JULIANA CARVALHO FERREIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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bookPart 0 Citação(ões) na Scopus Noninvasive ventilation interface: Influence on patient-ventilator interaction(2020) TUCCI, M. R.; COSTA, E. L. V.; FERREIRA, J. C.; NAKAMURA, M. A. M.; SOUSA, M. L. de AraújoNoninvasive ventilation (NIV) is an efficient treatment for acute respiratory failure (ARF), especially for hypercapnic patients and those with congestive heart failure. In patients at high risk of extubation failure, NIV can also be used prophylactically to avoid reintubation. Unfortunately, NIV failure can occur in up to 40% of patients, half of the time due to issues associated with the interface. In this chapter, we discuss the performance of the NIV interfaces in adult patients with ARF, the factors associated with NIV failures and strategies to avoid interface problems. We discuss the use of different types of interface, including the oronasal mask, total-face mask, and helmet and we discuss on what conditions we favor the use of each one. Additionally, we detail the influence of the ventilator type, ventilator settings, and amount of leak on NIV tolerance. © 2020 Nova Science Publishers, Inc.- Response to the letter: Esophageal pressure and potential confounders for evaluating patient-ventilator asynchrony(2020) SOUSA, Mayson Laercio de Araujo; MAGRANS, Rudys; HAYASHI, Fatima K.; BLANCH, Lluis; KACMAREK, Robert M.; FERREIRA, Juliana C.
conferenceObject Predictors of Significant Patient-Ventilator Asynchrony During Invasive Mechanical Ventilation(2018) SOUSA, M. L.; NICIEZA, R. M.; ISENSEE, L. P.; HAYASHI, F. K.; BLANCH, L.; KACMAREK, R. M.; FERREIRA, J. C.- Simulation-based Assessment to Measure Proficiency in Mechanical Ventilation among Residents(2022) HAYASHI, Fatima K.; SOUSA, Mayson L. A.; GARCIA, Marcos V. F.; MACEDO, Bruno R.; FERREIRA, Juliana C.Background: Mechanical ventilation (MV) skills are essential for clinicians caring for critically ill patients, yet few training programs use structured curricula and appropriate assessments. Objective structured clinical exams (OSCEs) have been used to assess clinical competency in many areas, but there are no OSCE models focused on MV. Objective: To develop and validate a simulation-based assessment (SBA) with an OSCE structure to assess baseline MV competence among residents and identify knowledge gaps. Methods: We developed an SBA using a lung simulator and a mechanical ventilator, and an OSCE structure, with six clinical scenarios in MV. We included internal medicine residents at the beginning of their rotation in the respiratory intensive care unit (ICU) of a university-affiliated hospital. A subset of residents was also evaluated with a validated multiple-choice exam (MCE) at the beginning and at the end of the ICU rotation. Scores on both assessments were normalized to range from 0 to 10. We used Cronbach's a coefficient to assess reliability and Spearman correlation to estimate the correlation between the SBA and the MCE. Results: We included 80 residents, of whom 42 also completed the MCE examinations. The final version of the SBA had 32 items, and the Cronbach's a coefficient was 0.72 (95% confidence interval [CI], 0.64-0.81). The average SBA score was 6.2 +/- 1.3, and performance was variable across items, with 80% correctly adjusting initial ventilatory settings and only 12% correctly identifying asynchrony. The MCE had 24 questions, and the average score was 7.6 +/- 2.4 at the beginning of the rotation and 8.2 +/- 2.3 at the end of the rotation (increase of 0.6 points; 95% CI, 0.30-0.90; P < 0.001). There was moderate correlation between the SBA and the MCE (rho = 0.41; P = 0.002). Conclusion: We developed and validated an objective structured assessment on MV using a pulmonary simulator and a mechanical ventilator addressing the main competencies in MV. The performance of residents in the SBA at the beginning of an ICU rotation was lower than the performance in MCE, highlighting the need for greater emphasis on practical skills in MV during residency.
