EDUARDO LEITE VIEIRA COSTA

(Fonte: Lattes)
Índice h a partir de 2011
26
Lattes
ResearcherID
ORCID
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

Filtros

Mostrar mais
Limpar filtros

Configurações

Autor: AMATO, Marcelo B. P. ×

Resultados de Busca

Agora exibindo 1 - 10 de 24
  • article 16 Citação(ões) na Scopus
    Regional Lung Derecruitment and Inflammation during 16 Hours of Mechanical Ventilation in Supine Healthy Sheep
    (2013) TUCCI, Mauro R.; COSTA, Eduardo L. V.; WELLMAN, Tyler J.; MUSCH, Guido; WINKLER, Tilo; HARRIS, R. Scott; VENEGAS, Jose G.; AMATO, Marcelo B. P.; MELO, Marcos F. Vidal
    Background: Lung derecruitment is common during general anesthesia. Mechanical ventilation with physiological tidal volumes could magnify derecruitment, and produce lung dysfunction and inflammation. The authors used positron emission tomography to study the process of derecruitment in normal lungs ventilated for 16 h and the corresponding changes in regional lung perfusion and inflammation. Methods: Six anesthetized supine sheep were ventilated with V-T = 8 ml/kg and positive end-expiratory pressure = 0. Transmission scans were performed at 2-h intervals to assess regional aeration. Emission scans were acquired at baseline and after 16 h for the following tracers: (1) F-18-fluorodeoxyglucose to evaluate lung inflammation and (2) (NN)-N-13 to calculate regional perfusion and shunt fraction. Results: Gas fraction decreased from baseline to 16 h in dorsal (0.31 +/- 0.13 to 0.14 +/- 0.12, P < 0.01), but not in ventral regions (0.61 +/- 0.03 to 0.63 +/- 0.07, P = nonsignificant), with time constants of 1.5-44.6 h. Although the vertical distribution of relative perfusion did not change from baseline to 16 h, shunt increased in dorsal regions (0.34 +/- 0.23 to 0.63 +/- 0.35, P < 0.01). The average pulmonary net F-18-fluorodeoxyglucose uptake rate in six regions of interest along the ventral-dorsal direction increased from 3.4 +/- 1.4 at baseline to 4.1 +/- 1.510(-3)/min after 16 h (P < 0.01), and the corresponding average regions of interest F-18-fluorodeoxyglucose phosphorylation rate increased from 2.0 +/- 0.2 to 2.5 +/- 0.210(-2)/min (P < 0.01). Conclusions: When normal lungs are mechanically ventilated without positive end-expiratory pressure, loss of aeration occurs continuously for several hours and is preferentially localized to dorsal regions. Progressive lung derecruitment was associated with increased regional shunt, implying an insufficient hypoxic pulmonary vasoconstriction. The increased pulmonary net uptake and phosphorylation rates of F-18-fluorodeoxyglucose suggest an incipient inflammation in these initially normal lungs.
  • article 3 Citação(ões) na Scopus
    Effect of Cardiogenic Oscillations on Trigger Delay During Pressure Support Ventilation
    (2018) PLENS, Glauco M.; MORAIS, Caio C. A.; NAKAMURA, Maria A.; SOUZA, Patricia N.; AMATO, Marcelo B. P.; TUCCI, Mauro R.; V, Eduardo L. Costa
    BACKGROUND: Sensitive flow or pressure triggers are usually applied to improve ventilator response time. Conversely, too sensitive triggers can incur risk of auto-triggering, a type of asynchrony in which a breath is triggered without inspiratory muscle activity. A frequent cause of auto-triggering is cardiogenic oscillations, characterized by cyclical variations in pressure and flow waveforms caused by cardiac contractions. Our goal was to test trigger performance and capacity to abolish auto-triggering in 5 different ICU ventilators using different simulated levels of cardiogenic oscillations. METHODS: A mechanical breathing simulator was used to test 5 different ICU ventilators' trigger response time and capacity to minimize auto-triggering in conditions with 0, 0.25, 0.5, and 1 cm H2O cardiogenic oscillation. Each ventilator was evaluated until an ideal trigger was found (the most sensitive that abolished auto-triggering). When the least sensitive flow trigger was unable to avoid auto-triggering, a pressure trigger was used. We compared time delay, airway pressure drop until triggering, and work of breathing before each trigger, all at the ideal trigger level fur each cardiogenic oscillation amplitude. We also assessed the proportion of auto-triggered breaths in the whole range of