SERGIO BRASIL TUFIK
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- Evaluation of cerebral hemodynamics by transcranial Doppler ultrasonography and its correlation with intracranial pressure in an animal model of intracranial hypertension(2022) SOARES, Matheus Schmidt; ANDRADE, Almir Ferreira de; BRASIL, Sergio; DE-LIMA-OLIVEIRA, Marcelo; BELON, Alessandro Rodrigo; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo de Carvalho; GODOY, Daniel Agustin; PAIVA, Wellingson SilvaBackground: Transcranial Doppler has been tested in the evaluation of cerebral hemodynamics as a non-invasive assessment of intracranial pressure (ICP), but there is controversy in the literature about its actual benefit and usefulness in this situation. Objective: To investigate cerebral blood flow assessed by Doppler technique and correlate with the variations of the ICP in the acute phase of intracranial hypertension in an animal model. Methods:An experimental animal model of intracranial hypertension was used. The experiment consisted of two groups of animals in which intracranial balloons were implanted and inflated with 4 mL (A) and 7 mL (B) for controlled simulation of different volumes of hematoma. The values of ICP and Doppler parameters (systolic [FVs], diastolic [FVd], and mean [FVm] cerebral blood flow velocities and pulsatility index [PI]) were collected during the entire procedure (before and during hematoma simulations and venous hypertonic saline infusion intervention). Comparisons between Doppler parameters and ICP monitoring were performed. Results: Twenty pigs were studied, 10 in group A and 10 in group B. A significant correlation between PI and ICP was obtained, especially shortly after abrupt elevation of ICP. There was no correlation between ICP and FVs, FVd or FVm separately. There was also no significant change in ICP after intravenous infusion of hypertonic saline solution. Conclusions:These results demonstrate the potential of PI as a parameter for the evaluation of patients with suspected ICP elevation.
- A Novel Noninvasive Technique for Intracranial Pressure Waveform Monitoring in Critical Care(2021) BRASIL, Sergio; SOLLA, Davi Jorge Fontoura; NOGUEIRA, Ricardo de Carvalho; TEIXEIRA, Manoel Jacobsen; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson da SilvaBackground: We validated a new noninvasive tool (B4C) to assess intracranial pressure waveform (ICPW) morphology in a set of neurocritical patients, correlating the data with ICPW obtained from invasive catheter monitoring. Materials and Methods: Patients undergoing invasive intracranial pressure (ICP) monitoring were consecutively evaluated using the B4C sensor. Ultrasound-guided manual internal jugular vein (IJV) compression was performed to elevate ICP from the baseline. ICP values, amplitudes, and time intervals (P2/P1 ratio and time-to-peak [TTP]) between the ICP and B4C waveform peaks were analyzed. Results: Among 41 patients, the main causes for ICP monitoring included traumatic brain injury, subarachnoid hemorrhage, and stroke. Bland-Altman's plot indicated agreement between the ICPW parameters obtained using both techniques. The strongest Pearson's correlation for P2/P1 and TTP was observed among patients with no cranial damage (r = 0.72 and 0.85, respectively) to the detriment of those who have undergone craniotomies or craniectomies. P2/P1 values of 1 were equivalent between the two techniques (area under the receiver operator curve [AUROC], 0.9) whereas B4C cut-off 1.2 was predictive of intracranial hypertension (AUROC 0.9, p < 000.1 for ICP > 20 mmHg). Conclusion: B4C provided biometric amplitude ratios correlated with ICPW variation morphology and is useful for noninvasive critical care monitoring.
- Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study(2021) BRASIL, Sergio; TACCONE, Fabio Silvio; WAYHS, Samia Yasin; TOMAZINI, Bruno Martins; ANNONI, Filippo; FONSECA, Sergio; BASSI, Estevao; LUCENA, Bruno; NOGUEIRA, Ricardo De Carvalho; DE-LIMA-OLIVEIRA, Marcelo; BOR-SENG-SHU, Edson; PAIVA, Wellingson; TURGEON, Alexis Fournier; TEIXEIRA, Manoel Jacobsen; MALBOUISSON, Luiz Marcelo SaIntroduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00-1.28] vs. 1.00 [0.88-1.16]; p = 0.03) and eICP (14 [11-25] vs. 11 [7-15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8-12] vs. 6 [5-7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75-0.97); a score > 8.5 had 63 (46-77)% sensitivity and 87 (62-97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5-31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.
bookPart Doppler transcraniano(2021) NOGUEIRA, Ricardo de Carvalho; AZEVEDO, Daniel Silva de; BRASIL, Sérgio; BOR-SENG-SHU, Edson- Decompressive craniectomy in TBI: What is beyond static evaluations in terms of prognosis?(2018) BRASIL, Sergio; PAIVA, Wellingson Silva; NOGUEIRA, Ricardo de Carvalho; SALINET, Angela Macedo; TEIXEIRA, Manoel Jacobsen
conferenceObject TRANSCRANIAL DOPPLER PULSATILITY INDEX ACCURACY ON THE INDICATION OF IMPAIRED CEREBRAL COMPLIANCE(2017) BRASIL, S.; DE-LIMA-OLIVEIRA, M.; NOGUEIRA, R.; PAIVA, W.; BOR-SENG-SHU, E.; TEIXEIRA, M. Jacobsen- Obesity and its implications on cerebral circulation and intracranial compliance in severe COVID-19(2021) BRASIL, Sergio; RENCK, Alessandra Covallero; TACCONE, Fabio Silvio; SOLLA, Davi Jorge Fontoura; TOMAZINI, Bruno Martins; WAYHS, Samia Yasin; FONSECA, Sergio; BASSI, Estevao; LUCENA, Bruno; NOGUEIRA, Ricardo De Carvalho; PAIVA, Wellingson; TEIXEIRA, Manoel Jacobsen; COSTA, Elaine Maria Frade; MALBOUISSON, Luiz Marcelo SaObjective: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID-19. Thus, the hypothesis of severe acute respiratory syndrome (SARS) conducing to cerebral hemodynamic disorders (CHD) able to worsen ICCI and play an additional role on prognosis determination for COVID-19 among obese patients becomes suitable. Methods: 50 cases of SARS by COVID-19 were evaluated, for the presence of ICCI and cerebrovascular circulatory disturbances in correspondence with whether unfavorable outcomes (death or impossibility for mechanical ventilation weaning [MVW]) within 7 days after evaluation. The objective was to observe whether obese patients (BMI >= 30) disclosed worse outcomes and tests results compared with lean subjects with same clinical background. Results: 23 (46%) patients among 50 had obesity. ICCI was verified in 18 (78%) obese, whereas in 13 (48%) of 27 non-obese (p = 0,029). CHD were not significantly different between groups, despite being high prevalent in both. 69% unfavorable outcomes were observed among obese and 44% for lean subjects (p = 0,075). Conclusion: In the present study, intracranial compliance impairment was significantly more observed among obese subjects and may have contributed for SARS COVID-19 worsen prognosis.
- Determination of Brain Death(2021) BRASIL, Sergio; NOGUEIRA, Ricardo de Carvalho; DE-LIMA-OLIVEIRA, Marcelo