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Abstract The pathogenesis of systemic lupus erythematosus (SLE) is complex. Few studies in Brazilian population have addressed cell phenotypes associated with immunological responses and their associations with SLE activity. The aim of this study is to investigate cell phenotypes associated to SLE diagnosis, treatment and activity. Twenty-eight SLE female patients (17 inactive, 11 active) and 10 healthy women were included in this study. Markers of natural killer (Nk), T and B cells in peripheral blood were evaluated by flow cytometry. Nkt cells were decreased only in SLE active patients. Activated CD4+, regulatory T FoxP3+ and B cells were decreased in both active and inactive SLE patients, compared to control group. The data corroborate the disruption of immune regulatory response in SLE patients and suggest phenotipic changes as possible biomarkers of SLE activity. (SLE complex activity diagnosis Twentyeight Twenty eight 17 (1 1 Nk, Nk , (Nk) cytometry CD4 CD CD4+ FoxP3 FoxP group ( (Nk

https://doi.org/10.1590/s2175-97902023e20052

Postoperative Period of Myocardial Revascularization Surgery: Retrospective Cohort Study of a Single Center Surgery
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Macedo, Ana Carolina Longui

; Falcão, Antônio Luís Eiras

; Martins, Luiz Claudio

; Petrucci Junior, Orlando

; Moreira, Marcos Mello

Brazilian Journal of Cardiovascular Surgery

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2023, Volume 38 N. 5 elocation e20220332

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. Objective: To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. Methods: This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. Results: Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. Conclusion: Factors and clinical conditions such as the patients’ age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting. Introduction Objective Methods singlecenter single center 201 2019 characteristics analyzed Results seventytwo seventy two study 623 62 3 62. years 273 27 27.3 4 4% ventilatorassociated ventilator died hemodialysis 20 33 respectively death Conclusion comorbidities 6 2 27.

https://doi.org/10.21470/1678-9741-2022-0332

VOLUMETRIC CAPNOGRAPHY FOR RESPIRATORY MONITORING OF PATIENTS DURING ROUTINE COLONOSCOPY WITH ROOM-AIR AND CARBON DIOXIDE INSUFFLATION
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CAMARGO, Michel Gardere

; MOREIRA, Marcos Mello

; MAGRO, Daniéla Oliveira

; SANTOS, José Olympio Meirelles

; AYRIZONO, Maria de Lourdes Setsuko

Arquivos de Gastroenterologia

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sep 2022, Volume 59 N. 3 Pages 383 - 389

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Contexto: A capnografia e a insuflação de gás carbônico (CO2) durante endoscopia digestiva sob sedação são associados à maior segurança e conforto do paciente, respectivamente. A capnografia pode detectar precocemente a apneia e hipoxemia, enquanto a insuflação de CO2 causa menor desconforto periprocedimento. Relatos da aplicação da capnografia volumétrica em colonoscopias são escassos. Objetivo: Avaliar o uso de capnograifa volumétrica durante colonoscopia diagnóstica com insuflação de ar comprimido e CO2. Métodos: Em estudo prospectivo de coorte, foram incluídos um total de 101 pacientes submetidos a colonoscopia diagnóstica sob sedação com monitoração respiratória por meio de capnografia volumétrica. Insuflação com ar comprimido foi usado para distender o lúmen intestinal no Grupo 1 (n=51), enquanto o Grupo 2 (n=50) utilizou CO2 para insuflação. Objetivos primários foram avaliar episódios de hipóxia, hipoventilação alveolar e CO2 expirado (EtCO2). Objetivos secundários foram avaliar o volume alveolar por minuto, consumo de sedativos e a dor pós-colonoscopia por meio da Escala de Dor Modificada de Gloucester. Resultados: O número de episódios de hipóxia (SpO2 <90%) foi semelhante entre os grupos: quatro episódios no Grupo 1 e dois episódios no Grupo 2. A duração da hipóxia foi significativamente maior no Grupo 2 (P=0,02). A hipoventilação alveolar (EtCO2 ≥25% do valor basal) ocorreu mais frequentemente no Grupo 2 quando comparado ao Grupo 1 (27 vs 18 episódios, P=0,05). Em relação ao EtCO2, o Grupo 2 apresentou valores maiores no momento de aferição cecal (28.94±4.68 vs 26.65±6.12 mmHg, P=0,04). Quanto ao volume alveolar por minuto, o Grupo 2 apresentou valores significativamente menores no momento de aferição cecal quando comparado ao Grupo 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0,009). Não houve ocorrência de hipercapnia durante o estudo (EtCO2 >60 mmHg). Não houve diferença em relação ao consumo de sedativos entre os dois grupos. Imediatamente após a colonoscopia, o Grupo 2 apresentou significativamente menos dor que o Grupo 1 (P=0,05). Conclusão: Em nosso estudo, a capnografia volumétrica durante colonoscopia foi factível e eficaz para monitorar parâmetros ventilatórios e detectar complicações respiratórias, e a insuflação com CO2 foi segura e associada a menor dor imediatamente pós-colonoscopia.

ABSTRACT Background: Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy. Objective: This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy. Methods: In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale. Results: The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05). Conclusion: In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.

https://doi.org/10.1590/s0004-2803.202203000-69

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021
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Nicolau, José Carlos

; Feitosa Filho, Gilson Soares

; Petriz, João Luiz

; Furtado, Remo Holanda de Mendonça

; Précoma, Dalton Bertolim

; Lemke, Walmor

; Lopes, Renato Delascio

; Timerman, Ari

; Marin Neto, José A.

