ELISANGELA PINTO MARINHO DE ALMEIDA

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor e Coautores FMUSP-HC Normalizados: ELISANGELA PINTO MARINHO DE ALMEIDA × Categoria: original article × search.filters.applied.f.dateIssued: 2017 ×

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  • article 74 Citação(ões) na Scopus
    Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial
    (2017) BERGAMIN, Fabricio S.; ALMEIDA, Juliano P.; LANDONI, Giovanni; GALAS, Filomena R. B. G.; FUKUSHIMA, Julia T.; FOMINSKIY, Evgeny; PARK, Clarice H. L.; OSAWA, Eduardo A.; DIZ, Maria P. E.; OLIVEIRA, Gisele Q.; FRANCO, Rafael A.; NAKAMURA, Rosana E.; ALMEIDA, Elisangela M.; ABDALA, Edson; FREIRE, Maristela P.; FILHO, Roberto K.; AULER JR., Jose Otavio C.; HAJJAR, Ludhmila A.
    Objective: To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock. Design: Single center, randomized, double-blind controlled trial. Setting: Teaching hospital. Patients: Adult cancer patients with septic shock in the first 6 hours of ICU admission. Interventions: Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay. Measurements and Main Results: Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0-3] vs 0 [0-2] unit; p<0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53-1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53-0.97; p = 0.03). Conclusions: We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.
  • article 55 Citação(ões) na Scopus
    Early mobilization programme improves functional capacity after major abdominal cancer surgery: a randomized controlled trial
    (2017) ALMEIDA, E. P. M. de; ALMEIDA, J. P. de; LANDONI, G.; GALAS, F. R. B. G.; FUKUSHIMA, J. T.; FOMINSKIY, E.; BRITO, C. M. M. de; CAVICHIO, L. B. L.; ALMEIDA, L. A. A. de; RIBEIRO- JR., U.; OSAWA, E. A.; DIZ, M. P. E.; CECATTO, R. B.; BATTISTELLA, L. R.; HAJJAR, L. A.
    Background: Major abdominal oncology surgery is associated with substantial postoperative loss of functional capacity, and exercise may be an effective intervention to improve outcomes. The aim of this study was to assess efficacy, feasibility and safety of a supervised postoperative exercise programme. Methods: We performed a single-blind, parallel-arm, randomized trial in patients who underwent major abdominal oncology surgery in a tertiary university hospital. Patients were randomized to an early mobilization postoperative programme based on supervised aerobic exercise, resistance and flexibility training or to standard rehabilitation care. The primary outcome was inability to walk without human assistance at postoperative day 5 or hospital discharge. Results: A total of 108 patients were enrolled, 54 into the early mobilization programme group and 54 into the standard rehabilitation care group. The incidence of the primary outcome was nine (16.7%) and 21 (38.9%), respectively (P = 0.01), with an absolute risk reduction of 22.2% [95% confidence interval (CI) 5.9-38.6] and a number needed to treat of 5 (95% CI 3-17). All patients in the intervention group were able to follow at least partially the exercise programme, although the performance among them was rather heterogeneous. There were no differences between groups regarding clinical outcomes or complications related to the exercises. Conclusions: An early postoperative mobilization programme based on supervised exercises seems to be safe and feasible and improves functional capacity in patients undergoing major elective abdominal oncology surgery. However, its impact on clinical outcomes is still unclear.