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
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Protection of cerebral microcirculation, mitochondrial function, and electrocortical activity by small-volume resuscitation with terlipressin in a rat model of haemorrhagic shock(2018) IDA, K. K.; CHISHOLM, K. I.; MALBOUISSON, L. M. S.; PAPKOVSKY, D. B.; DYSON, A.; SINGER, M.; DUCHEN, M. R.; SMITH, K. J.Background: During early treatment of haemorrhagic shock, cerebral perfusion pressure can be restored by small-volume resuscitation with vasopressors. Whether this therapy is improved with additional fluid remains unknown. We assessed the value of terlipressin and lactated Ringer's solution (LR) on early recovery of microcirculation, tissue oxygenation, and mitochondrial and electrophysiological function in the rat cerebral cortex. Methods: Animals treated with LR replacing three times (3LR) the volume bled (n = 26), terlipressin (n = 27), terlipressin plus 1LR (n = 26), 2LR (n = 16), or 3LR (n = 15) were compared with untreated (n = 36) and sham-operated rats (n = 17). In vivo confocal microscopy was used to assess cortical capillary perfusion, changes in tissue oxygen concentration, and mitochondrial membrane potential and redox state. Electrophysiological function was assessed by cortical somatosensory evoked potentials, spinal cord dorsum potential, and peripheral electromyography. Results: Compared with sham treatment, haemorrhagic shock reduced the mean (SD) area of perfused vessels [82% (SD 10%) vs 38% (12%); P<0.001] and impaired oxygen concentration, mitochondrial redox state [99% (4%) vs 59% (15%) of baseline; P<0.001], and somatosensory evoked potentials [97%(13%) vs 27%(19%) of baseline]. Administration of terlipressin plus 1LR or 2LR was able to recover these measures, but terlipressin plus 3LR or 3LR alone were not as effective. Spinal cord dorsum potential was preserved in all groups, but no therapy protected electromyographic function. Conclusions: Resuscitation from haemorrhagic shock using terlipressin with small-volume LR was superior to high-volume LR, with regard to cerebral microcirculation, and mitochondrial and electrophysiological functions.
- Ventilator-associated events as a quality indicator in intensive care units(2018) ALMEIDA, M. C. S. de; MEDEIROS, E. A. S.; AGENA, F.; OLIVEIRA, C. C.; SAWAMURA, M. V. Y.; COSTA, S. F.; CARMONA, M. J. C.; MALBOUISSON, L. M. de Sa
- Application of a pharmacokinetics-pharmacodynamics approach to the free propofol plasma levels during coronary artery bypass grafting surgery with hypothermic cardiopulmonary bypass(2018) SILVA-FILHO, Carlos R.; BARBOSA, Ricardo Antonio G.; SILVA- JR., Carlindo V.; MALBOUISSON, Luiz M. S.; CARMONA, Maria Jose C.; JORGE-SANTOS, Silvia Regina C.OBJECTIVES: The objective of this study was to apply a pharmacokinetics-pharmacodynamics approach to investigate the free propofol plasma levels in patients undergoing coronary artery bypass grafting under hypothermic conditions compared with the off-pump procedure. METHODS: Nineteen patients scheduled for on-pump coronary artery bypass grafting under hypothermic conditions (n=10) or the equivalent off-pump surgery (n=9) were anesthetized with sufentanil and propofol target-controlled infusion (2 mg/mL) during surgery. The propofol concentration was then reduced to 1 mu g/mL, and a pharmacokinetics-pharmacodynamics analysis using the maximum-effect-sigmoid model obtained by plotting the bispectral index values against the free propofol plasma levels was performed. RESULTS: Significant increases (two-to five-fold) in the free propofol plasma levels were observed in the patients subjected to coronary artery bypass grafting under hypothermic conditions. The pharmacokinetics of propofol varied according to the free drug levels in the hypothermic on-pump group versus the off-pump group. After hypothermic coronary artery bypass was initiated, the distribution volume increased, and the distribution half-life was prolonged. Propofol target-controlled infusion was discontinued when orotracheal extubation was indicated, and the time to patient extubation was significantly higher in the hypothermic on-pump group than in the off-pump group (459 versus 273 min, p=0.0048). CONCLUSIONS: The orotracheal intubation time was significantly longer in the hypothermic on-pump group than in the off-pump group. Additionally, residual hypnosis was identified through the pharmacokinetics-pharmacodynamics approach based on decreases in drug plasma protein binding in the hypothermic on-pump group, which could explain the increased hypnosis observed with this drug in this group of patients.
bookPart Trauma cranioencefálico e manejo da hipertensão intracraniana(2018) MIRANDA, Leandro Costa; COSTA, Luiz Guilherme Villares da; MALBOUISSON, Luis Marcelo de SáconferenceObject The Mechanical Ventilation Discontinuation Process and Unnecessary Days of Ventilation Analysis(2018) MOL, C. G.; AQUINO, M. A.; REIS, R. B.; OLIVEIRA, C. C.; SANTOS, L. B.; LUCENA, B. M.; MALBOUISSON, L. S.; TANAKA, C.- Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial(2018) AMENDOLA, Cristina Prata; SILVA-JR, Joao Manoel; CARVALHO, Taisa; SANCHES, Luciana Coelho; SILVA, Ulysses Vasconcelos de Andrade e; ALMEIDA, Rosana; BURDMANN, Emmanuel; LIMA, Emerson; BARBOSA, Fabiana Ferreira; FERREIRA, Renata Souza; CARMONA, Maria Jose C.; MALBOUISSON, Luiz Marcelo Sa; NOGUEIRA, Fernando A. M.; AULER-JUNIOR, Jose Otavio Costa; LOBO, Suzana MargarethOBJECTIVES: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goaldirected therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906. RESULTS: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p.0.001) compared to the control group (p.O.572). No significant differences in the change in serum creatinine level (p.0.96), persistence of acute kidney injury beyond 72h (p.0.064) or the need for renal replacement therapy (p.0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.
bookPart O paciente com trauma na UTI(2018) MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimaraes Morando Marzocchi; FERREIRA, César Biselli; MALBOUISSON, Luis Marcelo de SábookPart Previsão de indicação de cuidado intensivo no período pós-operatório(2018) RODRIGUES, Roseny dos Reis; MALBOUISSON, Luiz Marcelo Sá; CARMONA, Maria José CarvalhoconferenceObject Modified Diaphragmatic Breathing: An Alternative to Improve Diaphragmatic Mobility and Respiratory Function in Critically III Patients(2018) MOL, C. G.; AQUINO, M. A.; REIS, R. B.; OLIVEIRA, C. C.; LUCENA, B. M.; MALBOUISSON, L. S.; TANAKA, C.