conferenceObject Association Between Asynchrony Index During Assisted Ventilation and on the Day of the Spontaneous Breathing Trial with Extubation Failure(2020) PEREIRA, E.; SOUSA, M. L.; MAGRANS, R.; HAYASHI, F. K.; KACMAREK, R. M.; BLANCH, L.; FERREIRA, J. C.conferenceObject Knowledge, Attitudes And Practices Among Critical Care Professionals Towards Patient-Ventilator Asynchrony: A Pilot Survey(2017) SOUSA, M. L. A.; FELTRIM, M. I. Z.; DINIZ-SILVA, F.; HAYASHI, F. K.; CARVALHO, C. R. R.; FERREIRA, J. C.- Predictors of asynchronies during assisted ventilation and its impact on clinical outcomes: The EPISYNC cohort study(2020) SOUSA, Mayson Laercio de Araujo; MAGRANS, Rudys; HAYASHI, Fatima K.; BLANCH, Lluis; KACMAREK, Robert M.; FERREIRA, Juliana C.Purpose: To investigate if respiratory mechanics and other baseline characteristics are predictors of patient-ventilator asynchrony and to evaluate the relationship between asynchrony during assisted ventilation and clinical outcomes. Methods: We performed a prospective cohort study in patients under mechanical ventilation (MV). Baseline measurements included severity of illness and respiratory mechanics. The primary outcome was the Asynchrony Index (AI), defined as the number of asynchronous events divided by the number of ventilator cycles and wasted efforts. We recorded ventilator waveforms throughout the entire period of MV. Results: We analyzed 11,881 h of MV from 103 subjects. Median AI during the entire period of MV was 5.1% (IQR:2.6-8.7). Intrinsic PEEP was associated with AI (OR:1.72, 95%CI:1.1-2.68), but static compliance and airway resistance were not. Simplified Acute Physiology Score 3 (OR:1.03, 95%CI:1-1.06) was also associated with AI. Median AI was higher during assisted (5.4%, IQR:2.9-9.1) than controlled (2%, IQR:0.6-4.9) ventilation, and 22% of subjects had high incidence of asynchrony (AI=10%). Subjects with AI=10% had more extubation failure (33%) than patients with AIb10% (6%), p =.01. Conclusions: Predictors of high incidence of asynchrony were severity of illness and intrinsic PEEP. High incidence of asynchrony was associated with extubation failure, but not mortality. Trial registration: ClinicalTrials.gov, NCT02687802 (c) 2020 Elsevier Inc. All rights reserved.
- COVID-19 knowledge, attitudes, and practices among health care workers in Latin America(2022) SOUSA, Mayson Laercio de Araujo; SHIMIZU, Iara S.; PATINO, Cecilia M.; TORRES-DUQUE, Carlos A.; ZABERT, Ignacio; ZABERT, Gustavo E.; PEREZ-PADILLA, Rogelio; VARON-VEGA, Fabio; COHEN, Mark; FERREIRA, Juliana C.Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/ private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.
conferenceObject Development and Validation of a Tool for Assessment of Competence in Mechanical Ventilation for Internal Medicine Residents(2019) HAYASHI, F. K.; SOUSA, M. L.; GARCIA, M.; MACEDO, B. R.; FERREIRA, J. C.- Clusters of Double Triggering Impact Clinical Outcomes: Insights From the EPIdemiology of Patient-Ventilator aSYNChrony (EPISYNC) Cohort Study(2021) SOUSA, Mayson Laerciod E. Araujo; MAGRANS, Rudys; HAYASHI, Fatima K.; BLANCH, Lluis; KACMAREK, Robert M.; FERREIRA, Juliana C.OBJECTIVES: To measure the impact of clusters of double triggering on clinical outcomes. DESIGN: Prospective cohort study. SETTING: Respiratory ICU in Brazil. PATIENTS: Adult patients under recent mechanical ventilation and with expectation of mechanical ventilation for more than 24 hours after enrollment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used a dedicated software to analyze ventilator waveforms throughout the entire period of mechanical ventilation and detect double triggering. We defined a cluster of double triggering as a period of time containing at least six double triggering events in a 3-minute period. Patients were followed until hospital discharge. We addressed the association between the presence and the duration of clusters with clinical outcomes. A total of 103 patients were enrolled in the study and 90 (87%) had at least one cluster of double triggering. The median number of clusters per patient was 19 (interquartile range, 6-41), with a median duration of 8 minutes (6-12 min). Compared with patients who had no clusters, patients with at least one cluster had longer duration of mechanical ventilation (7 d [4-11 d] vs 2 d [2-3 d]) and ICU length of stay (9 d [7-16 d] vs 13 d [2-8 d]). Thirty-three patients had high cumulative duration of clusters of double triggering (>= 12 hr), and it was associated with longer duration of mechanical ventilation, fewer ventilator-free days, and longer ICU length of stay. Adjusted by duration of mechanical ventilation and severity of illness, high cumulative duration of clusters was associated with shorter survival at 28 days (hazard ratio, 2.09 d; 95% CI, 1.04-4.19 d). CONCLUSIONS: Clusters of double triggering are common and were associated with worse clinical outcomes. Patients who had a high cumulative duration of clusters had fewer ventilator-free days, longer duration of mechanical ventilation, longer ICU length of stay, and shorter survival than patients with low cumulative duration of cluster.