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
9 resultados
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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.
- Functional recovery of chronically critically ill patients in the first days after discharge from the intensive care unit: Feasibility of the 6-minute step test(2023) GAIA, Viviane Roccasecca Sampaio; COSTA, Eduardo Leite Vieira; YAMAGUTI, Wellington Pereira; FRANCISCO, Davi de Souza; FUMIS, Renata Rego LinsBackground Survivors of chronic critical illness often experience weakness and functional dependence to various degrees after their intensive care unit (ICU) stay. Evaluating their functional status with the traditional six-minute walk test is challenging due to space constraints or patient intolerance. Objective Our aim was to evaluate the feasibility of using the six-minute step test (6MST) as a measure of functional capacity in chronically critically ill patients early after ICU discharge. Methods This prospective study was undertaken in a private Brazilian hospital. From July 2019 to July 2020, all chronically critically ill patients were asked to participate 48 hours after ICU discharge. On the day of study inclusion and a week later, those who consented underwent functional assessment comprised of the 6MST, peripheral muscle strength using handgrip strength (HGS), and mobility using the ICU mobility scale (IMS). Results A total of 40 patients were included. The 6MST was feasible in 40% on the first evaluation and 57% on the second. The median 6MST was 0 [0-5] on the first evaluation and 3.5 [0-7.75] on the second (P = 0.005). The median HGS increased from 11.50 [9.25-18] on the first evaluation to 14.5 [10-20] on the second (P = 0.006). The median IMS was 4.5 [3.25-7] on the first evaluation and 6 [3.25-7] on the second (P<0.001). Despite the significant improvement, all parameters measured remained well below normal. Conclusion The 6MST was a feasible measure of functional capacity in chronically critically ill patients early after ICU discharge. Patients had functional capacity well below predicted values.
- Impact on the ability of healthcare professionals to correctly identify patient-ventilator asynchronies of the simultaneous visualization of estimated muscle pressure curves on the ventilator display: a randomized study (P-mus study)(2023) SILVA, Daniel Oliveira; SOUZA, Patricia Nery de; SOUSA, Mayson Laercio de Araujo; MORAIS, Caio Cesar Araujo; FERREIRA, Juliana Carvalho; HOLANDA, Marcelo Alcantara; YAMAGUTI, Wellington Pereira; PASTORE JUNIOR, Laerte; COSTA, Eduardo Leite VieiraBackgroundPatient-ventilator asynchronies are usually detected by visual inspection of ventilator waveforms but with low sensitivity, even when performed by experts in the field. Recently, estimation of the inspiratory muscle pressure (P-mus) waveforms through artificial intelligence algorithm has been proposed (Magnamed (R), Sao Paulo, Brazil). We hypothesized that the display of these waveforms could help healthcare providers identify patient-ventilator asynchronies.MethodsA prospective single-center randomized study with parallel assignment was conducted to assess whether the display of the estimated P-mus waveform would improve the correct identification of asynchronies in simulated clinical scenarios. The primary outcome was the mean asynchrony detection rate (sensitivity). Physicians and respiratory therapists who work in intensive care units were randomized to control or intervention group. In both groups, participants analyzed pressure and flow waveforms of 49 different scenarios elaborated using the ASL-5000 lung simulator. In the intervention group the estimated P-mus waveform was displayed in addition to pressure and flow waveforms.ResultsA total of 98 participants were included, 49 per group. The sensitivity per participant in identifying asynchronies was significantly higher in the P-mus group (65.8 +/- 16.2 vs. 52.94 +/- 8.42, p < 0.001). This effect remained when stratifying asynchronies by type.ConclusionsWe showed that the display of the P-mus waveform improved the ability of healthcare professionals to recognize patient-ventilator asynchronies by visual inspection of ventilator tracings. These findings require clinical validation.Trial registration: ClinicalTrials.gov: NTC05144607. Retrospectively registered 3 December 2021.
- Fibrinolytic therapy in patients with COVID-19 and ARDS: protocol for a systematic review and meta-analysis(2023) SAVIOLI, Felicio; SANTOS, Lucas Ribeiro Dos; DUARTE, Marcio Luis; CARMO, Andreia Cristina Feitosa do; GOIS, Aecio; NAKANO, Luis; RAMOS, Fernando Jose Da Silva; PASTORE, Laerte; COSTA, Eduardo Leite VieiraIntroduction In COVID-19-related acute respiratory distress syndrome (ARDS), the clot play a role in gas exchange abnormalities. Fibrinolytic therapy can improve alveolar ventilation by restoring blood flow. In this systematic review and meta-analysis protocol, we aim to assess the safety and efficacy of fibrinolytic therapy in such a population. Methods We will perform a systematic search in MEDLINE, EMBASE, Cochrane CENTRAL and LILACS databases without language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs. Two review authors will independently perform data extraction and quality assessments of data from included studies. In case of divergence, a third author will be contacted. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis, a descriptive analysis will be performed. Discussion This systematic review and meta-analysis protocol will provide current evidence about the safety and efficacy of fibrinolytic therapy in patients with COVID-19 and ARDS. These findings will provide if fibrinolytic therapy might be an option for a desperate clinical setting, where all medical efforts have been used. PROSPERO registration number PROSPERO CRD42020187482. Ethics and dissemination Ethics committee approval is not necessary. We intend to update the public registry, report any protocol amendments and publish the results in a widely accessible journal.
