EDUARDO LEITE VIEIRA COSTA

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina

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  • 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 3 Citação(ões) na Scopus
    High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients' Respiratory System Mechanics
    (2024) TARTLER, Tim M.; AHRENS, Elena; MUNOZ-ACUNA, Ricardo; AZIZI, Basit A.; CHEN, Guanqing; SULEIMAN, Aiman; WACHTENDORF, Luca J.; COSTA, Eduardo L. V.; TALMOR, Daniel S.; AMATO, Marcelo B. P.; BAEDORF-KASSIS, Elias N.; SCHAEFER, Maximilian S.
    OBJECTIVES: High mechanical power and driving pressure (Delta P) have been associated with postoperative respiratory failure (PRF) and may be important parameters guiding mechanical ventilation. However, it remains unclear whether high mechanical power and Delta P merely reflect patients with poor respiratory system mechanics at risk of PRF. We investigated the effect of mechanical power and Delta P on PRF in cohorts after exact matching by patients' baseline respiratory system compliance.DESIGN: Hospital registry study.SETTING: Academic hospital in New England.PATIENTS: Adult patients undergoing general anesthesia between 2008 and 2020.INTERVENTION: None.MEASUREMENTS AND MAIN RESULTS: The primary exposure was high (>= 6.7 J/min, cohort median) versus low mechanical power and the key-secondary exposure was high (>= 15.0 cm H2O) versus low Delta P. The primary endpoint was PRF (reintubation or unplanned noninvasive ventilation within seven days). Among 97,555 included patients, 4,030 (4.1%) developed PRF. In adjusted analyses, high intraoperative mechanical power and Delta P were associated with higher odds of PRF (adjusted odds ratio [aOR] 1.37 [95% CI, 1.25-1.50]; p < 0.001 and aOR 1.45 [95% CI, 1.31-1.60]; p < 0.001, respectively). There was large variability in applied ventilatory parameters, dependent on the anesthesia provider. This facilitated matching of 63,612 (mechanical power cohort) and 53,260 (Delta P cohort) patients, yielding identical baseline standardized respiratory system compliance (standardized difference [SDiff] = 0.00) with distinctly different mechanical power (9.4 [2.4] vs 4.9 [1.3] J/min; SDiff = -2.33) and Delta P (19.3 [4.1] vs 11.9 [2.1] cm H2O; SDiff = -2.27). After matching, high mechanical power and Delta P remained associated with higher risk of PRF (aOR 1.30 [95% CI, 1.17-1.45]; p < 0.001 and aOR 1.28 [95% CI, 1.12-1.46]; p < 0.001, respectively).CONCLUSIONS: High mechanical power and Delta P are associated with PRF independent of patient's baseline respiratory system compliance. Our findings support utilization of these parameters for titrating mechanical ventilation in the operating room and ICU.
  • conferenceObject
    IMPACT OF ABDOMINAL MASS LOADING ON LUNG COLLAPSE DETECTED BY EIT DURING PEEP TITRATION ON A PORCINE MODEL OF ACUTE LUNG INJURY
    (2013) TORSANI, V.; HUKRAUF, S.; RAU, A.; HAMMERMUELLER, S.; GOMES, S.; SANTIAGO, R. R. D. S.; COSTA, E. L. V.; RESKE, A. W.; AMATO, M. B. P.
  • article 15 Citação(ões) na Scopus
    Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study
    (2022) SULEIMAN, Aiman; COSTA, Eduardo; SANTER, Peter; TARTLER, Tim M.; WACHTENDORF, Luca J.; TEJA, Bijan; CHEN, Guanqing; BAEDORF-KASSIS, Elias; NAGREBETSKY, Alexander; MELO, Marcos F. Vidal; EIKERMANN, Matthias; SCHAEFER, Maximilian S.