trigger levels tested. RESULTS: Larger cardiogenic oscillations were associated with more frequent auto-triggering. To avoid auto-triggering, less sensitive triggers were required ( +2.51 L/min per 1 cm H2O increase in cardiogenic oscillation; 95% CI 2.26-2.76, P < .001). Time delay increased with larger cardiogenic oscillations, because less sensitive trigger levels were required to abolish auto-triggering (4.79-ms increase per 1 L/min increment on flow trigger). CONCLUSIONS: More sensitive triggers led to faster ventilator response, but also to more frequent auto-triggering. To avoid auto-triggering, less sensitive triggers were required, with consequent slower trigger response. To compare trigger performance in a scenario that more closely represents clinical practice, evaluation of the tradeoff between time delay and frequency of auto-triggering should be considered.
  • article 1716 Citação(ões) na Scopus
    Driving Pressure and Survival in the Acute Respiratory Distress Syndrome
    (2015) AMATO, Marcelo B. P.; MEADE, Maureen O.; SLUTSKY, Arthur S.; BROCHARD, Laurent; COSTA, Eduardo L. V.; SCHOENFELD, David A.; STEWART, Thomas E.; BRIEL, Matthias; TALMOR, Daniel; MERCAT, Alain; RICHARD, Jean-Christophe M.; CARVALHO, Carlos R. R.; BROWER, Roy G.
    BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V-T), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C-RS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (Delta P=V-T/C-RS), in which V-T is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than V-T or PEEP in patients who are not actively breathing. METHODS Using a statistical tool known as multilevel mediation analysis to analyze individual data from 3562 patients with ARDS enrolled in nine previously reported randomized trials, we examined Delta P as an independent variable associated with survival. In the mediation analysis, we estimated the isolated effects of changes in Delta P resulting from randomized ventilator settings while minimizing confounding due to the baseline severity of lung disease. RESULTS Among ventilation variables, Delta P was most strongly associated with survival. A 1-SD increment in Delta P (approximately 7 cm of water) was associated with increased mortality (relative risk, 1.41; 95% confidence interval [CI], 1.31 to 1.51; P<0.001), even in patients receiving ""protective"" plateau pressures and V-T (relative risk, 1.36; 95% CI, 1.17 to 1.58; P<0.001). Individual changes in V-T or PEEP after randomization were not independently associated with survival; they were associated only if they were among the changes that led to reductions in Delta P (mediation effects of Delta P, P=0.004 and P=0.001, respectively). CONCLUSIONS We found that Delta P was the ventilation variable that best stratified risk. Decreases in Delta P owing to changes in ventilator settings were strongly associated with increased survival. (Funded by Fundacao de Amparo e Pesquisa do Estado de Sao Paulo and others.)
  • article 16 Citação(ões) na Scopus
    Estimation of Stroke Volume and Stroke Volume Changes by Electrical Impedance Tomography
    (2018) RAMOS, Fernando Jose da Silva; HOVNANIAN, Andre; SOUZA, Rogerio; AZEVEDO, Luciano C. P.; AMATO, Marcelo B. P.; COSTA, Eduardo L. V.
    BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations (Zsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of Zsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between Zsys and SV. METHODS: Twelve Agroceres pigs were instrumented with transpulmonary thermodilution catheter and EIT and were mechanically ventilated in a random order using different settings of tidal volume (V-T) and positive end-expiratory pressure (PEEP): V-T 10 mLkg-1 and PEEP 10 cm H2O, V-T 10 mLkg-1 and PEEP 5 cm H2O, V-T 6 mLkg-1 and PEEP 10 cm H2O, and V-T 6 mLkg-1 and PEEP 5 cm H2O. After baseline data collection, subjects were submitted to hemorrhagic shock and successive fluid challenges. RESULTS: A total of 204 paired measurements of SV and Zsys were obtained. The 4-quadrant plot showed acceptable trending ability with a concordance rate of 91.2%. Changes in Zsys after fluid challenges presented an area under the curve of 0.83 (95% confidence interval, 0.74-0.92) to evaluate SV changes. Conversely, the linear association between Zsys and SV was poor, with R-2 from linear mixed model of 0.35. Adding information on body dimensions improved the linear association between Zsys and SV up to R-2 from linear mixed model of 0.85. CONCLUSIONS: EIT showed good trending ability and is a promising hemodynamic monitoring tool. Measurements of absolute SV require that body dimensions be taken into account.
