EDUARDO LEITE VIEIRA COSTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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- Quantitative analysis of pulmonary perfusion with dual-energy CT angiography: comparison of two quantification methods in patients with pulmonary embolism(2023) LEE, Hye Ju; WANDERLEY, Mark; RUBIN, Vivian Cardinal da Silva; ALCALA, Glasiele Cristina; COSTA, Eduardo Leite Vieira; PARGA, Jose Rodrigues; AMATO, Marcelo Britto PassosThe study aimed to evaluate a quantification method of pulmonary perfusion with Dual-Energy CT Angiography (DE-CTA) normalized by lung density in the prediction of outcome in acute pulmonary embolism (PE). In this prospective study with CTA scans acquired with different breathing protocols, two perfusion parameters were calculated: %PBV (relative value of PBV, expressed per unit volume) and PBVm (PBV normalized by lung density, expressed per unit mass). DE-CTA parameters were correlated with simplified pulmonary embolism severity index (sPESI) and with outcome groups, alone and in combinationwith tomographic right-to-left ventricular ratios (RV/LV). PBVm showed significant correlation with sPESI. PBVm presented higher accuracy than %PBV In the prediction of ICU admission or death in patients with PE, with the best performance when combined with RV/LV volumetric ratio.
bookPart 0 Citação(ões) na Scopus Noninvasive ventilation interface: Influence on patient-ventilator interaction(2020) TUCCI, M. R.; COSTA, E. L. V.; FERREIRA, J. C.; NAKAMURA, M. A. M.; SOUSA, M. L. de AraújoNoninvasive ventilation (NIV) is an efficient treatment for acute respiratory failure (ARF), especially for hypercapnic patients and those with congestive heart failure. In patients at high risk of extubation failure, NIV can also be used prophylactically to avoid reintubation. Unfortunately, NIV failure can occur in up to 40% of patients, half of the time due to issues associated with the interface. In this chapter, we discuss the performance of the NIV interfaces in adult patients with ARF, the factors associated with NIV failures and strategies to avoid interface problems. We discuss the use of different types of interface, including the oronasal mask, total-face mask, and helmet and we discuss on what conditions we favor the use of each one. Additionally, we detail the influence of the ventilator type, ventilator settings, and amount of leak on NIV tolerance. © 2020 Nova Science Publishers, Inc.- What is the optimal large airway size reduction value to determine malacia: exploratory bronchoscopic analysis in patients in Mounier-Kuhn syndrome(2021) LIMA, Evelise; GENTA, Pedro Rodrigues; ATHANAZIO, Rodrigo Abensur; RODRIGUES, Ascedio Jose; APARECIDA, Maria; NAKAMURA, Maria Aparecida Miyuki; RACHED, Samia Zahi; COSTA, Eduardo Leite Vieira; STELMACH, Rafael
- Determinants of Oxygen and Carbon Dioxide Transfer during Extracorporeal Membrane Oxygenation in an Experimental Model of Multiple Organ Dysfunction Syndrome(2013) PARK, Marcelo; COSTA, Eduardo Leite Vieira; MACIEL, Alexandre Toledo; SILVA, Debora Prudencio e; FRIEDRICH, Natalia; BARBOSA, Edzangela Vasconcelos Santos; HIROTA, Adriana Sayuri; SCHETTINO, Guilherme; AZEVEDO, Luciano Cesar PontesExtracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, p<0.001) and a negative association with premembrane PaCO2 (slope = -0.96, P = 0.001) and SatO(2) (slope = 21.7, p<0.001). Carbon dioxide transfer had a positive association with blood flow (slope = 17, p<0.001), gas flow (slope = 33, p<0.001), pre-membrane PaCO2 (slope = 1.2, p<0.001) and a negative association with the hemoglobin (slope = -3.478, P = 0.042). We found an increase in pH in the baseline from 7.50[7.46,7.54] to 7.60[7.55,7.65] (p<0.001), and during the MOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (p<0.001). Likewise, the PCO2 fell in the baseline from 35 [32,39] to 25 [22,27] mmHg (p<0.001), and during the MOF from 59 [47,91] to 34 [28,45] mmHg (p<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO(2) and CO2, while carbon dioxide transfer was affected by the gas flow, pre-membrane CO2 and hemoglobin.
