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
33 resultados
Resultados de Busca
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- Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial(2022) ZANGRILLO, Alberto; LOMIVOROTOV, Vladimir V.; PASYUGA, Vadim V.; BELLETTI, Alessandro; GAZIVODA, Gordana; MONACO, Fabrizio; NETO, Caetano Nigro; LIKHVANTSEV, Valery V.; BRADIC, Nikola; LOZOVSKIY, Andrey; LEI, Chong; BUKAMAL, Nazar A. R.; SILVA, Fernanda Santos; BAUTIN, Andrey E.; MA, Jun; YONG, Chow Yen; CAROLLO, Cristiana; KUNSTYR, Jan; WANG, Chew Yin; V, Evgeny Grigoryev; RIHA, Hynek; WANG, Chengbin; EL-TAHAN, Mohamed R.; SCANDROGLIO, Anna Mara; MANSOR, Marzida; LEMBO, Rosalba; PONOMAREV, Dmitry N.; BEZERRA, Francisco Jose Lucena; RUGGERI, Laura; CHERNYAVSKIY, Alexander M.; XU, Junmei; TARASOV, Dmitry G.; NAVALESI, Paolo; YAVOROVSKIY, Andrey; BOVE, Tiziana; KUZOVLEV, Artem; HAJJAR, Ludhmila A.; LANDONI, GiovanniObjective: To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). Design: A post hoc analysis of a randomized trial. Setting: Cardiac surgical operating rooms. Participants: Patients undergoing elective, isolated CABG. Interventions: Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. Measurements and Main Results: A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 +/- 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). Conclusions: An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
- Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials(2015) FOMINSKIY, E.; PUTZU, A.; MONACO, F.; SCANDROGLIO, A. M.; KARASKOV, A.; GALAS, F. R. B. G.; HAJJAR, L. A.; ZANGRILLO, A.; LANDONI, G.Background: Guidelines support the use of a restrictive strategy in blood transfusion management in a variety of clinical settings. However, recent randomized controlled trials (RCTs) performed in the perioperative setting suggest a beneficial effect on survival of a liberal strategy. We aimed to assess the effect of liberal and restrictive blood transfusion strategies on mortality in perioperative and critically ill adult patients through a meta-analysis of RCTs. Methods: We searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, Transfusion Evidence Library, and Google Scholar up to 27 March 2015, for RCTs performed in perioperative or critically ill adult patients, receiving a restrictive or liberal transfusion strategy, and reporting all-cause mortality. We used a fixed or random-effects model to calculate the odds ratio (OR) and 95% confidence interval (CI) for pooled data. We assessed heterogeneity using Cochrane's Q and I-2 tests. The primary outcome was all-cause mortality within 90-day follow-up. Results: Patients in the perioperative period receiving a liberal transfusion strategy had lower all-cause mortality when compared with patients allocated to receive a restrictive transfusion strategy (OR 0.81; 95% CI 0.66-1.00; P=0.05; I-2=25%; Number needed to treat=97) with 7552 patients randomized in 17 trials. There was no difference in mortality among critically ill patients receiving a liberal transfusion strategy when compared with the restrictive transfusion strategy (OR 1.10; 95% CI 0.99-1.23; P=0.07; I-2=34%) with 3469 patients randomized in 10 trials. Conclusion: According to randomized published evidence, perioperative adult patients have an improved survival when receiving a liberal blood transfusion strategy.
- Microcirculation in Cardiovascular Diseases(2019) SLOVINSKI, Augusto Passoni; HAJJAR, Ludhmila Abrahao; INCE, CanMicrocirculation is a system composed of interconnected microvessels, which is responsible for the distribution of oxygenated blood among and within organs according to regional metabolic demand. Critical medical conditions, e.g., sepsis, and heart failure are known triggers of microcirculatory disturbance, which usually develops early in such clinical pictures and represents an independent risk factor for mortality. Therefore, hemodynamic resuscitation aiming at restoring microcirculatory perfusion is of paramount importance. Until recently, however, resuscitation protocols were based on macrohemodynamic variables, which increases the risk of under or over resuscitation. The introduction of hand-held video-microscopy (HVM) into clinical practice has allowed real-time analysis of microcirculatory variables at the bedside and, hence, favored a more individualized approach. In the cardiac intensive care unit scenario, HVM provides essential information on patients' hemodynamic status, e.g., to classify the type of shock, to adequate the dosage of vasopressors or inotropes according to demand and define safer limits, to guide fluid therapy and red blood cell transfusion, to evaluate response to treatment, among others. Nevertheless, several drawbacks have to be addressed before HVM becomes a standard of care.
