LUDHMILA ABRAHAO HAJJAR
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina
LIM/08 - Laboratório de Anestesiologia, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Impact of intensive glycemic control on acute renal injury: a randomized clinical trial(2019) SANTANA-SANTOS, Eduesley; KANKE, Patricia Hatanaka; VIEIRA, Rita de Cassia Almeida; OLIVEIRA, Larissa Bertacchini de; FERRETTI-REBUSTINI, Renata Eloah de Lucena; MENEZES, Andreia Freire de; BARRETO, Ikaro Daniel de Carvalho; HAJJAR, Ludhmila AbrahaoObjective: To evaluate the impact of intensive glycemic control on the reduction of the incidence of acute renal injury in adult patients undergoing cardiac surgery. Methods: Randomized clinical trial, evaluating 95 patients undergoing two glycemic control strategies. Patients were randomized to the intervention n group (IG), with the goal of maintaining postoperative glycemia between 90 and 110 mg/dl. For patients allocated into the conventional group (CG) the goal was to maintain glycaemia between 140 and 180 mg/dl. The insulin dose adjustment was based on undiluted arterial blood glucose measurements at one hour intervals, by means of a blood glucose and beta-ketone monitoring system. Results: The incidence of acute kidney injury was 53.7% (KDIGO stages 1, 2 or 3). There was no significant difference between the groups regarding the primary outcome (p=0.294). However, a greater frequency of complete renal function recovery (p = 0.010), ICU discharge (p = 0.028), and hospital discharge (p = 0.048) was found among patients undergoing conventional glycemic control. The use of intensive glycemic control was associated with longer ICU stay (p=0.031). The number of episodes of hypoglycemia was similar in both groups (1.6 +/- 0.9 vs. 1.3 +/- 0.6, p=0.731), demonstrating the safety of the strategies used. Conclusion: The impact of intensive glycemic control on reducing the incidence of acute kidney injury was not observed. In contrast, patients treated in the CG had a higher frequency of complete renal function recovery.
- Position Statement on Women's Cardiovascular Health-2022(2022) OLIVEIRA, Glaucia Maria Moraes de; ALMEIDA, Maria Cristina Costa de; MARQUES-SANTOS, Celi; COSTA, Maria Elizabeth Navegantes Caetano; CARVALHO, Regina Coeli Marques de; FREIRE, Claudia Maria Vilas; MAGALHAES, Lucelia Batista Neves Cunha; HAJJAR, Ludhmila Abrahao; RIVERA, Maria Alayde Mendonca; CASTRO, Marildes Luiza de; AVILA, Walkiria Samuel; LUCENA, Alexandre Jorge Gomes de; BRANDAO, Andrea Araujo; MACEDO, Ariane Vieira Scarlatelli; LANTIERI, Carla Janice Baister; POLANCZYK, Carisi Anne; ALBUQUERQUE, Carlos Japhet da Matta; BORN, Daniel; FALCHETO, Eduardo Belisario; BRAGANCA, Erika Olivier Vilela; BRAGA, Fabiana Goulart Marcondes; COLOMBO, Fernanda M. Consolim; JATENE, Ieda Biscegli; COSTA, Isabela Bispo Santos da Silva; RIVERA, Ivan Romero; SCHOLZ, Jaqueline Ribeiro; MELO FILHO, Jose Xavier de; SANTOS, Magaly Arrais dos; BARBOSA, Marcia de Melo; IZAR, Maria Cristina de Oliveira; AZEVEDO, Maria Fatima; MOURA, Maria Sanali; CAMPOS, Milena dos Santos Barros; SOUZA, Olga Ferreira de; MEDEIROS, Orlando Otavio de; SILVA, Sheyla Cristina Tonheiro Ferro da; RIZK, Stephanie Itala; RODRIGUES, Thais de Carvalho Vieira; SALIM, Thais Rocha; LEMKE, Viviana de Mello Guzzo; ALEXANDRE, Elisabeth Regina Giunco
- Haemodynamic monitoring in the perioperative setting(2023) QUINTAO, Vinicius Caldeira; JR, Armindo Jreige; RIZK, Stephanie Itala; HAJJAR, Ludhmila AbrahaoPurpose of reviewThe aim of this study was to review the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, to describe the type of devices, to analyse the scientific evidence and to suggest algorithms of haemodynamic care in high-risk surgical patients.Recent findingsIn the last 50 years, many advances have contributed to better understand cardiovascular physiology at bedside, and haemodynamic monitoring has moved from invasive methods to minimally invasive and noninvasive devices. Randomized clinical trials have shown benefits of perioperative haemodynamic therapy to improve outcomes in high-risk surgical patients. A multimodal approach is purposed in the perioperative setting to optimize haemodynamic parameters, involving clinical analysis at bedside, the use of dynamic tests for fluid responsiveness and integration of variables, including cardiac output, systolic volume, tissue oxygen markers and echocardiographic measures.In this review, we summarize the benefits of haemodynamic monitoring, the type of devices with advantages and disadvantages, the scientific evidence supporting perioperative haemodynamic therapy, and we suggest a multimodal approach to improve patients' care.