- Pronation Reveals a Heterogeneous Response of Global and Regional Respiratory Mechanics in Patients With Acute Hypoxemic Respiratory Failure(2023) MORAIS, C. C. A.; ALCALA, G.; SANTIAGO, R. R. De Santis; VALSECCHI, C.; DIAZ, E.; WANDERLEY, H.; FAKHR, B. S.; FENZA, R. Di; GIANNI, S.; FOOTE, S.; CHANG, M. G.; BITTNER, E. A.; CARROLL, R. W.; COSTA, E. L. V.; AMATO, M. B. P.; BERRA, L.OBJECTIVES: Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients. DESIGN: A prospective cohort study. PATIENTS: Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia. INTERVENTIONS: Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm H2O to 6 cm H2O in supine and prone positions. MEASUREMENTS: Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions. MAIN RESULTS: Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients (n = 13), of which the Crs decreased in 32% (n = 7) and increased in 27% (n = 6). To reach maximum Crs after pronation, PEEP was changed in 45% of the patients by at least 4 cm H2O. After pronation, the ventilation and compliance of the dorsal region did not consistently change in the entire sample of patients, increasing specifically in a subgroup of patients who showed a positive change in Crs when transitioning from supine to prone position. These combined changes in ventilation and compliance suggest dorsal recruitment postpronation. In addition, the subgroup with increased Crs postpronation demonstrated the most pronounced difference between dorsal and ventral ventilation distribution from supine to prone position (p = 0.01), indicating heterogeneous ventilation distribution in prone position. CONCLUSIONS: Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.
- Ninety-day outcomes in patients diagnosed with COVID-19 in Sao Paulo, Brazil: a cohort study(2023) FUMIS, Renata Rego Lins; COSTA, Eduardo Leite Vieira; TOMAZINI, Bruno Martins; TANIGUCHI, Leandro Utino; COSTA, Livia do Valle; MORINAGA, Christian Valle; SA, Marcia Martiniano de Sousa e; AZEVEDO, Luciano Cesar Pontes de; NASCIMENTO, Teresa Cristina; LEDO, Carla Bernardes; OLIVEIRA, Maura Salaroli de; CARDOSO, Luiz Francisco; PASTORE JUNIOR, Laerte; VIEIRA JUNIOR, Jose MauroObjective: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. Methods: Patients with COVID-19 admitted to a private hospital in the city of Sao Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. Results: A total of 2,138 patients were included. The mean age was 58.6 +/- 15.8 years, and the median length of hospital stay was 9.0 (5.015.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. Conclusions: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.
- Effect of general anesthesia and controlled mechanical ventilation on pulmonary ventilation distribution assessed by electrical impedance tomography in healthy children(2023) NASCIMENTO, Milena; REBELLO, Celso; COSTA, Eduardo L. V. C.; CORREA, Leticia; ALCALA, Glasiele; ROSSI, Felipe; MORAIS, Caio C. A.; LAURENTI, Eliana; CAMARA, Mauro; IASI, Marcelo; APEZZATO, Maria L. P.; PRADO, Cristiane do; AMATO, Marcelo B. P.IntroductionGeneral anesthesia is associated with the development of atelectasis, which may affect lung ventilation. Electrical impedance tomography (EIT) is a noninvasive imaging tool that allows monitoring in real time the topographical changes in aeration and ventilation. ObjectiveTo evaluate the pattern of distribution of pulmonary ventilation through EIT before and after anesthesia induction in pediatric patients without lung disease undergoing nonthoracic surgery. MethodsThis was a prospective observational study including healthy children younger than 5 years who underwent nonthoracic surgery. Monitoring was performed continuously before and throughout the surgical period. Data analysis was divided into 5 periods: induction (spontaneous breathing, SB), ventilation-5min, ventilation-30min, ventilation-late and recovery-SB. In addition to demographic data, mechanical ventilation parameters were also collected. Ventilation impedance (Delta Z) and pulmonary ventilation distribution were analyzed cycle by cycle at the 5 periods. ResultsTwenty patients were included, and redistribution of ventilation from the posterior to the anterior region was observed with the beginning of mechanical ventilation: on average, the percentage ventilation distribution in the dorsal region decreased from 54%(IC95%:49-60%) to 49%(IC95%:44-54%). With the restoration of spontaneous breathing, ventilation in the posterior region was restored. ConclusionThere were significant pulmonary changes observed during anesthesia and controlled mechanical ventilation in children younger than 5 years, mirroring the findings previously described adults. Monitoring these changes may contribute to guiding the individualized settings of the mechanical ventilator with the goal to prevent postoperative complications.
- Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT) A Multicenter Study of COVID-19 Acute Respiratory Distress Syndrome(2023) JONKMAN, Annemijn H.; ALCALA, Glasiele C.; PAVLOVSKY, Bertrand; ROCA, Oriol; SPADARO, Savino; SCARAMUZZO, Gaetano; CHEN, Lu; DIANTI, Jose; SOUSA, Mayson L. de A.; SKLAR, Michael C.; PIRAINO, Thomas; GE, Huiqing; CHEN, Guang-Qiang; ZHOU, Jian-Xin; LI, Jie; GOLIGHER, Ewan C.; COSTA, Eduardo; MANCEBO, Jordi; MAURI, Tommaso; AMATO, Marcelo; BROCHARD, Laurent J.Rationale: Defining lung recruitability is needed for safe positive end-expiratory pressure (PEEP) selection in mechanically ventilated patients. However, there is no simple bedside method including both assessment of recruitability and risks of overdistension as well as personalized PEEP titration. Objectives: To describe the range of recruitability using electrical impedance tomography (EIT), effects of PEEP on recruitability, respiratory mechanics and gas exchange, and a method to select optimal EIT-based PEEP. Methods: This is the analysis of patients with coronavirus disease (COVID-19) from an ongoing multicenter prospective physiological study including patients with moderate-severe acute respiratory distress syndrome of different causes. EIT, ventilator data, hemodynamics, and arterial blood gases were obtained during PEEP titration maneuvers. EIT-based optimal PEEP was defined as the crossing point of the overdistension and collapse curves during a decremental PEEP trial. Recruitability was defined as the amount of modifiable collapse when increasing PEEP from 6 to 24 cm H2O (Delta Collapse(24-6)). Patients were classified as low, medium, or high recruiters on the basis of tertiles of Delta Collapse(24-6). Measurements and Main Results: In 108 patients with COVID-19, recruitability varied from 0.3% to 66.9% and was unrelated to acute respiratory distress syndrome severity. Median EIT-based PEEP differed between groups: 10 versus 13.5 versus 15.5 cm H2O for low versus medium versus high recruitability (P < 0.05). This approach assigned a different PEEP level from the highest compliance approach in 81% of patients. The protocol was well tolerated; in four patients, the PEEP level did not reach 24 cm H2O because of hemodynamic instability. Conclusions: Recruitability varies widely among patients with COVID-19. EIT allows personalizing PEEP setting as a compromise between recruitability and overdistension.
- Worsening of lung perfusion to tissue density distributions during early acute lung injury(2023) MOTTA-RIBEIRO, Gabriel C.; WINKLER, Tilo; COSTA, Eduardo L. V.; PROST, Nicolas de; TUCCI, Mauro R.; MELO, Marcos F. VidalLung perfusion magnitude and distribution are essential for oxygenation and, potentially, lung inflammation and protection during acute respiratory distress syndrome (ARDS). Yet, perfusion patterns and their relationship to inflammation are unknown preARDS. We aimed to assess perfusion/density ratios and spatial perfusion-density distributions and associate these to lung inflam-mation, during early lung injury in large animals at different physiological conditions caused by different systemic inflammation and positive end-expiratory pressure (PEEP) levels. Sheep were protectively ventilated (16-24 h) and imaged for lung density, pulmonary capillary perfusion ((13)Nitrogen-saline), and inflammation (F-18-fluorodeoxyglucose) using positron emission and computed tomography. We studied four conditions: permissive atelectasis (PEEP = 0 cmH(2)O); and ARDSNet low-stretch PEEP-setting strategy with supine moderate or mild endotoxemia, and prone mild endotoxemia. Perfusion/density heterogeneity increased pre-ARDS in all groups. Perfusion redistribution to density depended on ventilation strategy and endotoxemia level, producing more atelectasis in mild than moderate endotoxemia (P = 0.010) with the oxygenation-based PEEP-setting strategy. The spatial distribution of F-18-fluorodeoxyglucose uptake was related to local Q/D (P < 0.001 for Q/D group interaction). Moderate endotoxemia yielded markedly low/zero perfusion in normal-low density lung, with (13)Nitrogen-saline perfusion indicating nondependent capillary obliteration. Prone animals' perfusion was remarkably homogeneously distributed with density. Lung perfusion redistributes heterogeneously to density during pre-ARDS protective ventilation in animals. This is associated with increased inflamma-tion, nondependent capillary obliteration, and lung derecruitment susceptibility depending on endotoxemia level and ventilation strategy.