WELLINGSON SILVA PAIVA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina

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Autor: TEIXEIRA, Manoel Jacobsen × Autor e Coautores FMUSP-HC Normalizados: EDSON BOR-SENG SHU ×

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  • article 46 Citação(ões) na Scopus
    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 Silva
    Background: 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.
  • article 1 Citação(ões) na Scopus
    Transcranial Doppler: A Useful Tool to Predict Brain Death Still Not Confirmed by Clinical Assessment
    (2021) RONCONI, Karla de Almeida Lins; AMORIM, Robson Luis Oliveira de; JR, Fernando Mendes Paschoal; OLIVEIRA, Marcelo de Lima; NOGUEIRA, Ricardo de Carvalho; PAIVA, Wellingson Silva; GONCALVES, Daniel Buzaglo; FARIAS, Stephanie Ramos de; BRASIL, Sergio Paulo; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Background. Diagnosing brain death (BD) with accuracy and urgency is of great importance because an early diagnosis may guide the clinical management, optimize hospital beds, and facilitate organ transplantation. The clinical diagnosis of nonreactive and irreversible coma can be confirmed with additional tests. Among the complimentary exams that may testify brain circulatory arrest, transcranial Doppler (TCD) can be an option. It is a real-time, bedside, inexpensive, noninvasive method that assesses cerebral blood flow. In patients with suspected BD, especially those who are under sedative drugs, early diagnosis is imperative. The aim of the present study was to evaluate the role of TCD in predicting BD. Methods. One hundred consecutive comatose patients with a Glasgow Coma Scale score of less than 5, owing to different etiologies, were included. TCD was performed in all patients. The TCD operator was blinded for clinical and neurologic data. This study is in compliance with the Declaration of Helsinki. Results. Sixty-nine patients with TCD-brain circulatory collapse were diagnosed later with BD. Of the 31 patients with brain circulatory activity, 8 (25.8%) were clinically brain dead and 23 (74.2%) were alive. TCD showing brain circulatory collapse had a sensitivity of 89.6%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 74.2%. Conclusion. TCD is highly specific (100%) and sensitive (89.6%) as a method to confirm the clinical diagnosis of BD, even in patients under sedation. The possibility of patients presenting with cerebral circulatory activity and clinical diagnosis of BD was demonstrated to occur.
  • article 23 Citação(ões) na Scopus
    Improved Hemodynamic Parameters in Middle Cerebral Artery Infarction After Decompressive Craniectomy
    (2014) AMORIM, Robson Luis; ANDRADE, Almir Ferreira de; GATTAS, Gabriel S.; PAIVA, Wellingson Silva; MENEZES, Marcos; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Background and Purpose Decompressive craniectomy (DC) reduces mortality and improves functional outcome in patients with malignant middle cerebral artery infarction. However, little is known regarding the impact of DC on cerebral hemodynamics. Therefore, our goal was to study the hemodynamic changes that may occur in patients with malignant middle cerebral artery infarction after DC and to assess their relationship with outcomes. Methods Twenty-seven patients with malignant middle cerebral artery infarction who were treated with DC were studied. The perfusion CT hemodynamic parameters, mean transit time, cerebral blood flow, and cerebral blood volume were evaluated preoperatively and within the first 24 hours after DC. Results There was a global trend toward improved cerebral hemodynamics after DC. Preoperative and postoperative absolute mean transit times were associated with mortality at 6 months, and the ratio of post- and preoperative cerebral blood flow was significantly higher in patients with favorable outcomes than those with unfavorable outcomes. Patients who underwent surgery 48 hours after stroke, those with midline brain shift >10 mm, and those who were >55 years showed no significant improvement in any perfusion CT parameters. Conclusions DC improves cerebral hemodynamics in patients with malignant middle cerebral artery infarction, and the level of improvement is related to outcome. However, some patients did not seem to experience any additional hemodynamic benefit, suggesting that perfusion CT may play a role as a prognostic tool in patients undergoing DC after ischemic stroke.