- Bronchial Injury and Pneumothorax after Reintubation using an Airway Exchange Catheter(2013) ALMEIDA, Juliano P. de; HAJJAR, Ludhmila A.; FUKUSHIMA, Julia T.; NAKAMURA, Rosana E.; ALBERTINI, Rodolfo; GALAS, Filomena R. B. G.Background and objectives: We report a case of pneumothorax caused by a bronchial perforation during a reintubation using an airway exchange catheter (AEC) in a patient with a head and neck cancer. Case report: A 53 year old man with oropharynx carcinoma was admitted to ICU for severe pneumonia and severe acute respiratory distress syndrome (ARDS). The patient was recognized as a difficult-to-intubate patient and an endotracheal tube (Err) was inserted through a bronchoscope. After one week of treatment, it was observed an endotracheal cuff perforation. Exchanging the endotracheal tube was necessary to achieve satisfactory pulmonary ventilation. An AEC Cook 14 was used to perform the reintubation. After reintubation, the patient presented a worsening in oxygen saturation and a chest radiography (CXR) revealed a large pneumothorax. A chest tube was inserted and we observed immediate improvement in oxygen saturation. A repeat CXR confirmed correct positioning of the chest tube and reexpansion of the right lung. A bronchoscopy performed showed a posterior laceration in the right main bronchus. The patient was extubated the following day. After four days, the chest tube was removed. A CXR performed a day after chest tube removal revealed a small right upper pneumothorax, but the patient remained asymptomatic. Conclusions: Airway exchange catheter is a valuable tool to handle with difficult-to-intubate patients. Although the physicians generally focus their attention in avoid barotrauma - caused by oxygen supplement or jet ventilation through AEC - concern for insertion technique can minimize life threatening complications and increase the safety of AEC.
- Continuous Magnesium Infusion to Prevent Atrial Fibrillation After Cardiac Surgery: A Sequential Matched Case-Controlled Pilot Study(2020) OSAWA, Eduardo A.; CUTULI, Salvatore L.; CIOCCARI, Luca; BITKER, Laurent; PECK, Leah; YOUNG, Helen; HESSELS, Lara; YANASE, Fumitaka; FUKUSHIMA, Julia T.; HAJJAR, Ludhmila A.; SEEVANAYAGAM, Siven; MATALANIS, George; EASTWOOD, Glenn M.; BELLOMO, RinaldoObjective: The authors aimed to test whether a bolus of magnesium followed by continuous intravenous infusion might prevent the development of atrial fibrillation (AF) after cardiac surgery. Design: Sequential, matched, case-controlled pilot study. Setting: Tertiary university hospital. Participants: Matched cohort of 99 patients before and intervention cohort of 99 consecutive patients after the introduction of a continuous magnesium infusion protocol. Interventions: The magnesium infusion protocol consisted of a 10 mmol loading dose of magnesium sulphate followed by a continuous infusion of 3 mmol/h over a maximum duration of 96 hours or until intensive care unit discharge. Measurements and Main Results: The study groups were balanced except for a lower cardiac index in the intervention cohort. The mean duration of magnesium infusion was 27.93 hours (95% confidence interval [CI]: 24.10-31.76 hours). The intervention group had greater serum peak magnesium levels: 1.72 mmol/L 0.34 on day 1, 1.32 0.36 on day 2 versus 1.01 +/- 1.14 and 0.97 +/- 0.13, respectively, in the control group (p < 0.01). Atrial fibrillation occurred in 25 patients (25.3%) in the intervention group and 40 patients (40.4%) in the control group (odds ratio 0.49, 95% CI, 0.27-0.92; p = 0.023). On a multivariate Cox proportional hazards model, the hazard ratio for the development of AF was significantly less in the intervention group (hazard ratio 0.45, 95% CI, 0.26-0.77; p = 0.004). Conclusion: The magnesium delivery strategy was associated with a decreased incidence of postoperative AF in cardiac surgery patients. These findings provide a rationale and preliminary data for the design of future randomized controlled trials.
- A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality(2019) SARTINI, Chiara; LOMIVOROTOV, Vladimir; PIERI, Manna; LOPEZ-DELGADO, Juan Carlos; REDAELLI, Martina Baiardo; HAJJAR, Ludhmila; PISANO, Antonio; LIKHVANTSEV, Valery; FOMINSKIY, Evgeny; BRADIC, Nikola; CABRINI, Luca; NOVIKOV, Maxim; AVANCINI, Daniele; RIHA, Hynek; LEMBO, Rosalba; GAZIVODA, Gordana; PATERNOSTER, Gianluca; WANG, Chengbin; TAMA, Simona; ALVARO, Gabriele; WANG, Chew Yin; ROASIO, Agostino; RUGGERI, Laura; YONG, Chow-Yen; PASERO, Daniela; SEVERI, Luca; PASIN, Laura; MANCINO, Giuseppe; MURA, Paolo; MUSU, Mario; SPADARO, Savino; CONTE, Massimiliano; LOBREGLIO, Rosetta; SILVETTI, Simona; VOTTA, Carmine Domenico; BELLETTI, Alessandro; FRAJA, Diana Di; CORRADI, Francesco; BRUSASCO, Claudia; SAPORITO, Emanuela; D'AMICO, Alessandro; SARDO, Salvatore; ORTALDA, Alessandro; RIEFOLO, Claudio; FABRIZIO, Monaco; ZANGRILLO, Alberto; BELLOMO, Rinaldo; LANDONI, GiovanniThe authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement >= 67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to ""do you agree"" and ""do you use"") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.
