LEANDRO UTINO TANIGUCHI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
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- Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis(2015) ZAMPIERI, Fernando G.; NASSAR JR., Antonio P.; GUSMAO-FLORES, Dimitri; TANIGUCHI, Leandro U.; TORRES, Antoni; RANZANI, Otavio T.Introduction: Nebulized antibiotics are a promising new treatment option for ventilator-associated pneumonia. However, more evidence of the benefit of this therapy is required. Methods: The Medline, Scopus, EMBASE, Biological Abstracts, CAB Abstracts, Food Science and Technology Abstracts, CENTRAL, Scielo and Lilacs databases were searched to identify randomized controlled trials or matched observational studies that compared nebulized antibiotics with or without intravenous antibiotics to intravenous antibiotics alone for ventilator-associated pneumonia treatment. Two reviewers independently collected data and assessed outcomes and risk of bias. The primary outcome was clinical cure. Secondary outcomes were microbiological cure, ICU and hospital mortality, duration of mechanical ventilation, ICU length of stay and adverse events. A mixed-effect model meta-analysis was performed. Trial sequential analysis was used for the main outcome of interest. Results: Twelve studies were analyzed, including six randomized controlled trials. For the main outcome analysis, 812 patients were included. Nebulized antibiotics were associated with higher rates of clinical cure (risk ratio (RR) = 1.23; 95% confidence interval (CI), 1.05 to 1.43; I-2 = 34%; D-2 = 45%). Nebulized antibiotics were not associated with microbiological cure (RR = 1.24; 95% CI, 0.95 to 1.62; I-2 = 62.5), mortality (RR = 0.90; CI 95%, 0.76 to 1.08; I-2 = 0%), duration of mechanical ventilation (standardized mean difference = -0.10 days; 95% CI, -1.22 to 1.00; I-2 = 96.5%), ICU length of stay (standardized mean difference = 0.14 days; 95% CI, -0.46 to 0.73; I-2 = 89.2%) or renal toxicity (RR = 1.05; 95% CI, 0.70 to 1.57; I-2 = 15.6%). Regarding the primary outcome, the number of patients included was below the information size required for a definitive conclusion by trial sequential analysis; therefore, our results regarding this parameter are inconclusive. Conclusions: Nebulized antibiotics seem to be associated with higher rates of clinical cure in the treatment of ventilator-associated pneumonia. However, the apparent benefit in the clinical cure rate observed by traditional meta-analysis does not persist after trial sequential analysis. Additional high-quality studies on this subject are highly warranted.
- Importance of a registered and structured protocol when conducting systematic reviews: comments about nebulized antibiotics for ventilator-associated pneumonia(2015) ZAMPIERI, Fernando G.; NASSAR JR., Antonio P.; GUSMAO-FLORES, Dimitri; TANIGUCHI, Leandro U.; TORRES, Antoni; RANZANI, Otavio T.
- HEMOCOVID-19 Study: An International Clinical Study to Evaluate Microvascular and Endothelial Impairments in Severe COVID-19 Patients Using Near-Infrared Spectroscopy(2021) CORTESE, L.; OLIVEIRA, L. Bacchin de; BARCELONA, M.; DELAZARI, L. E. Bernardes; BESEN, B. A. M. P.; BUSCH, D. R.; CABALLER, A.; ROBLES, V. Carbajal; CASTRO, P.; LIMA, A. L. Cavallaro Barauna; CHERUKU, S.; CHISCANO, L.; CHOI, C.; MESQUITA, R. Coelho; DAVE, S.; RATTI, L. dos Santos Roceto; FALCAO, A. L. Eiras; ESPINAL, C.; FERNANDEZ, S.; FERRER, R.; FONT, F.; ACILU, M. Garcia de; GRUARTMONER, G.; KARADENIZ, U.; LAHSAEI, P.; EMIDIO, G. Livio; CORRAL, J. Marin; MATAS, A.; FORTI, R. Menezes; MERA, A.; HERNANDEZ, F. J. Monte de Oca; MYERS, T.; NOGALES, S.; OLSON, D.; PAGLIAZZI, M.; GUZMAN, M. Parada; PACHECO, A. Perez; TERAN, P. Perez; PICAZO, L.; VAZQUEZ, D. Pineda; SOTO, A. F. Quiroga; SICCHA, R. M. Quispe; ROMERO, D.; AGUAYO, E. Santillan; SERRA, I; LOYOLA, R. Serrano; TELLEZ, A.; TANIGUCHI, L. Utino; VILA, C.; ZANOLETTI, M.; MESQUIDA, J.; DURDURAN, T.We present the HEMOCOVID-19 study spanning four countries and eight hospitals where near-infrared spectroscopy is utilized to evaluate microvascular and endothelial health of severe COVID-19 patients at the intensive care.
- Severity scoring systems for pneumonia: current understanding and next steps(2018) RANZANI, Otavio T.; TANIGUCHI, Leandro Utino; TORRES, AntoniPurpose of reviewTo describe the current understanding and clinical applicability of severity scoring systems in pneumonia management.Recent findingsSeverity scores in community-acquired pneumonia are strong markers of mortality, but are not necessarily clinical decision-aid tools. The use of severity scores to support outpatient care in low-risk patients has moderate-to-strong evidence available in the literature, mainly for the pneumonia severity index, and must be applied together with clinical judgment. It is not clear that severity scores are helpful to guide empiric antibiotic treatment. The inclusion of biomarkers and performance status might improve the predictive performance of the well known severity scores in community-acquired pneumonia. We should improve our methods for score evaluation and move toward the development of decision-aid tools.SummaryThe application of the available evidence favors the use of severity scoring systems to improve the delivery of care for pneumonia patients. The incorporation of new methodologies and the formulation of different questions other than mortality prediction might help the further development of severity scoring systems, and enhance their support to the clinical decision-making process for the pneumonia-management cascade.