall mortality achieved through Naive Bayes (area under the curve = 0.906). The most significant predictors were the GCS at admission and prehospital GCS, age, and pupil reaction. When predicting the length of stay at the intensive care unit, the Conditional Inference Tree model had the best performance (root mean square error = 1.011), with the most important variable across all models being the GCS at scene. Conclusions: Models for early mortality and hospital length of stay using Machine Learning can achieve high performance when based on registry data even in LMICs. These models have the potential to inform treatment decisions and counsel family members.
bookPart Tratamento de hipercalemia aguda(2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe Matheus- Trends in perioperative practices of high-risk surgical patients over a 10-year interval(2023) GOMES, Brenno Cardoso; LOBO, Suzana Margareth Ajeje; MALBOUISSON, Luiz Marcelo Sa; CHAVES, Renato Carneiro de Freitas; CORREA, Thiago Domingos; AMENDOLA, Cristina Prata; SILVA JUNIOR, Joao Manoel; BraSIS Res GrpIntroductionIn Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart.MethodsThe patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards.ResultsAfter matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery.ConclusionIn this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
conferenceObject A PRAGMATIC MULTI-CENTRE TRIAL ON INTRAOPERATIVE FLUID MANAGEMENT USING PULSE PRESSURE VARIATION IN HIGH-RISK PATIENTS(2014) MALBOUISSON, L. M. S.; SILVA JR., J. M.; CARMONA, M. J. C.; ASSUNCAO, M. C. S.; VALIATTI, J. L.; LOPES, M. R.; SIMOES, C. M.; MICHARD, E.; AULER JR., J. O. C.bookPart Apresentação(2023) MALBOUISSON, Luiz Marcelo SábookPart Protocolo de indicações e critérios de UTI(2014) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo de Sá; RIBAS, Amanda; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; BISELLI, Cesar; CATEBELOTTI, Fabiola; SANTOS, João Alexandre Dias e; SILVA JUNIOR, João Manoel; BASSI, Estêvão; CADAMURO, Filipe MatheusconferenceObject RESUSCITATION WITH FLUID OR TERLIPRESSLN DOES NOT INFLUENCE COAGULATION STATUS IN A MODEL OF SEVERE CONTROLLED HAEMORRHAGIC SHOCK(2012) SASAKI, A. T. C.; OTSUKI, D. A.; IDA, K. K.; AULER JR., J. O. C.; MALBOUISSON, L. M. S.