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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- NEGATIVE FLUID BALANCE IN SEPSIS: WHEN AND HOW?(2017) BESEN, Bruno Adler Maccagnan Pinheiro; TANIGUCHI, Leandro UtinoFluid resuscitation plays a fundamental role in the treatment of septic shock. Administration of inappropriately large quantities of fluid may lead to volume overload, which is increasingly recognized as an independent risk factor for morbidity and mortality in critical illness. In the early treatment of sepsis, timely fluid challenges should be given to optimize organ perfusion, but continuous positive fluid balance is discouraged. In fact, achievement of a negative fluid balance during treatment of sepsis is associated with better outcomes. This review will discuss the relationship between fluid overload and unfavorable outcomes in sepsis, and how fluid overload can be prevented and managed.
- Subjective score and outcomes after discharge from the intensive care unit: a prospective observational study(2019) TANIGUCHI, Leandro Utino; RAMOS, Fernando Jose da Silva; MOMMA, Arthur Khan; MARTINS FILHO, Antonio Paulo Ramos; BARTOCCI, Juliana Jardim; LOPES, Maria Fernanda Dias; SAD, Matheus Horta; RODRIGUES, Cinthia Mendes; SIQUEIRA, Ellen Maria Pires; VIEIRA JR., Jose MauroObjective Intensive care unit (ICU) discharge is a decision process that is usually performed subjectively. We evaluated whether a subjective score (Sabadell score) is associated with hospital outcomes. Methods We conducted a prospective cohort study from August 2014 to May 2015 at a tertiary-care private hospital in Brazil. We analyzed 425 patients who were discharged alive from the ICU to the wards. We used univariate and multivariate analysis to identify risk factors associated with a composite endpoint of worse outcomes (later ICU readmission or ward death) during the same hospitalization. Results Forty-three patients (10.1%) were readmitted after ICU discharge, and 19 died in the ward. Compared with patients with successful outcomes, those with the composite endpoint were older and more severely ill, had a nonsurgical reason for hospitalization, more frequently came from the ward, were less frequently independent during daily activities, had sepsis, had higher C-reactive protein concentrations at ICU admission, and had higher Sabadell scores at discharge. The multivariate analysis showed that sepsis and the Sabadell score were independently and significantly associated with worse outcomes. Conclusion Sepsis at admission and the Sabadell score were predictors of worse hospital outcomes. The Sabadell score might be a promising predictive tool.
conferenceObject ASSOCIATION BETWEEN EARLY FLUID BALANCE, ORGAN FAILURES AND OUTCOMES IN VENTILATED PATIENTS(2015) AZEVEDO, Luciano; IGNACIO, Fernando; SILVA, Ulysses; SOUZA-DANTAS, Vicente; TANIGUCHI, Leandro; SALLUH, Jorge; REA-NETO, Alvaro; SOARES, Marcio- Prevalence of Ventilatory Conditions for Dynamic Fluid Responsiveness Prediction in 2 Tertiary Intensive Care Units(2016) MENDES, Pedro V.; RODRIGUES, Bruno N.; MIRANDA, Leandro C.; ZAMPIERI, Fernando G.; QUEIROZ, Eduardo L.; SCHETTINO, Guilherme; AZEVEDO, Luciano C.; PARK, Marcelo; TANIGUCHI, Leandro U.Background: Dynamic parameters for fluid responsiveness obtained from heart-lung interaction during invasive mechanical ventilation require specific conditions not always present in intensive care unit (ICU) patients. The aim of this study was to examine the prevalence of these conditions in critically ill patients. Methods: We conducted a prospective observational study in 2 medical-surgical ICUs. We evaluated whether it would be possible to measure dynamic indices of fluid responsiveness when fluid expansion was administered. We recorded whether the patients were in controlled invasive mechanical ventilation with tidal volume >8 mL/kg and without arrhythmias. The proportion of patients who fulfilled these conditions was recorded. A post hoc subgroup analyses by terciles of Simplified Acute Physiology Score 3 (SAPS3) were performed. Results: A total of 826 fluid challenges were undertaken in 424 patients during the study. The use of controlled mechanical ventilation with tidal volume > 8 mL/kg and without arrhythmias occurred in only 2.9% of the patients at the time of fluid challenge episodes. There was an increase in the prevalence of these conditions as the severity of the patients also increased: lower tercile of SAPS3 (0%), intermediate tercile (2%), and higher tercile (6.9%; P < .01 Pearson chi-square test). Conclusions: Respiratory-dependent dynamic parameters for predicting fluid responsiveness in ICU may have restricted applicability in daily practice, even in more severe patients, due to low prevalence of required conditions.