  • article 12 Citação(ões) na Scopus
    Ultra-protective tidal volume: how low should we go?
    (2013) COSTA, Eduardo L. V.; AMATO, Marcelo B. P.
    Applying tidal volumes of less than 6 mL/kg might improve lung protection in patients with acute respiratory distress syndrome. In a recent article, Retamal and colleagues showed that such a reduction is feasible with conventional mechanical ventilation and leads to less tidal recruitment and overdistension without causing carbon dioxide retention or auto-positive end-expiratory pressure. However, whether the compensatory increase in the respiratory rate blunts the lung protection remains unestablished.
  • article 38 Citação(ões) na Scopus
    Heterogeneous effects of alveolar recruitment in acute respiratory distress syndrome: a machine learning reanalysis of the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial
    (2019) ZAMPIERI, Fernando G.; COSTA, Eduardo L.; IWASHYNA, Theodore J.; CARVALHO, Carlos R. R.; DAMIANI, Lucas P.; TANIGUCHI, Leandro U.; AMATO, Marcelo B. P.; CAVALCANTI, Alexandre B.
    Background: Despite a robust physiological rationale, recruitment manoeuvres with PEEP titration were associated with harm in the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). We sought to investigate the potential heterogeneity in treatment effects in patients enrolled in the ART, using a machine learning approach. Methods: The primary outcome was hospital mortality. Patients were clustered using baseline clinical and physiological data using the k-means for mixed large data method. The heterogeneity in treatment effect between clusters was investigated using Bayesian methods. We further investigated whether baseline driving pressure could modulate the association between treatment arm, cluster, and mortality. Results: Data from all 1010 patients enrolled in the ART were analysed. Partitioning suggested that three clusters were present in the ART population. The largest cluster (Cluster 1) was characterised by patients with pneumonia and requiring vasopressor support. Recruitment manoeuvres with PEEP titration were associated with higher mortality in Cluster 1 (probability of harm of >98%), but this association was absent in Clusters 2 and 3 (probability of harm of 45% and 68%, respectively). Higher baseline driving pressure was associated with a progressive reduction in the association between alveolar recruitment with PEEP titration and mortality. Conclusions: Recruitment manoeuvre with PEEP titration may be harmful in acute respiratory distress syndrome (ARDS) patients with pneumonia or requiring vasopressor support. Driving pressure appears to modulate the association between the ART study intervention, aetiology of ARDS, and mortality. This machine learning approach may help tailor future RCTs.
  • article 4 Citação(ões) na Scopus
    Driving Pressure as a Key Ventilation Variable REPLY
    (2015) COSTA, Eduardo L. V.; SLUTSKY, Arthur S.; AMATO, Marcelo B. P.
  • article 12 Citação(ões) na Scopus
    Correlation of Lung Collapse and Gas Exchange - A Computer Tomographic Study in Sheep and Pigs with Atelectasis in Otherwise Normal Lungs
    (2015) WOLF, Samuel J.; RESKE, Alexander P.; HAMMERMUELLER, Soeren; COSTA, Eduardo L. V.; SPIETH, Peter M.; HEPP, Pierre; CARVALHO, Alysson R.; KRASSLER, Jens; WRIGGE, Hermann; AMATO, Marcelo B. P.; RESKE, Andreas W.