- Outcomes and prognostic factors of decompensated pulmonary hypertension in the intensive care unit(2021) GARCIA, Marcos Vinicius Fernandes; SOUZA, Rogerio; COSTA, Eduardo Leite Vieira; FERNANDES, Caio Julio Cesar Santos; JARDIM, Carlos Viana Poyares; CARUSO, PedroBackground: Patients with acute decompensation of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) admitted to intensive care unit (ICU) have high in-hospital mortality. We hypothesized that pulmonary hypertension (PH) severity, measured by a simplified version of European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment, and the severity of organ dysfunction upon ICU admission, measured by sequential organ failure assessment score (SOFA) were associated with in-hospital mortality in decompensated patients with PAH and CTEPH. We also described clinical and laboratory variables during ICU stay. Methods: Observational study including adults with decompensated PAH or CTEPH with unplanned ICU admission between 2014 and 2019. Multivariate logistic regression models were used to evaluate the association of ESC/ERS risk assessment and SOFA score with in-hospital mortality. ESC/ERS risk assessment and SOFA score were included in a decision tree to predict in-hospital mortality. Results: 73 patients were included. In-hospital mortality was 41.1%. ESC/ERS high-risk group (adjusted odds ratio = 95.52) and SOFA score (adjusted odds ratio = 1.80) were associated with in-hospital mortality. The decision tree identified four groups with in-hospital mortality between 8.1% and 100%. Nonsurvivors had a lower central venous oxygen saturation, higher arterial lactate and higher brain natriuretic peptide in the end of first week in the ICU. Conclusions: High-risk on a simplified version of ERS/ESC risk assessment and SOFA score upon ICU admission are associate with in-hospital mortality. A decision tree based on ESC/ERS risk assessment and SOFA score identifies four groups with in-hospital mortality between 8.1% and 100%.
conferenceObject Knowledge In Mechanical Ventilation Among Internal Medicine Residents Before And After A Respiratory Icu Rotation(2016) AYRES, P. P. M. R.; MIETHKE-MORAIS, A.; COSTA, E. L. V.; CARUSO, P.; BARBAS, C. S. V.; CARVALHO, C. R.; FERREIRA, J. C.- Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: A systematic review and meta-analysis of current evidence(2013) ZAMPIERI, Fernando Godinho; MENDES, Pedro Vitale; RANZANI, Otavio T.; TANIGUCHI, Leandro Utino; AZEVEDO, Luciano Cesar Pontes; COSTA, Eduardo Leite Vieira; PARK, MarceloBackground: Extracorporeal membrane oxygenation (ECMO) for acute respiratory failure is still a matter of debate. Methods: We performed a structured search on Pubmed, EMBASE, Lilacs, and the Cochrane Library for randomized controlled trials and observational case-control studies with severity-paired patients, evaluating the use of ECMO on severe acute respiratory failure in adult patients. A random-effect model using DerSimonian and Laird method for variance estimator was performed to evaluate the effect of ECMO use on hospital mortality. Heterogeneity between studies was assessed with Cochran's Q statistic and Higgin's I-2. Results: Three studies were included on the metanalysis, comprising 353 patients in the main analysis, in which 179 patients were ECMO supported. One study was a randomized controlled trial and two were observational studies with a propensity score matching. The most common reason for acute respiratory failure was influenza H1N1 pneumonia (45%) and pneumonia (33%). ECMO was not associated with a reduction in hospital mortality (OR = 0.71; CI 95% = 0.34-1.47; P = 0.358). If alternative severity-pairing method presented by the two observational studies was included, a total of 478 cases were included, in which 228 received ECMO support. In the former analysis, ECMO had a benefit on hospital mortality (OR = 0.52; CI 95% = 0.35-0.76; P < 0.001). Conclusion: Extracorporeal membrane oxygenation benefit on hospital mortality is unclear. Results were sensitive to statistical analysis, and no definitive conclusion can be drawn from the available data. More studies are needed before the widespread use of ECMO can be recommended.
- Effect of Lowering V-T on Mortality in Acute Respiratory Distress Syndrome Varies with Respiratory System Elastance(2021) GOLIGHER, Ewan C.; V, Eduardo L. Costa; YARNELL, Christopher J.; BROCHARD, Laurent J.; STEWART, Thomas E.; TOMLINSON, George; BROWER, Roy G.; SLUTSKY, Arthur S.; AMATO, Marcelo P. B.Rationale: If the risk of ventilator-induced lung injury in acute respiratory distress syndrome (ARDS) is causally determined by driving pressure rather than by V-T, then the effect of ventilation with lower V-T on mortality would be predicted to vary according to respiratory system elastance (Ers). Objectives: To determine whether the mortality benefit of ventilation with lower V-T varies according to Ers. Methods: In a secondary analysis of patients from five randomized trials of lower-versus higher-V-T ventilation strategies in ARDS and acute hypoxemic respiratory failure, the posterior probability of an interaction between the randomized V-T strategy and Ers on 60-day mortality was computed using Bayesian multivariable logistic regression. Measurements and Main Results: Of 1,096 patients available for analysis, 416 (38%) died by Day 60. The posterior probability that the mortality benefit from lower-V-T ventilation strategies varied with Ers was 93% (posterior median interaction odds ratio, 0.80 per cm H2O/[ml/kg]; 90% credible interval, 0.63-1.02). Ers was classified as low (<2 cm H2O/[ml/kg], n=321, 32%), intermediate (2-3 cm H2O/[ml/kg], n=475, 46%), and high (>3 cm H2O/[ml/kg], n=224, 22%). In these groups, the posterior probabilities of an absolute risk reduction in mortality >= 1% were 55%, 82%, and 92%, respectively. The posterior probabilities of an absolute risk reduction >= 5% were 29%, 58%, and 82%, respectively. Conclusions: The mortality benefit of ventilation with lower V-T in ARDS varies according to elastance, suggesting that lungprotective ventilation strategies should primarily target driving pressure rather than V-T.
