BRUNO ADLER MACCAGNAN PINHEIRO BESEN
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
13 resultados
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- Effect modification in a clinical trial should be assessed through interaction terms, not prognostic modelling (vol 48, pg 1122, 2022)(2022) ROEPKE, Roberta M. L.; MENDES, Pedro V.; CARDOZO JUNIOR, Luis C. M.; PARK, Marcelo; BESEN, Bruno A. M. P.
- Effect modification in a clinical trial should be assessed through interaction terms, not prognostic modelling(2022) ROEPKE, Roberta M. L.; MENDES, Pedro V.; CARDOZO JUNIOR, Luis C. M.; PARK, Marcelo; BESEN, Bruno A. M. P.
- Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients: Systematic Review and Meta-Analysis(2019) BESEN, Bruno Adler Maccagnan Pinheiro; ROMANO, Thiago Gomes; MENDES, Pedro Vitale; GALLO, Cesar Albuquerque; ZAMPIERI, Fernando Godinho; NASSAR JR., Antonio Paulo; PARK, MarceloObjective: Early initiation of renal replacement therapy (RRT) effect on survival and renal recovery of critically ill patients is still uncertain. We aimed to systematically review current evidence comparing outcomes of early versus late initiation of RRT in critically ill patients. Methods: We searched the Medline (via Pubmed), LILACS, Science Direct, and CENTRAL databases from inception until November 2016 for randomized clinical trials (RCTs) or observational studies comparing early versus late initiation of RRT in critically ill patients. The primary outcome was mortality. Duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), hospital LOS, and renal function recovery were secondary outcomes. Meta-analysis and trial sequential analysis (TSA) were used for the primary outcome. Results: Sixty-two studies were retrieved and analyzed, including 11 RCTs. There was no difference in mortality between early and late initiation of RRT among RCTs (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.52-1.19; I-2 = 63.1%). Trial sequential analysis of mortality across all RCTs achieved futility boundaries at both 1% and 5% type I error rates, although a subgroup analysis of studies including only acute kidney injury patients was not conclusive. There was also no difference in time on mechanical ventilation, ICU and hospital LOS, or renal recovery among studies. Early initiation of RRT was associated with reduced mortality among prospective (OR = 0.69; 95% CI: 0.49-0.96; I-2 = 85.9%) and retrospective (OR = 0.61; 95% CI: 0.41-0.92; I-2 = 90.9%) observational studies, both with substantial heterogeneity. However, subgroup analysis excluding low-quality observational studies did not achieve statistical significance. Conclusion: Pooled analysis of randomized trials indicates early initiation of RRT is not associated with lower mortality rates. The potential benefit of reduced mortality associated with early initiation of RRT was limited to low-quality observational studies.
bookPart Manejo da COVID-19 na Unidade de Terapia Intensiva(2022) BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro Vitale; NASSAR JUNIOR, Antonio Paulo; PARK, Marcelo; TANIGUCHI, Leandro Utino- Association of fasting in the first 72 h of intensive care unit stay with outcomes of critically ill patients(2023) CARDOZO JUNIOR, Luis Carlos Maia; BESEN, Bruno Adler Maccagnan Pinheiro; SANTOS, Yuri de Albuquerque Pessoa dos; MENDES, Pedro Vitale; PARK, MarceloBackground Whether fasting early in critical illness course is acceptable is not clear and high-quality data on this topic are lacking. To generate equipoise for future clinical trials and bring additional data to current literature, we compared outcomes of patients fasted during the first 72 h of intensive care unit (ICU) stay to patients receiving any nutrition support during this period. Methods Retrospective cohort study of a medical ICU from a tertiary academic center in Brazil. Adult patients treated between November 2017 and February 2022 with an ICU length of stay of >= 5 days were included. Baseline and daily data were retrieved from the prospectively collected administrative database. We did 1:1 propensity score matching to compare patients fasting for at least 72 h with controls. Primary outcome was hospital mortality and secondary outcomes were other resources' use. Results During the study period, 1591 patients were cared for in this ICU, of which 998 stayed >= 5 days. After excluding readmissions and propensity score matching, 93 patients in the fasting group were matched to 93 controls. Hospital mortality was similar between fasting and matched control groups (odds ratio = 1.04; 95% CI = 0.56-1.94; P > 0.99). Secondary outcomes were not different between groups, including length of stay, days on mechanical ventilation, and incidence of new infections. Conclusion Withholding nutrition support in the first 72 h of ICU stay was not associated with worse outcomes in this cohort of severe critically ill patients.
- Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study(2021) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno Adler Maccagnan Pinheiro; MALBOUISSON, Luiz Marcelo Sa; TANIGUCHI, Leandro Utino; MENDES, Pedro Vitale; COSTA, Eduardo Leite Vieira; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; SILVA-JR, Joao M.; CARMONA, Maria Jose Carvalho; CARVALHO, Carlos R. R.Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 +/- 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 +/- 1.3 mL/kg of ideal body weight, plateau pressure was 24 +/- 5 cmH(2)O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH(2)O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.
- Ultrasound-guided percutaneous dilatational tracheostomy: Going deep into the sea(2015) GOBATTO, Andre Luiz Nunes; BESEN, Bruno Adler Maccagnan Pinheiro; TIERNO, Paulo Fernando Guimaraes Morando Marzocchi; MENDES, Pedro Vitale; CADAMURO, Filipe; JOELSONS, Daniel; MELRO, Livia; PARK, Marcelo; MALBOUISSON, Luiz Marcelo Sa
bookPart Terapia substitutiva renal na UTI(2020) BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro VitalebookPart Manejo da COVID-19 na unidade de terapia intensiva(2023) BESEN, Bruno Adler Maccagnan Pinheiro; MENDES, Pedro Vitale; NASSAR JUNIOR, Antonio Paulo; PARK, Marcelo; TANIGUCHI, Leandro Utino- Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial(2016) GOBATTO, Andre Luiz Nunes; BESEN, Bruno A. M. P.; TIERNO, Paulo F. G. M. M.; MENDES, Pedro V.; CADAMURO, Filipe; JOELSONS, Daniel; MELRO, Livia; CARMONA, Maria J. C.; SANTORI, Gregorio; PELOSI, Paolo; PARK, Marcelo; MALBOUISSON, Luiz M. S.Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopy guidance. Recently, ultrasound has emerged as a potentially useful tool to assist PDT and reduce procedure-related complications. An open-label, parallel, non-inferiority randomized controlled trial was conducted comparing an ultrasound-guided PDT with a bronchoscopy-guided PDT in mechanically ventilated critically ill patients. The primary outcome was procedure failure, defined as a composite end-point of conversion to a surgical tracheostomy, unplanned associated use of bronchoscopy or ultrasound during PDT, or the occurrence of a major complication. A total of 4965 patients were assessed for eligibility. Of these, 171 patients were eligible and 118 underwent the procedure, with 60 patients randomly assigned to the ultrasound group and 58 patients to the bronchoscopy group. Procedure failure occurred in one (1.7 %) patient in the ultrasound group and one (1.7 %) patient in the bronchoscopy group, with no absolute risk difference between the groups (90 % confidence interval, -5.57 to 5.85), in the ""as treated"" analysis, not including the prespecified margin of 6 % for noninferiority. No other patient had any major complication in either group. Procedure-related minor complications occurred in 20 (33.3 %) patients in the ultrasound group and in 12 (20.7 %) patients in the bronchoscopy group (P = 0.122). The median procedure length was 11 [7-19] vs. 13 [8-20] min (P = 0.468), respectively, and the clinical outcomes were also not different between the groups. Ultrasound-guided PDT is noninferior to bronchoscopy-guided PDT in mechanically ventilated critically ill patients.