  • article 12 Citação(ões) na Scopus
    Experimental rnodel of intracranial hypertension with continuous multiparametric monitoring in swine
    (2013) ANDRADE, Almir Ferreira de; SOARES, Matheus Schmidt; PATRIOTA, Gustavo Cartaxo; BELON, Alessandro Rodrigo; PAIVA, Wellingson Silva; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; NASCIMENTO, Clarissa Nobrega; NOLETO, Gustavo Sousa; ALVES JUNIOR, Aderaldo Costa; FIGUEIREDO, Eberval Gadelha; OTOCH, Jose Pinhata; TEIXEIRA, Manoel Jacobsen
    Objective: Intracranial hypertension (IN) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods: We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results: None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion: The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.
  • article 7 Citação(ões) na Scopus
    Estimation of intracranial pressure by ultrasound of the optic nerve sheath in an animal model of intracranial hypertension
    (2021) JENG, Brasil Chian Ping; ANDRADE, Almir Ferreira de; BRASIL, Sergio; BOR-SENG-SHU, Edson; BELON, Alessandro Rodrigo; ROBERTIS, Maira; DE-LIMA-OLIVEIRA, Marcelo; RUBIANO, Andres Mariano; GODOY, Daniel Agustin; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva
    Background: Ultrasound of the optic nerve sheath diameter (ONSD) has been used as a non-invasive and cost-effective bedside alternative to invasive intracranial pressure (ICP) monitoring. However, ONSD time-lapse behavior in intracranial hypertension (ICH) and its relief by means of either saline infusion or surgery are still unknown. The objective of this study was to correlate intracranial pressure (ICP) and ultrasonography of the optic nerve sheath (ONS) in an experimental animal model of ICH and deter-mine the interval needed for ONSD to return to baseline levels. Methods: An experimental study was conducted on 30 pigs. ONSD was evaluated by ultrasound at differ-ent ICPs generated by intracranial balloon inflation, saline infusion, and balloon deflation, and measured using an intraventricular catheter. Results: All variables obtained by ONS ultrasonography such as left, right, and average ONSD (AON) were statistically significant to estimate the ICP value. ONSD changed immediately after balloon inflation and returned to baseline after an average delay of 30 min after balloon deflation (p = 0.016). No statistical sig-nificance was observed in the ICP and ONSD values with hypertonic saline infusion. In this swine model, ICP and ONSD showed linear correlation and ICP could be estimated using the formula:-80.5 + 238.2 x AON. Conclusion: In the present study, ultrasound to measure ONSD showed a linear correlation with ICP, although a short delay in returning to baseline levels was observed in the case of sudden ICH relief.
  • article 9 Citação(ões) na Scopus
    Computed tomography angiography accuracy in brain death diagnosis
    (2020) BRASIL, Sergio; BOR-SENG-SHU, Edson; DE-LIMA-OLIVEIRA, Marcelo; TACCONE, Fabio Silvio; GATTAS, Gabriel; NUNES, Douglas Mendes; OLIVEIRA, Raphael A. Gomes de; TOMAZINI, Bruno Martins; TIERNO, Paulo Fernando; BECKER, Rafael Akira; BASSI, Estevao; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson da Silva; TEIXEIRA, Manoel Jacobsen; NOGUEIRA, Ricardo de Carvalho
    OBJECTIVE The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest. METHODS A unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score <= 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally. RESULTS A total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS. CONCLUSIONS CTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.
  • article 3 Citação(ões) na Scopus
    The influence of intracranial hypertension on static cerebral autoregulation
    (2020) DE-LIMA-OLIVEIRA, Marcelo; FERREIRA, Almir Andrade; BELON, Alessandro Rodrigo; SALINET, Angela Macedo; NOGUEIRA, Ricardo Carvalho; PING, Brasil Chian; PAIVA, Wellingson Silva; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Objectives To analyze the influences of mild and severe intracranial hypertension on cerebral autoregulation (CA). Patients and Methods Duroc piglets were monitored with an intracranial pressure (ICP) catheter. Intracranial hypertension was induced via infusion of 4 or 7 ml of saline solution by a bladder catheter that was inserted into the parietal lobe. The static cerebral autoregulation (sCA) index was evaluated via cerebral blood flow velocities (CBFv). Piglets with ICPs <= 25 and > 25 mmHg were considered as group 1 and 2, respectively. Continuous variables were evaluated using the Kolmogorov-Smirnov goodness-of-fit test. The main parameters were collected before and after ICH induction and compared using two-factor mixed-design ANOVAs with the factor of experimental group (mild and severe ICH). Results In group 1 (ICP <= 25 mmHg), there were significant differences in sCA (p= .01) and ICP (p= .0002) between the basal and balloon inflation conditions. In group 2 (ICP > 25 mmHg), there were significant differences in CBFv (p= .0072), the sCA index (p= .0001) and ICP (p= .00001) between the basal and balloon inflation conditions. Conclusion We conclude that ICH may have a direct effect on mild and severe sCA.