- Stress Echocardiography Another Hilltop, and It Is Better Than Ever(2023) MATHIAS, Wilson; BIHAN, David Costa de Souza Le; HAJJAR, Ludhmila Abrahao
- Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography(2023) HAJJAR, Ludhmila Abrahao; ANCONA, Marco B.; KALIL FILHO, Roberto; TRESOLDI, Moreno; CALDAS, Jose Guilherme; MONTI, Giacomo; CARNEVALE, Francisco Cesar; COBELLI, Francesco De; ASSIS, Andre Moreira de; CICERI, Fabio; LANDONI, Giovanni; DIJKSTRA, Jouke; MORONI, Francesco; ABIZAID, Alexandre Antonio Cunha; UNGARETTI, Fernanda Willemann; CARMONA, Maria Jose Carvalho; BACKER, Daniel De; POMPILIO, Carlos Eduardo; JR, Fabio S. de Britto; CAMPOS, Carlos M.; ZANGRILLO, Alberto; MONTORFANO, MatteoBackground Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 +/- 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 +/- 4.6 mm(2), with stenosis of 60.9 +/- 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 +/- 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 & PLUSMN; 2.6, and the mean thrombus-containing lesion length was 14.1 +/- 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.
- Modified endoscopic vacuum therapy for duodenal hemorrhage in patients with severe acute respiratory syndrome coronavirus 2(2022) MOURA, Diogo Turiani Hourneaux de; MOURA, Eduardo Guimaraes Hourneaux de; HIRSCH, Bruno Salomao; SILVA, Gustavo L. Rodela; RIZK, Stephanie I.; HOFF, Paulo M.; HAJJAR, Ludhmila A.
- A plea for personalization of the hemodynamic management of septic shock(2022) BACKER, Daniel De; CECCONI, Maurizio; CHEW, Michelle S.; HAJJAR, Ludhmila; MONNET, Xavier; OSPINA-TASCON, Gustavo A.; OSTERMANN, Marlies; PINSKY, Michael R.; VINCENT, Jean-LouisAlthough guidelines provide excellent expert guidance for managing patients with septic shock, they leave room for personalization according to patients' condition. Hemodynamic monitoring depends on the evolution phase: salvage, optimization, stabilization, and de-escalation. Initially during the salvage phase, monitoring to identify shock etiology and severity should include arterial pressure and lactate measurements together with clinical examination, particularly skin mottling and capillary refill time. Low diastolic blood pressure may trigger vasopressor initiation. At this stage, echocardiography may be useful to identify significant cardiac dysfunction. During the optimization phase, echocardiographic monitoring should be pursued and completed by the assessment of tissue perfusion through central or mixed-venous oxygen saturation, lactate, and carbon dioxide veno-arterial gradient. Transpulmonary thermodilution and the pulmonary artery catheter should be considered in the most severe patients. Fluid therapy also depends on shock phases. While administered liberally during the resuscitation phase, fluid responsiveness should be assessed during the optimization phase. During stabilization, fluid infusion should be minimized. In the de-escalation phase, safe fluid withdrawal could be achieved by ensuring tissue perfusion is preserved. Norepinephrine is recommended as first-line vasopressor therapy, while vasopressin may be preferred in some patients. Essential questions remain regarding optimal vasopressor selection, combination therapy, and the most effective and safest escalation. Serum renin and the angiotensin I/II ratio may identify patients who benefit most from angiotensin II. The optimal therapeutic strategy for shock requiring high-dose vasopressors is scant. In all cases, vasopressor therapy should be individualized, based on clinical evaluation and blood flow measurements to avoid excessive vasoconstriction. Inotropes should be considered in patients with decreased cardiac contractility associated with impaired tissue perfusion. Based on pharmacologic properties, we suggest as the first test a limited dose of dobutamine, to add enoximone or milrinone in the second line and substitute or add levosimendan if inefficient. Regarding adjunctive therapies, while hydrocortisone is nowadays advised in patients receiving high doses of vasopressors, patients responding to corticosteroids may be identified in the future by the analysis of selected cytokines or specific transcriptomic endotypes. To conclude, although some general rules apply for shock management, a personalized approach should be considered for hemodynamic monitoring and support.