conferenceObject In-hospital mortality prediction by American Society of Anesthesiology and POSSUM score in patients with cancer undergoing abdominal surgery(2012) SIMOES, Claudia Marquez; CARVALHO, Maria Jose; LUDHMILA, Carmona; HAJJAR, Abrahao; REGINA, Filomena; GALLAS, Barbosa; FUKUSHIMA, Julia TizueIntroduction: Preoperative evaluation and risk stratification is essential to perioperative planning. There are multiple risk scores applied to predict different outcomes. However, specific populations as patients with cancer may have specific risk factors, so it is needed to evaluate if global risk scoresas ASA and POSSUM or P POSSUM are able to assist the surgical team. Objective: To retrospectively assess the value of the ASA classification (American Society of Anesthesiology), POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity), and Porthsmouth POSSUM in prediction of hospital mortality in patients with cancer undergoing abdominal surgery. Methods: Three hundred and thirteen patients who under-went three hundred and nineteen oncologic abdominal surgeries were evaluated using ASA, POSSUM and Porthsmouth-POSSUM in relation to hospital mortality. The variables observed were: age, gender, ASA classification, pul- monary diseases, cardiovascular diseases, preoperative sys-tolic arterial pressure and cardiac rate, Glasgow scale, urea, potassium, sodium, hemoglobin, white cell count, number of simultaneous surgical procedures, observed blood losses, peritoneal contamination, oncological disease and dissemination, elective, emergent or urgent surgery, intensive care support and hospital mortality. Results: The overall hospital mortality rate was 5.59%. These results showed that POSSUM over predicted in-hospital deaths when compared to American Society of Anesthesiologists classification (relative risk, 0.55; P=.07) and Porths- mouth POSSUM (relative risk, 0,43; P=.0007) didn’t equally correspond to ASA predicted perioperative mortality. All evaluated scores didn’t equally predict observed mortality as the standardized mortality rate was 2.25 for ASA classification, 0.4 for POSSUM and 0.8 for P-POSSUM. Conclusion: The ASA classification, POSSUM and P POSSUM scores were not useful in predicting perioperative mortality for patients with cancer submitted to abdominal surgeries. It is needed to evaluate specific populations to adjust the existing perioperative prediction scores to serve as objective methods to assist the surgical team in classifying patients into risk groups with different probabilities of perioperative complications. ASA classification is based mainly on subjective clinical judgments and probably POSUUM and P-POSSUM need to have the equations balanced to specific populations.- Liberal Transfusion Practice or Perioperative Treatment of Anemia to Avoid Transfusion? Reply(2015) VINCENT, Jean-Louis; HAJJAR, Ludhmila A.; ALMEIDA, Juliano Pinheiro de
- Strategies to reduce blood transfusion: a Latin-American perspective(2015) HAJJAR, Ludhmila Abrahao; FUKUSHIMA, Julia Tizue; ALMEIDA, Juliano Pinheiro de; OSAWA, Eduardo Atsushi; GALAS, Filomena Regina Barbosa GomesPurpose of review Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion. Recent findings In the past decades, clinical studies comparing transfusion strategies in different populations were conducted. Despite the challenges imposed by the development of such studies, evidence-based medicine on transfusion medicine in critically ill patients is being created. Different results arising from these studies reflect population heterogeneity, specific circumstances, and difficulties in measuring the impact of anemia and transfusion in a clinical trial. Summary An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
- The need for data describing the surgical population in Latin America(2022) STEFANI, Luciana C.; HAJJAR, Ludhmila; BICCARD, Bruce; PEARSE, Rupert M.Latin American countries have a huge diversity in sociocultural factors, ethnicity, geography, and political systems. Provision of healthcare varies widely in Latin America, and it is unclear how these disparities relate to outcomes for individual patients undergoing surgery. The Latin American Surgical Outcome Study (LASOS), with its pragmatic design, will provide a snapshot of surgical activity throughout Latin America and identify the next steps needed to improve postoperative outcomes.