ESTEVAO BASSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
20 resultados
Resultados de Busca
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bookPart Manejo do politraumatizado(2023) BUSTAMANTE, Pedro Fortes Osório; DOBRE, Ana Clara; CARNEIRO, Barbara Vieira; ROEPKE, Roberta Muriel Longo; CADAMURO, Filipe Mateus; BASSI, EstevãobookPart Abordagem do choque refratário(2015) BASSI, EstevãobookPart Abordagem do choque refratário(2022) MESQUITA, Paula Sepulveda; BASSI, EstevãobookPart Estratégias Protetoras Orgânicas no Perioperatório(2021) BASSI, Estevão; TOMAZINI, Bruno Martins; MALBOUISSON, Luiz Marcelo SábookPart Manejo de choque refratário(2014) BASSI, EstêvãobookPart Manejo da hipertensão intracraniana(2023) BOTêGA, Amanda Pinto; BASSI, Estevão; ROEPKE, Roberta Muriel Longo- Computed tomography angiography accuracy in brain death diagnosis(2020) BRASIL, Sergio; BOR-SENG-SHU, Edson; DE-LIMA-OLIVEIRA, Marcelo; TACCONE, Fabio Silvio; GATTAS, Gabriel; NUNES, Douglas Mendes; OLIVEIRA, Raphael A. Gomes de; TOMAZINI, Bruno Martins; TIERNO, Paulo Fernando; BECKER, Rafael Akira; BASSI, Estevao; MALBOUISSON, Luiz Marcelo Sa; PAIVA, Wellingson da Silva; TEIXEIRA, Manoel Jacobsen; NOGUEIRA, Ricardo de CarvalhoOBJECTIVE The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest. METHODS A unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score <= 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally. RESULTS A total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS. CONCLUSIONS CTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.
- Transfusion requirements after head trauma: a randomized feasibility controlled trial(2019) GOBATTO, Andre L. N.; LINK, Milena A.; SOLLA, Davi J.; BASSI, Estevao; TIERNO, Paulo F.; PAIVA, Wellingson; TACCONE, Fabio S.; MALBOUISSON, Luiz M.BackgroundAnemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined.MethodsAll eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a restrictive (hemoglobin transfusion threshold of 7g/dL), or a liberal (threshold 9g/dL) transfusion strategy. The transfusion strategy was continued for up to 14days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome.ResultsA total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.41.0 and 9.31.3 (p<0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p=0.02). There was negative correlation (r=-0.265, p<0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p<0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p=0.048) and the liberal group tended to have a better neurological status at 6months (p=0.06).Conclusions The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group.Trial registration ClinicalTrials.gov, NCT02203292. Registered on 29 July 2014.
- Mensuração da pressão intracraniana e desfechos em curto prazo de pacientes com lesão encefálica traumática: uma análise de propensão pareada(2015) FERREIRA, Cesar Biselli; BASSI, Estevão; LUCENA, Lucas; CARRETA, Hernandez; MIRANDA, Leandro Costa; TIERNO, Paulo Fernando Guimarães Mazorcchi; AMORIM, Robson Luis; ZAMPIERI, Fernando Godinho; MALBOUISSON, Luis Marcelo SáABSTRACT Objective: To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients. Methods: Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm). Results: Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups. Conclusion: Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.
- Fraturas de esterno em uma unidade de tratamento intensivo especializada em trauma(2019) PEREIRA, Leonardo Dantas da Silva; BASSI, Estevão; TOMAZINI, Bruno Martins; JESUS, Vinicius Luiz Menezes; TIERNO, Paulo Fernando Guimarães Morando Marzocchi; NOVO, Fernando Da Costa Ferreira; MALBOUISSON, Luiz Marcelo; UTIYAMA, Edivaldo MassazoABSTRACT Objective: to evaluate epidemiology, anatomical characteristics, management, and prognosis of critical patients with sternum fractures. Methods: retrospective analysis of patients admitted to intensive care unit (ICU) of a Level III trauma center in Sao Paulo, Brazil. Results: 1552 trauma patients were admitted from January 2012 to April 2016. A total of 439 patients had thoracic trauma and among these, 13 patients had sternum fracture, making up 0.9% of all trauma admissions and 3% of all thoracic trauma cases. Three of these 13 patients had unstable chest, two underwent surgical management for fracture fixation, and three died (mortality was of 29%). In one of the deaths, sternum fracture was assessed as the main contributor to the outcome. Conclusion: sternum fracture was diagnosed in 0.9% of critical trauma patients in a specialized ICU. Only 15% of patients required specific surgical management in the acute phase. In most cases, mortality was due to other injuries.