LEANDRO UTINO TANIGUCHI
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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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- Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study(2021) ZAMPIERI, Fernando G.; ROMANO, Thiago G.; SALLUH, Jorge I. F.; TANIGUCHI, Leandro U.; V, Pedro Mendes; JR, Antonio P. Nassar; COSTA, Roberto; VIANA, William N.; MAIA, Marcelo O.; LIMA, Mariza F. A.; CAPPI, Sylas B.; CARVALHO, Alexandre G. R.; MARCO, Fernando V. C. De; SANTINO, Marcelo S.; PERECMANIS, Eric; MIRANDA, Fabio G.; V, Grazielle Ramos; SILVA, Aline R.; HOFF, Paulo M.; BOZZA, Fernando A.; SOARES, MarcioPurpose To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. Methods We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. Results 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. Conclusion Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.
- Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study(2021) DOI, Dimitria; VALE, Romulo Ribeiro do; MONTEIRO, Jean Michell Correia; PLENS, Glauco Cabral Marinho; FERREIRA JUNIOR, Mario; FONSECA, Luiz Augusto Marcondes; PERAZZIO, Sandro Felix; BESEN, Bruno Adler Maccagnan Pinheiro; LICHTENSTEIN, Arnaldo; TANIGUCHI, Leandro Utino; SUMITA, Nairo Massakazu; CORA, Aline Pivetta; EISENCRAFT, Adriana Pasmanik; DUARTE, Alberto Jose da SilvaThe demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents' training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents' subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.
- Resuscitation fluid practices in Brazilian intensive care units: A secondary analysis of Fluid-TRIPS(2021) FREITAS, F. G. R. de; HAMMOND, N.; LI, Y.; AZEVEDO, L. C. P. de; CAVALCANTI, A. B.; TANIGUCHI, L.; GOBATTO, A.; Japiassú A. M.; BAFI, A. T.; MAZZA, B. F.; NORITOMI, D. T.; ANDRADE, J. N.; JUSTO, A. P. P.; SANTOS, A. P.; ALBUQUERQUE, A. C. D. de; SCAZUFKA, A.; SILVA, G. A. da; RODRIGUES, A. B.; FERNANDINO, B. B.; ARAUJO, F. F. de; CAVALCANTI, G. S.; SALLUH, J. I. F.; SILVA, B. G.; VIDAL, B. S.; PINHEIRO, B. V.; PINTO, B. V. C.; SOBRINHO, J. O. D. C.; FEIJO, C. A. R.; FILHO, C. D. A.; BOSSO, C. E. D. C. Nunes; COSTA, G.; MOREIRA, C. E. N.; ARBEX, M.; FERREIRA, J.; TREVISOL, F. S.; RAMOS, C. H. F.; VASSALLO, P. F.; LINS, C.; BERALDO, D.; FONTES, D.; BONI, D.; CASTIGLIONI, D.; PAISANI, D. D. M.; RODRIGUES, M. L.; PEDROSO, D. F. F.; MATTOS, E. R.; ALVES, J. A.; SOBRINHO, E. D. B.; ANTONIAZZI, P.; BETôNICO, G. N.; CAVALCANTI, G. S.; TRONCOSO, E. M. V.; ROSENBLAT, R.; AMORIM, F. F.; GUERREIRO, M. O.; GIANNINI, F. P.; SANTOS, F. P. M.; BUARQUE, F.; LIMA, F. G.; COSTA, F. A. Alvares da; GOTTARDO, P. C.; SAD, F. C. dos Anjos; ARANHA, F. G.; GANEM, F.; CALLIL, F.; ROCHA, M.; SOUZA, R. M. de; SATO, K. M.; GOMES, J.; COSTA FILHO, F. F.; ZAJAC, S.; BETôNICO, G. N.; CORREIA, P.; REIS, H.; ARAUJO, H. B. N.; HORTIZ, H. A. Jr.; SANTOS, T. M.; GUIMARAES, H. P.; URBANO, H.; ALMEIDA, R.; MAIA, I.; FILHO, I. L. S.; JúNIOR, J. F.; ALVAREZ, J. R.; FERREIRA, P.; VAZ, S. M.; GERENT, K.; ALVES, M. A. P.; PASSOS, J. T.; PARANHOS, J. E. da Rocha; DAL-PIZZOL, F.; TEIXEIRA, K. M. Costa; NARCISO, R. C.; CONDE, K. A. P.; MARTINS, L. F.; FIGUEIRêDO, L.; SOARES, M.; REZEGUE, L.; ALVES, M. A. P.; TCHERNIACOVSK, L.; BEZERRA, S. A. B.; FERRAZ, L. O.; CAVALCANTE, L.; RABELO, L.; MIILHER, L.; MARCO, R.; BOZZA, F.; GARCIA, L.; TORRES, P.; BIONDI, R.; TANNOUS, L.; HAJJAR, L. A.; PACIêNCIA, L. E. M.; CRUZ NETO, L. M. da; FARHAT, T. B. T.; BLEY, M. V.; SOUSA, M. F.; PUGA, M. L.; WALTRICK, R.; ROMANO, M. L. P.; SILVA, U. V. A.; SILVA, P. G. M. de Barros e; NOBREGA, M.; TAVARES, C.; ROSA, M. D.; DIAS, M. D’Agostino; MARTINS, M.; OLIVEIRA, M. de; WESTPHAL, G. A.; MORETTI, M. M. S.; MATSUI, M.; MESSENDER, O.; SMITH, T.; SANTARéM, O. L. D. A.; ARANTES, C.; LISBOA, T.; FIGUEIREDO, R.; SILVEIRA, P. J. H. da; FILHO, E. M. R.; FOERNGES, R.; GOMES, R.; MORAES, R.; NONATO FILHO, R.; BORBA, R. L.; GOMES, R. V.; GRION, C.; CORDIOLI, R.; LIMA, R.; ASSUNçãO, M. S. C. de; LóPEZ, R. P.; NOGUEIRA, E. E. F.; NOBRE, V.; DAMASCENO, V. B.; GARGIONI, R. R. D. O.; DALL'ARTO, F. T. Campo; DUTRA, R. S.; MENDES, C. L.; BATISTA, R.; FELIPE, R.; FRANCO, R. S. da