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
15 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.
- Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves(2024) FREITAS, Daniela Helena Machado; COSTA, Eduardo Leite Vieira; ZIMMERMANN, Natalia Alcantara; GOIS, Larissa Santos Oliveira; ANJOS, Mirella Vittig Alves; LIMA, Felipe Gallego; ANDRADE, Pamela Santos; JOELSONS, Daniel; HO, Yeh-Li; SALES, Flavia Cristina Silva; SABINO, Ester Cerdeira; CARVALHO, Carlos Roberto Ribeiro; FERREIRA, Juliana Carvalho; NGAH, Veranyuy; REYES, Luis Felipe; REYES, Luis FelipeBackground The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. Methods This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60-day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). Results We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50-0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65-1.12). Conclusions In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.
- 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.
conferenceObject PEEP titration with lung ultrasound and electrical impedance tomography in an ARDS animal model(2014) PRINA, Elena; COSTA, Eduardo Leite Vieira; RANZANI, Otavio Tavares; GOMES, Susimeire; SANTIAGO, Roberta Ribeiro De Santis; NAKAMURA, Myiuki; AMATO, Marcelo Britto Passos; TORRES, Antoni; CARVALHO, Carlos Roberto Ribeiro De- 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.
- Pulmonary Aeration and Posterior Collapse Assessed by Electrical Impedance Tomography in Healthy Children: Contribution of Anesthesia and Controlled Mechanical Ventilation(2022) NASCIMENTO, Milena Siciliano; REBELLO, Celso Moura; COSTA, Eduardo Leite Vieira; ROSSI, Felipe de Souza; PRADO, Cristiane do; AMATO, Marcelo Britto Passos