    Background Atelectasis can provoke pulmonary and non-pulmonary complications after general anaesthesia. Unfortunately, there is no instrument to estimate atelectasis and prompt changes of mechanical ventilation during general anaesthesia. Although arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt have both been suggested to correlate with atelectasis, studies yielded inconsistent results. Therefore, we investigated these correlations. Methods Shunt, PaO2 and atelectasis were measured in 11 sheep and 23 pigs with otherwise normal lungs. In pigs, contrasting measurements were available 12 hours after induction of acute respiratory distress syndrome (ARDS). Atelectasis was calculated by computed tomography relative to total lung mass (M-total). We logarithmically transformed PaO2 (lnPaO(2)) to linearize its relationships with shunt and atelectasis. Data are given as median (interquartile range). Results M-total was 768 (715-884) g in sheep and 543 (503-583) g in pigs. Atelectasis was 26 (16-47)% in sheep and 18 (13-23) % in pigs. PaO2 (FiO(2) = 1.0) was 242 (106-414) mmHg in sheep and 480 (437-514) mmHg in pigs. Shunt was 39 (29-51)% in sheep and 15 (11-20) % in pigs. Atelectasis correlated closely with lnPaO(2) (R-2 = 0.78) and shunt (R-2 = 0.79) in sheep (P-values<0.0001). The correlation of atelectasis with lnPaO(2) (R-2 = 0.63) and shunt (R-2 = 0.34) was weaker in pigs, but R-2 increased to 0.71 for lnPaO(2) and 0.72 for shunt 12 hours after induction of ARDS. In both, sheep and pigs, changes in atelectasis correlated strongly with corresponding changes in lnPaO(2) and shunt. Discussion and Conclusion In lung-healthy sheep, atelectasis correlates closely with lnPaO(2) and shunt, when blood gases are measured during ventilation with pure oxygen. In lung-healthy pigs, these correlations were significantly weaker, likely because pigs have stronger hypoxic pulmonary vasoconstriction (HPV) than sheep and humans. Nevertheless, correlations improved also in pigs after blunting of HPV during ARDS. In humans, the observed relationships may aid in assessing anaesthesia-related atelectasis.
  • article 129 Citação(ões) na Scopus
    Spontaneous Effort During Mechanical Ventilation: Maximal Injury With Less Positive End-Expiratory Pressure
    (2016) YOSHIDA, Takeshi; ROLDAN, Rollin; BERALDO, Marcelo A.; TORSANI, Vinicius; GOMES, Susimeire; SANTIS, Roberta R. De; COSTA, Eduardo L. V.; TUCCI, Mauro R.; LIMA, Raul G.; KAVANAGH, Brian P.; AMATO, Marcelo B. P.
    Objectives: We recently described how spontaneous effort during mechanical ventilation can cause ""pendelluft,"" that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury. We hypothesize that higher positive end-expiratory pressure levels decrease the propensity to pendelluft and that with lower positive end-expiratory pressure levels, pendelluft is associated with improved gas exchange but increased tidal recruitment. Design: Crossover design. Setting: University animal research laboratory. Subjects: Anesthetized landrace pigs. Interventions: Surfactant depletion was achieved by saline lavage in anesthetized pigs, and ventilator-induced lung injury was produced by ventilation with high tidal volume and low positive end-expiratory pressure. Ventilation was continued in each of four conditions: positive end-expiratory pressure (low or optimized positive end-expiratory pressure after recruitment) and spontaneous breathing (present or absent). Tidal recruitment was assessed using dynamic CT and regional ventilation/perfusion using electric impedance tomography. Esophageal pressure was measured using an esophageal balloon manometer. Measurements and Results: Among the four conditions, spontaneous breathing at low positive end-expiratory pressure not only caused the largest degree of pendelluft, which was associated with improved ventilation/perfusion matching and oxygenation, but also generated the greatest tidal recruitment. At low positive end-expiratory pressure, paralysis worsened oxygenation but reduced tidal recruitment. Optimized positive end-expiratory pressure decreased the magnitude of spontaneous efforts (measured by esophageal pressure) despite using less sedation, from -5.6 +/- 1.3 to -2.0 +/- 0.7 cm H2O, while concomitantly reducing pendelluft and tidal recruitment. No pendelluft was observed in the absence of spontaneous effort. Conclusions: Spontaneous effort at low positive end-expiratory pressure improved oxygenation but promoted tidal recruitment associated with pendelluft. Optimized positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.
  • article 1 Citação(ões) na Scopus
    The 4DPRR Index and Mechanical Power: A Step Ahead or Four Steps Backward? Reply
    (2021) COSTA, Eduardo L. V.; SLUTSKY, Arthur S.; AMATO, Marcelo B. P.