  • conferenceObject
    CORRELATION BETWEEN CHANGES IN GREY AND WHITE MATTER RADIODENSITY WITH PROGNOSIS AFTER CRANIOPLASTY
    (2014) OLIVEIRA, Arthur Maynart Pereira; AMORIM, Robson Luis Oliveira de; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; PASCHOAL JUNIOR, Fernando Mendes; BOR-SENG-SHU, Edson; COELHO, Fernanda; GATTAS, Gabriel Scarabotolo; ANGHINAH, Renato; TEIXEIRA, Manoel Jacobsen
  • article 0 Citação(ões) na Scopus
    Assessing ultrasonographic optic nerve sheath diameter in animal model with anesthesia regimens
    (2022) AZEVEDO, Maira de Robertis; DE-LIMA-OLIVEIRA, Marcelo; BELON, Alessandro Rodrigo; BRASIL, Sergio; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva; BOR-SENG-SHU, Edson
    Purpose: To determine the normal optical nerve sheath (ONS) diameter ultrasonography (ONSUS) and evaluate the possible effects of drugs on ONS diameter during anesthetic induction in healthy pigs. Methods: Healthy piglets were divided into three groups: a control group, that received xylazine and ketamine (X/K); other that received xylazine, ketamine and propofol (X/K/P); and a third group that received xylazine, ketamine, and thiopental (X/K/T). The sheath diameter was assessed by ultrasonography calculating the average of three measurements of each eye from the left and right sides. Results: 118 animals were anesthetized (49 X/K 33 X/K/P and 39 X/K/T). Mean ONS sizes on both sides in each group were 0.394 +/- 0.048 (X/K), 0.407 +/- 0.029 (X/K/P) and 0.378 +/- 0.042 cm (X/K/T) (medians of 0.400, 0.405 and 0.389, respectively). The ONS diameter varied from 0.287-0.512 cm (mean of 0.302 +/- 0.039 cm). For group X/K, the mean diameter was 0.394 +/- 0.048 cm. Significant differences in ONS sizes between the groups P and T (X/K/P > X/K/T, p = 0.003) were found. No statistically significant differences were detected when other groups were compared (X/K = X/K/P, p = 0.302; X/K = X/K/T, p = 0.294). Conclusion: Sedation with thiopental lead to significative ONS diameter reduction in comparison with propofol. ONSUS may be useful to evaluate responses to thiopental administration.
  • article 16 Citação(ões) na Scopus
    Neuropathic pain in patients with spinal cord injury: report of 213 patients
    (2013) TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva; ASSIS, Maruska Salles; FONOFF, Erich Talamoni; BOR-SENG-SHU, Edson; CECON, Angelo Daros
    Objective: Management of neuropathic pain following spinal cord injury (SCI) can be a frustrating experience for patients since it poses a therapeutic challenge. In this article the authors describe the clinical characteristics of a group of patients with pain after spinal cord injury. Methods: In this retrospective study, 213 patients with SCI and neuropathic pain were assessed. We analyzed clinical characteristics, treatment options, and pain intensity for these patients. Results: The main cause of SCI was spine trauma, which occurred in 169 patients, followed by tumors and infection, complete lesions were verified in 144 patients. In our study, patients with traumatic SCI and partial lesions seem to be presented with more intense pain; however, this was not statistically significant. Conclusions: Neuropathic pain is a common complaint in patients with SCI and presents a treatment challenge. Knowledge of the clinical characteristics of this group of patients may help determine the best approach to intervention.