GUSTAVO HENRIQUE FRIGIERI VILELA
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject NONINVASIVE INTRACRANIAL PRESSURE PULSE MORPHOLOGY IN NEUROCRITICAL CARE(2023) BRASIL, Sergio; FRIGIERI, Gustavo; ROBBA, Chiara; TACCONE, Fabio- Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients(2023) BRASIL, Sergio; FRIGIERI, Gustavo; TACCONE, Fabio Silvio; ROBBA, Chiara; SOLLA, Davi Jorge Fontoura; NOGUEIRA, Ricardo de Carvalho; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson SilvaAnalysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. Intracranial hypertension (IHT) was defined by ICP > 20 mmHg. A total of 72 patients were included (mean age 39, 68% TBI). mICP and P2/P1 values were significantly correlated (r = 0.49, p < 0.001). P2/P1 ratio was significantly higher in patients with IHT and had an area under the receiving operator curve (AUROC) to predict IHT of 0.88 (95% CI 0.78-0.98). mICP and P2/P1 ratio was also significantly higher for ED group (n = 10) than the other groups. The AUROC of P2/P1 to predict ED was 0.71 [95% CI 0.53-0.87], and the threshold P2/P1 > 1.2 showed a sensitivity of 60% [95% CI 31-83%] and a specificity of 69% [95% CI 57-79%]. Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP.
- Application of non-invasive ICP waveform analysis in acute brain injury: Intracranial Compliance Scale(2023) FRIGIERI, Gustavo; ROBBA, Chiara; MACHADO, Fabio Santana; GOMES, Joao A. A.; BRASIL, Sergio
conferenceObject INTRACRANIAL PRESSURE WAVEFORM AND HYPERTENSION(2023) COSTA, Matheus Martins Da; LIMA, Lucas Monteiro; COSTA, Thiago Oliveira; ALVES, Ana Carolina Rodrigues; CORREIA, Mikaelle Costa; VITORINO, Priscila Valverde O.; SOUSA, Ana Luiza Lima; FRIGIERI, Gustavo; BARROSO, Weimar Kunz Sebba- Early prognostic value of non-invasive intracranial pressure methods in brain-injured patients(2022) ROBBA, Chiara; FRIGIERI, Gustavo; BRASIL, Sergio; TACCONE, Fabio S.
conferenceObject A NEW TOOL TO EVALUATE THE OPTIMAL ABP THROUGH THE INTRACRANIAL PRESSURE PULSE WAVEFORM(2023) NASSIF, Carlos; FRIGIERI, Gustavo- Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism(2023) FLATO, Uri Adrian Prync; PEREIRA, Barbara Cristina de Abreu; COSTA, Fernando Alvares; VILELA, Marcos Cairo; FRIGIERI, Gustavo; CAVALCANTE, Nilton Jose Fernandes; ALMEIDA, Samantha Longhi Simoes deNeuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.
- Intracranial pressure waveform in patients with essential hypertension(2023) COSTA, Matheus Martins da; SOUSA, Ana Luiza Lima; CORREIA, Mikaelle Costa; INUZUKA, Sayuri; COSTA, Thiago Oliveira; VITORINO, Priscila Valverde O.; PIZA, Polyana Vulcano de Toledo; FRIGIERI, Gustavo; COCA, Antonio; BARROSO, Weimar Kunz SebbaBackground: There is a strong association between hypertension and cerebrovascular diseases, but most of the mechanistic bases to justify this correlation remains misunderstood.Objective: To evaluate intracranial pressure waveform in long-term essential hypertensive patients with a non-invasive device, brain4care (b4c).Methods: Cross-sectional study in patients with hypertension. Office blood pressure was measured with an automatic oscillometric device. Intracranial pressure evaluation was acquired through a strain sensor that could detect and monitor nanometric skull bone displacements for each cardiac cycle. Under normal physiological conditions, P1 is greater than P2, and the normal P2/P1 ratio is <1. Time to peak (TTP) is the measurement in seconds of the beginning of waveform inscription until P1 and normal values are <0.20 s. The cut-off points >= 1.2 and >= 0.25 s were used to define intracranial hypertension (ICHT).Results: 391 consecutive patients were evaluated (75% female, mean age 64.3 +/- 12.0 years). Mean value of P2/P1 ratio was 1.18 +/- 0.25 and TTP 0.18 +/- 0.63 s The obtained P2/P1 ratios were divided in three categories according to results of previous studies of normalcy (<1.0), intracranial compliance disturbance (1.0-1.19) and ICHT (>= 1.2). Normal intracranial pressure was observed in 21.7% of patients, intracranial compliance disturbance in 32.7% and intracranial hypertension in 45.6%. Females showed a higher prevalence of ICHT (50.3%).Conclusion: The prevalence of 45.6% intra-cranial hypertension in patients with long-term hypertension, particularly in women, and in those over 65 years old, emphasizes the importance of evaluate intracranial pressure behaviour in these patients and raise a question concerning the real ability of cerebral autoregulation and vascular barriers to protect the brain.