- Physical capacity increase in patients with heart failure is associated with improvement in muscle sympathetic nerve activity(2023) GOES-SANTOS, Beatriz R.; RONDON, Eduardo; FONSECA, Guilherme W. P.; SALES, Allan R. K.; SANTOS, Marcelo R.; ANTUNES-CORREA, Ligia M.; UENO-PARDI, Linda M.; OLIVEIRA, Patricia; TREVIZAN, Patricia F.; FRANCO, Fabio G. Mello; FRAGA, Raffael; ALVES, Maria Janieire N. N.; RONDON, Maria Urbana P. B.; HAJJAR, Ludhmila A.; KALIL FILHO, Roberto; NEGRAO, Carlos E.Background: Exercise training improves physical capacity in patients with heart failure with reduced ejection fraction (HFrEF), but the mechanisms involved in this response is not fully understood. The aim of this study was to determine if physical capacity increase in patients HFrEF is associated with muscle sympathetic nerve activity (MSNA) reduction and muscle blood flow (MBF) increase. Methods: The study included 124 patients from a 17-year database, divided according to exercise training status: 1) exercise-trained (ET, n = 83) and 2) untrained (UNT, n = 41). MSNA and MBF were obtained using microneurography and venous occlusion plethysmography, respectively. Physical capacity was evaluated by cardiopulmonary exercise test. Moderate aerobic exercise was performed 3 times/wk. for 4 months. Results: Exercise training increased peak oxygen consumption (VO2, 16.1 +/- 0.4 vs 18.9 +/- 0.5 mL.kg(-1).min(-1), P < 0.001), LVEF (28 +/- 1 vs 30 +/- 1%, P = 0.027), MBF (1.57 +/- 0.06 vs 2.05 +/- 0.09 mL.min(-1).100 ml(-1), P < 0.001) and muscle vascular conductance (MVC, 1.82 +/- 0.07 vs 2.45 +/- 0.11 units, P < 0.001). Exercise training significantly decreased MSNA (45 +/- 1 vs 32 +/- 1 bursts/min, P < 0.001). The logistic regression analyses showed that MSNA [(OR) 0.921, 95% CI 0.883-0.962, P < 0.001] was independently associated with peak VO2. Conclusions: The increase in physical capacity provoked by aerobic exercise in patients with HFrEF is associated with the improvement in MSNA.
- Sympathetic neural overdrive and diminished exercise capacity in reduced ejection fraction heart failure related to anthracycline-based chemotherapy(2023) RODRIGUES, Amanda G.; SALES, Allan R. K.; FARIA, Diego; FONSECA, Silvia M. R.; BOND, Marina M. K.; JORDAO, Camila P.; SOUZA, Francis R. de; BITTAR, Cristina S.; SANTOS, Marilia H. H. Dos; SARMENTO, Adriana O.; NEGRAO, Marcelo V.; HAJJAR, Ludhmila A.; NEGRAO, Carlos E.; KALIL FILHO, RobertoCardiotoxicity is the most worrying cardiovascular alteration in patients treated with chemotherapy. To improve the understanding regarding the cardiotoxicity, we studied whether 1) patients with cardiac dysfunction related to anthracycline-based chemotherapy have augmented sympathetic nerve activity and decreased exercise capacity and 2) these responses are similar to those observed in patients with heart failure caused by other etiologies. Sixteen patients with heart failure with reduced ejection fraction related to anthracycline-based chemotherapy with or without chest radiation (HFrEFCA), 10 patients with heart failure with reduced ejection not related to cancer therapy (HFrEF), and 16 age- and body mass index (BMI)-matched healthy control subjects were studied. Left ventricular ejection fraction (LVEF, echocardiography), peak oxygen consumption (peak (V)over dot(O2), cardiopulmonary exercise test), muscle sympathetic nerve activity (MSNA, microneurography), and forearm blood flow (FBF, venous occlusion plethysmography) were measured. We found that peak oxygen consumption peak (V)over dot(O2) and LVEF were significantly reduced in patients with HFrEFCA compared with that of control subjects (P < 0.0001) but similar to those found in patients with HFrEFCA. The sympathetic nerve activity burst frequency and incidence were significantly higher in patients with HFrEFCA than that in control subjects (P < 0.0001). No differences were found between patients with HFrEF and HFrEFCA. Peak (V)over dot(O2) was inversely associated with MSNA burst frequency (r = -0.53, P = 0.002) and burst incidence (r = -0.38, P = 0.01) and directly associated with LVEF (r = 0.71, P < 0.0001). Taken together, we conclude that patients who develop heart failure due to anthracycline-based chemotherapy have sympathetic neural overdrive and reduced exercise capacity. In addition, these physiological changes are similar to those observed in patients with HFrEF.
- Carcinoid Heart Disease: A Case Report and Literature Review(2023) COSTA, Isabela Bispo Santos da Silva; MELO, Edielle de Sant Anna; FURTADO, Armando; SOBRAL-ALVES, Juliana Barbosa; RIZK, Stephanie Itala; BENVENUTI, Luiz Alberto; ROCHITTE, Carlos E.; BRANDAO, Carlos Manuel de Almeida; POMARENTZEFF, Pablo Maria; BITTAR, Cristina Salvadori; GALAS, Filomena Regina Barbosa Gomes; AULER JUNIOR, Jose Otavio Costa; HOFF, Paulo Marcelo Gehm; KALIL FILHO, Roberto; JATENE, Fabio Biscegli; HAJJAR, Ludhmila Abrahao