    Background: The impact of high vs low intraoperative tidal volumes on postoperative respiratory complications remains unclear. We hypothesised that the effect of intraoperative tidal volume on postoperative respiratory complications is dependent on respiratory system elastance. Methods: We retrospectively recorded tidal volume (Vt; ml kg(-1) ideal body weight [IBW]) in patients undergoing elective, non-cardiothoracic surgery from hospital registry data. The primary outcome was respiratory failure (requiring reintubation within 7 days of surgery, desaturation after extubation, or both). The primary exposure was defined as the interaction between Vt and standardised respiratory system elastance (driving pressure divided by Vt; cm H2O/[ml kg(-1)]). Multivariable logistic regression models, with and without interaction terms (which categorised Vt as low [Vt >8ml kg(-1)] or high [Vt >8 ml kg(-1)]), were adjusted for potential confounders. Additional analyses included path mediation analysis and fractional polynomial modelling. Results: Overall, 10 821/197 474 (5.5%) patients sustained postoperative respiratory complications. Higher Vt was associated with greater risk of postoperative respiratory complications (adjusted odds ratio=1.42 per ml kg(-1); 95% confidence interval [CI], 1.35-1.50]; P<0.001). This association was modified by respiratory system elastance (P<0.001); in patients with low compliance (<42.4 ml cm H2O-1), higher Vt was associated with greater risk of postoperative respiratory complications (adjusted risk difference= 0.3% [95% CI, 0.0-0.5] at 41.2 ml cm H2O-1 compliance, compared with 5.8% [95% CI, 3.8-7.8] at 14 ml cm H(2)O(-1)1 compliance). This association was absent when compliance exceeded 41.2 ml cm H2O-1. Adverse effects associated with high Vt were entirely mediated by driving pressures (P<0.001). Conclusions: The association of harm with higher tidal volumes during intraoperative mechanical ventilation is modified by respiratory system elastance. These data suggest that respiratory elastance should inform the design of perioperative trials testing intraoperative ventilatory strategies.
  • article 158 Citação(ões) na Scopus
    Associations between ventilator settings during extracorporeal membrane oxygenation for refractory hypoxemia and outcome in patients with acute respiratory distress syndrome: a pooled individual patient data analysis
    (2016) SERPA NETO, Ary; SCHMIDT, Matthieu; AZEVEDO, Luciano C. P.; BEIN, Thomas; BROCHARD, Laurent; BEUTEL, Gernot; COMBES, Alain; COSTA, Eduardo L. V.; HODGSON, Carol; LINDSKOV, Christian; LUBNOW, Matthias; LUECK, Catherina; MICHAELS, Andrew J.; PAIVA, Jose-Artur; PARK, Marcelo; PESENTI, Antonio; PHAM, Tai; QUINTEL, Michael; RANIERI, V. Marco; RIED, Michael; RONCON-ALBUQUERQUE JR., Roberto; SLUTSKY, Arthur S.; TAKEDA, Shinhiro; TERRAGNI, Pier Paolo; VEJEN, Marie; WEBER-CARSTENS, Steffen; WELTE, Tobias; ABREU, Marcelo Gama de; PELOSI, Paolo; SCHULTZ, Marcus J.
    Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate associations between ventilatory settings during ECMO for refractory hypoxemia and outcome in ARDS patients. In this individual patient data meta-analysis of observational studies in adult ARDS patients receiving ECMO for refractory hypoxemia, a time-dependent frailty model was used to determine which ventilator settings in the first 3 days of ECMO had an independent association with in-hospital mortality. Nine studies including 545 patients were included. Initiation of ECMO was accompanied by significant decreases in tidal volume size, positive end-expiratory pressure (PEEP), plateau pressure, and driving pressure (plateau pressure - PEEP) levels, and respiratory rate and minute ventilation, and resulted in higher PaO2/FiO(2), higher arterial pH and lower PaCO2 levels. Higher age, male gender and lower body mass index were independently associated with mortality. Driving pressure was the only ventilatory parameter during ECMO that showed an independent association with in-hospital mortality [adjusted HR, 1.06 (95 % CI, 1.03-1.10)]. In this series of ARDS patients receiving ECMO for refractory hypoxemia, driving pressure during ECMO was the only ventilator setting that showed an independent association with in-hospital mortality.
  • article 1 Citação(ões) na Scopus
  • article 37 Citação(ões) na Scopus
    Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study
    (2022) SANTER, Peter; WACHTENDORF, Luca J.; SULEIMAN, Aiman; HOULE, Timothy T.; FASSBENDER, Philipp; COSTA, Eduardo L.; TALMOR, Daniel; EIKERMANN, Matthias; BAEDORF-KASSIS, Elias; SCHAEFER, Maximilian S.
