FRANCINNI MAMBRINI PIRES REGO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Autor: FERREIRA, Juliana Carvalho ×

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  • article 2 Citação(ões) na Scopus
    Performance of Noninvasive Ventilation Masks in a Lung Model of COPD Exacerbation
    (2019) MACEDO, Bruno Rocha de; REGO, Francinni Mambrini Pires; SILVA, Fabia Diniz; PINAFFI, Juliana Valerio; FERREIRA, Juliana Carvalho
    BACKGROUND: Noninvasive ventilation (NIV) reduces intubation and mortality in patients with COPD exacerbation who present with respiratory failure, and the type of mask may affect its success. Our objective was to compare the performance of 3 different NIV masks in a lung model. METHODS: We set the lung simulator mechanics and respiratory rate, and tested a small oronasal mask, a total face mask, and a large oronasal mask. We added CO2 at a constant rate into the system and monitored the end-tidal carbon dioxide. We used a mechanical ventilator to deliver NW in 8 different combinations of inspiratory effort, pressure support, and expiratory positive airway pressure. We measured end-tidal carbon dioxide mask leakage, tidal volume, trigger time, time to achieve 90% of the inspiratory target during inspiration, and excess inspiratory time. RESULTS: We presented the mean +/- SD of the 8 simulated conditions for each mask. The mean +/- SD leakage was higher for the total face mask (51 +/- 6 L/min) than for the small oronasal mask (37 +/- 5 L/min) and for the large oronasal mask (21 +/- 3 L/min), P < .001; but end-tidal carbon dioxide and tidal volume were similar. The mean +/- SD 90% of the inspiratory target during inspiration was faster for the small oronasal mask (585 +/- 49 ms) compared with the large oronasal (647 +/- 107 ms) and total face mask (851 +/- 105 ms), P < .001, all other variables were similar. CONCLUSIONS: In this model, we found that the type of mask had no impact on CO2 washout or on most synchrony variables.
  • article 26 Citação(ões) na Scopus
    Risk factors for noninvasive ventilation failure in cancer patients in the intensive care unit: A retrospective cohort study
    (2015) FERREIRA, Juliana Carvalho; MEDEIROS JR., Pedro; REGO, Francinni Mambrini; CARUSO, Pedro
    Purpose: The purpose of the study is to identify risk factors for noninvasive ventilation (NIV) failure in cancer patients with acute respiratory failure (ARF). Materials and methods: A retrospective cohort study of adult patients admitted to intensive care unit (ICU), who received NIV for treatment of ARF, was conducted. We conducted a chart review to estimate the NIV failure rate and used logistic regression to identify risk factors. Results: Of 2258 patients admitted to the ICU during the study period, 114 (5%) received NIV for ARF. Noninvasive ventilation was successful in 67 patients (59%) and failed for 47 (41%), of whom 36 were intubated and 11 were sedated for palliation. Factors associated with NIV failure were infection as the primary cause of ARF (odds ratio [OR], 4.90; 95% confidence interval [CI], 1.78-13.45; P = .002), male sex (OR, 2.58; 95% CI, 1.20-5.56; P = .015), and Simplified Acute Physiology Score 3 (OR, 1.04; 95% CI, 1.01-1.07; P = .006). Overall ICU mortality was 40%, and hospital mortality was 56%. Noninvasive ventilation failure was the only independent predictor of ICU mortality (OR, 16.6; 95% CI, 6.5-41.5; P < .001). Conclusions: Noninvasive ventilation can avert ARF for most ICU cancer patientswith ARF. For patients with pulmonary infections and high severity scores, NIV should be used with caution. Identifying risk factors for NIV failure using a comprehensive diagnostic approach and monitoring of NIV are paramount to improve outcomes.