- Extracorporeal membrane oxygenation for severe respiratory failure in adult patients: A systematic review and meta-analysis of current evidence(2013) ZAMPIERI, Fernando Godinho; MENDES, Pedro Vitale; RANZANI, Otavio T.; TANIGUCHI, Leandro Utino; AZEVEDO, Luciano Cesar Pontes; COSTA, Eduardo Leite Vieira; PARK, MarceloBackground: Extracorporeal membrane oxygenation (ECMO) for acute respiratory failure is still a matter of debate. Methods: We performed a structured search on Pubmed, EMBASE, Lilacs, and the Cochrane Library for randomized controlled trials and observational case-control studies with severity-paired patients, evaluating the use of ECMO on severe acute respiratory failure in adult patients. A random-effect model using DerSimonian and Laird method for variance estimator was performed to evaluate the effect of ECMO use on hospital mortality. Heterogeneity between studies was assessed with Cochran's Q statistic and Higgin's I-2. Results: Three studies were included on the metanalysis, comprising 353 patients in the main analysis, in which 179 patients were ECMO supported. One study was a randomized controlled trial and two were observational studies with a propensity score matching. The most common reason for acute respiratory failure was influenza H1N1 pneumonia (45%) and pneumonia (33%). ECMO was not associated with a reduction in hospital mortality (OR = 0.71; CI 95% = 0.34-1.47; P = 0.358). If alternative severity-pairing method presented by the two observational studies was included, a total of 478 cases were included, in which 228 received ECMO support. In the former analysis, ECMO had a benefit on hospital mortality (OR = 0.52; CI 95% = 0.35-0.76; P < 0.001). Conclusion: Extracorporeal membrane oxygenation benefit on hospital mortality is unclear. Results were sensitive to statistical analysis, and no definitive conclusion can be drawn from the available data. More studies are needed before the widespread use of ECMO can be recommended.
- Comparação do desempenho do SAPS 3 em pacientes com e sem tumor sólido admitidos a uma unidade de terapia intensiva no Brasil: um estudo de coorte retrospectiva(2020) TANIGUCHI, Leandro Utino; SIQUEIRA, Ellen Maria PiresABSTRACT Objective: To compare the performance of the Simplified Acute Physiology Score 3 (SAPS 3) in patients with and without solid cancer who were admitted to the intensive care unit of a comprehensive oncological hospital in Brazil. Methods: We performed a retrospective cohort analysis of our administrative database of the first admission of adult patients to the intensive care unit from 2012 to 2016. The patients were categorized according to the presence of solid cancer. We evaluated discrimination using the area under the Receiver Operating Characteristic curve (AUROC) and calibration using the calibration belt approach. Results: We included 7,254 patients (41.5% had cancer, and 12.1% died during hospitalization). Oncological patients had higher hospital mortality than nononcological patients (14.1% versus 10.6%, respectively; p < 0.001). SAPS 3 discrimination was better for oncological patients (AUROC = 0.85) than for nononcological patients (AUROC = 0.79) (p < 0.001). After we applied the calibration belt in oncological patients, the SAPS 3 matched the average observed rates with a confidence level of 95%. In nononcological patients, the SAPS 3 overestimated mortality in those with a low-middle risk. Calibration was affected by the time period only for nononcological patients. Conclusion: SAPS 3 performed differently between oncological and nononcological patients in our single-center cohort, and variation over time (mainly calibration) was observed. This finding should be taken into account when evaluating severity-of-illness score performance.
- 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.
- Resposta para: Fatores na admissão à unidade de terapia intensiva associados à readmissão em pacientes onco-hematológicos graves: estudo retrospectivo de coorte(2016) RODRIGUES, Cinthia Mendes; PIRES, Ellen Maria Campos; FELICIANO, Jorge Patrick Oliveira; VIEIRA JR., Jose Mauro; TANIGUCHI, Leandro Utino
- Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study(2024) TOMAZINI, Bruno Martins; BESEN, Bruno Adler Maccagnan Pinheiro; TANIGUCHI, Leandro Utino; ZAMPIERI, Fernando Godinho; CAVALCANTI, Alexandre BiasiBackground: Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking. Objectives: To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients. Methods: We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT. Results: A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51-2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08-1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively). Conclusions: In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
- Spontaneous bacterial peritonitis complicating ovarian hyperstimulation syndrome-related ascites(2011) TANIGUCHI, Leandro Utino; JORGE, Claudia Gennari Lacerda; OLIVEIRA, Lucas Fernandes de