    Background: Mechanical power during ventilation estimates the energy delivered to the respiratory system through integrating inspiratory pressures, tidal volume, and respiratory rate into a single value. It has been linked to lung injury and mortality in the acute respiratory distress syndrome, but little evidence exists regarding whether the concept relates to lung injury in patients with healthy lungs. This study hypothesized that higher mechanical power is associated with greater postoperative respiratory failure requiring reintubation in patients undergoing general anesthesia. Methods: In this multicenter, retrospective study, 230,767 elective, noncardiac adult surgical out- and inpatients undergoing general anesthesia between 2008 and 2018 at two academic hospital networks in Boston, Massachusetts, were included. The risk-adjusted association between the median intraoperative mechanical power, calculated from median values of tidal volume (V-t), respiratory rate (RR), positive end-expiratory pressure (PEEP), plateau pressure (P-plat), and peak inspiratory pressure (P-peak), using the following formula: mechanical power (J/min) = 0.098 x RR x V-t x (PEEP + 1/2[P-plat - PEEP] + [P-peak - P-plat]), and postoperative respiratory failure requiring reintubation within 7 days, was assessed. Results: The median intraoperative mechanical power was 6.63 (interquartile range, 4.62 to 9.11) J/min. Postoperative respiratory failure occurred in 2,024 (0.9%) patients. The median (interquartile range) intraoperative mechanical power was higher in patients with postoperative respiratory failure than in patients without (7.67 [5.64 to 10.11] vs. 6.62 [4.62 to 9.10] J/min; P < 0.001). In adjusted analyses, a higher mechanical power was associated with greater odds of postoperative respiratory failure (adjusted odds ratio, 1.31 per 5 J/min increase; 95% CI, 1.21 to 1.42; P< 0.001). The association between mechanical power and postoperative respiratory failure was robust to additional adjustment for known drivers of ventilator-induced lung injury, including tidal volume, driving pressure, and respiratory rate, and driven by the dynamic elastic component (adjusted odds ratio, 1.35 per 5 J/min; 95% CI, 1.05 to 1.73; P= 0.02). Conclusions: Higher mechanical power during ventilation is statistically associated with a greater risk of postoperative respiratory failure requiring reintubation.
  • article 403 Citação(ões) na Scopus
    Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data
    (2016) NETO, Ary Serpa; HEMMES, Sabrine N. T.; BARBAS, Carmen S. V.; BEIDERLINDEN, Martin; FERNANDEZ-BUSTAMANTE, Ana; FUTIER, Emmanuel; GAJIC, Ognjen; EL-TAHAN, Mohamed R.; GHAMDI, Abdulmohsin A. Al; GUNAY, Ersin; JABER, Samir; KOKULU, Serdar; KOZIAN, Alf; LICKER, Marc; LIN, Wen-Qian; MASLOW, Andrew D.; MEMTSOUDIS, Stavros G.; MIRANDA, Dinis Reis; MOINE, Pierre; NG, Thomas; PAPARELLA, Domenico; RANIERI, V. Marco; SCAVONETTO, Federica; SCHILLING, Thomas; SELMO, Gabriele; SEVERGNINI, Paolo; SPRUNG, Juraj; SUNDAR, Sugantha; TALMOR, Daniel; TRESCHAN, Tanja; UNZUETA, Carmen; WEINGARTEN, Toby N.; WOLTHUIS, Esther K.; WRIGGE, Hermann; AMATO, Marcelo B. P.; COSTA, Eduardo L. V.; ABREU, Marcelo Gama de; PELOSI, Paolo; SCHULTZ, Marcus J.
    Background Protective mechanical ventilation strategies using low tidal volume or high levels of positive end expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications. Methods We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma). Findings We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1.16, 95% CI 1.13-1.19; p<0.0001), whereas we detected no association for tidal volume (1.05, 0.98-1.13; p=0.179). PEEP did not have a large enough effect in univariate analysis to warrant inclusion in the multivariate analysis. In a mediator analysis, driving pressure was the only significant mediator of the effects of protective ventilation on development of pulmonary complications (p=0.027). In two studies that compared low with high PEEP during low tidal volume ventilation, an increase in the level of PEEP that resulted in an increase in driving pressure was associated with more postoperative pulmonary complications (OR 3.11, 95% CI 1.39-6.96; p=0.006). Interpretation In patients having surgery, intraoperative high driving pressure and changes in the level of PEEP that result in an increase of driving pressure are associated with more postoperative pulmonary complications. However, a randomised controlled trial comparing ventilation based on driving pressure with usual care is needed to confirm these findings.