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
16 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 16
- 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.
- Brazilian recommendations of mechanical ventilation 2013. Part 2(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 Bernardete; 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 Meira; VICTORINO, Josue Almeida; FERREIRA, Juliana Carvalho; PRODOMO, Luciana Passuello do Vale; HAJJAR, 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, Ronaldo 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.
- 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.)
- Suporte respiratório extracorpóreo em pacientes adultos(2017) ROMANO, Thiago Gomes; MENDES, Pedro Vitale; PARK, Marcelo; COSTA, Eduardo Leite VieiraEm pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.
- 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.
- Noninvasive ventilation for acute respiratory distress syndrome: the importance of ventilator settings(2016) TUCCI, Mauro R.; COSTA, Eduardo L. V.; NAKAMURA, Maria A. M.; MORAIS, Caio C. A.Noninvasive ventilation (NIV) is commonly used to prevent endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Patients with hypoxemic acute respiratory failure who fail an NIV trial carry a worse prognosis as compared to those who succeed. Additional factors are also knowingly associated with worse outcomes: higher values of ICU severity score, presence of severe sepsis, and lower ratio of arterial oxygen tension to fraction of inspired oxygen. However, it is still unclear whether NIV failure is responsible for the worse prognosis or if it is merely a marker of the underlying disease severity. There is therefore an ongoing debate as to whether and which ARDS patients are good candidates to an NIV trial. In a recent paper published in JAMA, ""Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome: A Randomized Clinical Trial"", Patel et al. evaluated ARDS patients submitted to NIV and drew attention to the importance of the NIV interface. We discussed their interesting findings focusing also on the ventilator settings and on the current barriers to lung protective ventilation in ARDS patients during NIV.
- Diaphragmatic Electrical Activity A New Tool to Assess Lung Hyperinflation?(2014) COSTA, Eduardo Leite Vieira; MELO, Marcos F. Vidal
- 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
- Physiologic effects of alveolar recruitment and inspiratory pauses during moderately-high-frequency ventilation delivered by a conventional ventilator in a severe lung injury model(2017) CORDIOLI, Ricardo Luiz; COSTA, Eduardo Leite Vieira; AZEVEDO, Luciano Cesar Pontes; GOMES, Susimeire; AMATO, Marcelo Britto Passos; PARK, MarceloBackground and aims To investigate whether performing alveolar recruitment or adding inspiratory pauses could promote physiologic benefits (VT) during moderately-high-frequency positive pressure ventilation (MHFPPV) delivered by a conventional ventilator in a porcine model of severe acute respiratory distress syndrome (ARDS). Methods Prospective experimental laboratory study with eight pigs. Induction of acute lung injury with sequential pulmonary lavages and injurious ventilation was initially performed. Then, animals were ventilated on a conventional mechanical ventilator with a respiratory rate (RR) = 60 breaths/minute and PEEP titrated according to ARDS Network table. The first two steps consisted of a randomized order of inspiratory pauses of 10 and 30% of inspiratory time. In final step, we removed the inspiratory pause and titrated PEEP, after lung recruitment, with the aid of electrical impedance tomography. At each step, PaCO2 was allowed to stabilize between 57-63 mmHg for 30 minutes. Results The step with RR of 60 after lung recruitment had the highest PEEP when compared with all other steps (17 [16,19] vs 14 [10, 17]cmH(2)O), but had lower driving pressures (13 [13,11] vs 16 [14, 17]cmH(2)O), higher P/F ratios (212 [191,243] vs 141 [105, 184] mmHg), lower shunt (23 [20, 23] vs 32 [27, 49]%), lower dead space ventilation (10 [0, 15] vs 30 [20, 37]%), and a more homogeneous alveolar ventilation distribution. There were no detrimental effects in terms of lung mechanics, hemodynamics, or gas exchange. Neither the addition of inspiratory pauses or the alveolar recruitment maneuver followed by decremental PEEP titration resulted in further reductions in VT. Conclusions During MHFPPV set with RR of 60 bpm delivered by a conventional ventilator in severe ARDS swine model, neither the inspiratory pauses or PEEP titration after recruitment maneuver allowed reduction of VT significantly, however the last strategy decreased driving pressures and improved both shunt and dead space.