- F-18-FDG Kinetics Parameters Depend on the Mechanism of Injury in Early Experimental Acute Respiratory Distress Syndrome(2014) PROST, Nicolas de; FENG, Yan; WELLMAN, Tyler; TUCCI, Mauro R.; COSTA, Eduardo L.; MUSCH, Guido; WINKLER, Tilo; HARRIS, R. Scott; VENEGAS, Jose G.; CHAO, Wei; MELO, Marcos F. VidalPET with F-18-FDG allows for noninvasive assessment of regional lung metabolism reflective of neutrophilic inflammation. This study aimed at determining during early acute lung injury whether local F-18-FDG phosphorylation rate and volume of distribution were sensitive to the initial regional inflammatory response and whether they depended on the mechanism of injury: endotoxemia and surfactant depletion. Methods: Twelve sheep underwent homogeneous unilateral surfactant depletion (alveolar lavage) and were mechanically ventilated for 4 h (positive end-expiratory pressure, 10 cm H2O; plateau pressure, 30 cm H2O) while receiving intravenous endotoxin (lipopolysaccharide-positive [LPS+] group; n = 6) or not (lipopolysaccharide-negative group; n = 6). F-18-FDG PET emission scans were then acquired. F-18-FDG phosphorylation rate and distribution volume were calculated with a 4-compartment model. Lung tissue expression of inflammatory cytokines was measured using real-time quantitative reverse transcription polymerase chain reaction. Results: F-18-FDG uptake increased in LPS+ (P = 0.012) and in surfactant-depleted sheep (P < 0.001). These increases were topographically heterogeneous, predominantly in dependent lung regions, and without interaction between alveolar lavage and LPS. The increase of F-18-FDG uptake in the LPS+ group was related both to increases in the F-18-FDG phosphorylation rate (P < 0.05) and to distribution volume (P < 0.01). F-18-FDG distribution volume increased with infiltrating neutrophils (P < 0.001) and phosphorylation rate with the regional expression of IL-1 beta (P = 0.026), IL-8 (P = 0.011), and IL-10 (P = 0.023). Conclusion: Noninvasive F-18-FDG PET-derived parameters represent histologic and gene expression markers of early lung injury. Pulmonary metabolism assessed with F-18-FDG PET depends on the mechanism of injury and appears to be additive for endotoxemia and surfactant depletion. F-18-FDG PET may be a valuable imaging biomarker of early lung injury.
- Brazilian recommendations of mechanical ventilation 2013. Part 1(2014) CAVALCANTI, Alexandre Biasi; ISOLA, Alexandre Marini; GAMA, Ana Maria Casati; DUARTE, Antonio Carlos Magalhaes; VIANNA, Arthur; SERPA NETO, Ary; FARIAS, Augusto Manoel de Carvalho; BRAVIM, Bruno de Arruda; PINHEIRO, Bruno do Valle; MAZZA, Bruno Franco; CARVALHO, Carlos Roberto Ribeiro de; TOUFEN JUNIOR, Carlos; BARBAS, Carmen Silvia Valente; DAVID, Cid Marcos Nascimento; TANIGUCHI, Corine; MAZZA, Debora Dutra da Silveira; DRAGOSAVAC, Desanka; TOLEDO, Diogo Oliveira; COSTA, Eduardo Leite; CASER, Eliana Bemardete; SILVA, Eliezer; AMORIM, Fabio Ferreira; SADDY, Felipe; GALAS, Filomena Regina Barbosa Gomes; SILVA, Gisele Sampaio; MATOS, Gustavo Faissol Janot de; EMMERICH, Joao Claudio; VALIATTI, Jorge Luis dos Sanots; TELES, Jose Mario Vleira; VICTORINO, Josue Almeida; FERREIRA, Juliana Carvalho; PRODOMO, Luciana Passuello do Vale; HAJAR, Ludhmila Abrahao; MARTINS, Luiz Claudio; MALBOUISSON, Luiz Marcelo Sa; VARGAS, Mara Ambrosina de Oliveira; HOLANDA, Marcelo Alcantara; AMATO, Marcelo Brito Passos; PARK, Marcelo; JACOMELLI, Marcia; REIS, Marco Antonio Soares; TAVARES, Marcos; DAMASCENO, Marta Cristina Paulette; DAMASCENO, Moyzes Pinto Coelho Duarte; ASSUNCAO, Murillo Santucci Cesar; YOUSSEF, Nazah Cherif Mohamad; MESSEDER, Octavio; TEIXEIRA, Paulo Jose Zimmermann; CARUSO, Pedro; DUARTE, Pericles Almeida Delfino; EID, Raquel Caserta; RODRIGUES, Ricardo Goulart; JESUS, Rodrigo Francisco de; KAIRALLA, Ronald Adib; JUSTINO, Sandra; NEMER, Sergio Nogueira; ROMERO, Simone Barbosa; AMADO, Veronica MoreiraPerspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associacao de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in Sao Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.