Silva; HOULY, S.; FARIA, S. S.; FERREIRA, E. L.; PINTO, S. F.; LUZZI, S.; SANT’ANA, S.; FERNANDES, S. S.; KMOHAN, C.; MORENO, G.; BARBOSA, A. R.; LOBO, S. M. A.; YAMADA, S.; MARQUES, J. A.; DANTAS, V. C. de Souza; PACHECO, E. S.; IRINEU, V. M.; BOGADO, V.; NEDEL, W.; BEZERRA, J. T. D. Paiva; FILHO, W. C.; DANTAS, W.; FRIEDMAN, G.; VIANA, W.; FILHO, W. D. O.; DELGADINHO, W. M.; FINFER, S.; JODAR, E.; MOREIRA FILHO, J. G.; VENTURA, A. F.; PIRAS, C.; MACHADO, F. R.; GROUP, the Brazilian Research in Intensive Care Network - BRICNET Fluidos Investigators the George Institute for Global Health and the ANZICS Clinical Trials; SOUZA, A. F. de; SILVA, A. F.; MORALEZ, G. M.; TOLEDO, A.; REIS, A.; CEMBRANEL, A.; FERREIRA, E. L. A.; NETO, A. R.; CASTRO, C. P. P.; GUT, A. L.Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation. © 2021 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.
- Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study(2021) FERREIRA, Juliana C.; HO, Yeh-Li; BESEN, Bruno Adler Maccagnan Pinheiro; MALBOUISSON, Luiz Marcelo Sa; TANIGUCHI, Leandro Utino; MENDES, Pedro Vitale; COSTA, Eduardo Leite Vieira; PARK, Marcelo; DALTRO-OLIVEIRA, Renato; ROEPKE, Roberta M. L.; SILVA-JR, Joao M.; CARMONA, Maria Jose Carvalho; CARVALHO, Carlos R. R.Background Approximately 5% of COVID-19 patients develop respiratory failure and need ventilatory support, yet little is known about the impact of mechanical ventilation strategy in COVID-19. Our objective was to describe baseline characteristics, ventilatory parameters, and outcomes of critically ill patients in the largest referral center for COVID-19 in Sao Paulo, Brazil, during the first surge of the pandemic. Methods This cohort included COVID-19 patients admitted to the intensive care units (ICUs) of an academic hospital with 94 ICU beds, a number expanded to 300 during the pandemic as part of a state preparedness plan. Data included demographics, advanced life support therapies, and ventilator parameters. The main outcome was 28-day survival. We used a multivariate Cox model to test the association between protective ventilation and survival, adjusting for PF ratio, pH, compliance, and PEEP. Results We included 1503 patients from March 30 to June 30, 2020. The mean age was 60 +/- 15 years, and 59% were male. During 28-day follow-up, 1180 (79%) patients needed invasive ventilation and 666 (44%) died. For the 984 patients who were receiving mechanical ventilation in the first 24 h of ICU stay, mean tidal volume was 6.5 +/- 1.3 mL/kg of ideal body weight, plateau pressure was 24 +/- 5 cmH(2)O, respiratory system compliance was 31.9 (24.4-40.9) mL/cmH(2)O, and 82% of patients were ventilated with protective ventilation. Noninvasive ventilation was used in 21% of patients, and prone, in 36%. Compliance was associated with survival and did not show a bimodal pattern that would support the presence of two phenotypes. In the multivariable model, protective ventilation (aHR 0.73 [95%CI 0.57-0.94]), adjusted for PF ratio, compliance, PEEP, and arterial pH, was independently associated with survival. Conclusions During the peak of the epidemic in Sao Paulo, critically ill patients with COVID-19 often required mechanical ventilation and mortality was high. Our findings revealed an association between mechanical ventilation strategy and mortality, highlighting the importance of protective ventilation for patients with COVID-19.
- 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.
- Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study (Aug, 10.1007/s00134-020-06184-2, 2020)(2021) ZAMPIERI, Fernando G.; ROMANO, Thiago G.; SALLUH, Jorge I. F.; TANIGUCHI, Leandro U.; MENDES, Pedro V.; NASSAR JR., Antonio P.; COSTA, Roberto; VIANA, William N.; MAIA, Marcelo O.; LIMA, Mariza F. A.; CAPPI, Sylas B.; CARVALHO, Alexandre G. R.; MARCO, Fernando V. C. De; SANTINO, Marcelo S.; PERECMANIS, Eric; MIRANDA, Fabio G.; RAMOS, Grazielle V.; SILVA, Aline R.; HOFF, Paulo M.; BOZZA, Fernando A.; SOARES, MarcioThe original version of this article unfortunately contained a mistake in Fig. 4.