; Bezerra Neto, Luiz

; Gomes, Bruno Ferraz de Oliveira

; Santos, Eduardo Cavalcanti Lapa

; Piegas, Leopoldo Soares

; Soeiro, Alexandre de Matos

; Negri, Alexandre Jorge de Andrade

; Franci, Andre

; Markman Filho, Brivaldo

; Baccaro, Bruno Mendonça

; Montenegro, Carlos Eduardo Lucena

; Rochitte, Carlos Eduardo

; Barbosa, Carlos José Dornas Gonçalves

; Virgens, Cláudio Marcelo Bittencourt das

; Stefanini, Edson

; Manenti, Euler Roberto Fernandes

; Lima, Felipe Gallego

; Monteiro Júnior, Francisco das Chagas

; Correa Filho, Harry

; Pena, Henrique Patrus Mundim

; Pinto, Ibraim Masciarelli Francisco

; Falcão, João Luiz de Alencar Araripe

; Sena, Joberto Pinheiro

; Peixoto, José Maria

; Souza, Juliana Ascenção de

; Silva, Leonardo Sara da

; Maia, Lilia Nigro

; Ohe, Louis Nakayama

; Baracioli, Luciano Moreira

; Dallan, Luís Alberto de Oliveira

; Dallan, Luis Augusto Palma

; Mattos, Luiz Alberto Piva e

; Bodanese, Luiz Carlos

; Ritt, Luiz Eduardo Fonteles

; Canesin, Manoel Fernandes

; Rivas, Marcelo Bueno da Silva

; Franken, Marcelo

; Magalhães, Marcos José Gomes

; Oliveira Júnior, Múcio Tavares de

; Filgueiras Filho, Nivaldo Menezes

; Dutra, Oscar Pereira

; Coelho, Otávio Rizzi

; Leães, Paulo Ernesto

; Rossi, Paulo Roberto Ferreira

; Soares, Paulo Rogério

; Lemos Neto, Pedro Alves

; Farsky, Pedro Silvio

; Cavalcanti, Rafael Rebêlo C.

; Alves, Renato Jorge

; Kalil, Renato Abdala Karam

; Esporcatte, Roberto

; Marino, Roberto Luiz

; Giraldez, Roberto Rocha Corrêa Veiga

; Meneghelo, Romeu Sérgio

; Lima, Ronaldo de Souza Leão

; Ramos, Rui Fernando

; Falcão, Sandra Nivea dos Reis Saraiva

; Dalçóquio, Talia Falcão

; Lemke, Viviana de Mello Guzzo

; Chalela, William Azem

; Mathias Júnior, Wilson

Arquivos Brasileiros de Cardiologia

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jul 2021, Volume 117 N. 1 Pages 181 - 264

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210180 3052 downloads

Lung function and stress echocardiography in pulmonary arterial hypertension: a cross-sectional study
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de Almeida, Guilherme Casagrande

; Pereira, Mônica Corso

; Moreira, Marcos Mello

; Souza, José Roberto Matos

; Paschoal, Ilma Aparecida

Sao Paulo Medical Journal

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may 2021, Volume 139 N. 5 Pages 505 - 510

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE: To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING: Single-center prospective study conducted in a Brazilian university hospital. METHODS: We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS: The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS: The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.

https://doi.org/10.1590/1516-3180.2021.0045.r1.0604221 3 downloads

Volumetric capnography versus spirometry for the evaluation of pulmonary function in cystic fibrosis and allergic asthma,
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Almeida-Junior, Armando

; Marson, Fernando Augusto Lima

; Almeida, Celize Cruz Bresciani

; Ribeiro, Maria Ângela Gonçalves Oliveira

; Paschoal, Ilma Aparecida

; Moreira, Marcos Mello

; Ribeiro, José Dirceu

Jornal de Pediatria

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apr 2020, Volume 96 N. 2 Pages 255 - 264

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo Comparar os valores dos marcadores para capnografia volumétrica e espirometria e sua capacidade de classificar crianças e adolescentes com asma, fibrose cística (FC) e controles saudáveis. Métodos Foi realizado um estudo transversal que incluiu 103 pacientes com asma alérgica persistente controlada, 53 com FC e um grupo controle saudável com 40 voluntários (6 a 15 anos), de ambos os sexos. Os indivíduos foram submetidos a capnografia volumétrica e espirometria. Resultados O slope da fase III (SIII), SIII padronizada pelo volume tidal exalado (SIII/VT) e o índice capnográfico (SIII/SII) × 100 (KPIv) foram diferentes entre os três grupos avaliados, com maiores valores para o grupo FC. A relação entre o volume expiratório forçado no primeiro segundo e a capacidade vital forçada (VEF1/CVF) foi o único marcador de espirometria com diferenças nos três grupos. Nos indivíduos com espirometria normal, o KPIv e VEF1/CVF foram diferentes entre os três grupos. A curva ROC diferenciou os indivíduos com asma ou FC daqueles do grupo controle, ambos através da capnografia volumétrica (melhor para identificar a FC em relação aos controles pelo KPIv) e por meio da espirometria (melhor para identificar a asma em relação aos controles). O KPIv foi o melhor parâmetro para distinguir a asma da FC, mesmo em indivíduos com espirometria normal. Conclusão A capnografia volumétrica e a espirometria identificaram diferentes alterações de função pulmonar na asma, na FC e nos controles saudáveis, permitiram que os três grupos fossem diferenciados.

Abstract Objective: To compare the values of the markers for volumetric capnography and spirometry and their ability to classify children and adolescents with asthma, cystic fibrosis (CF), and healthy controls. Methods: This was a cross-sectional study that included 103 patients with controlled persistent allergic asthma, 53 with CF and a healthy control group with 40 volunteers (aged 6 to 15 years), of both sexes. The individuals underwent volumetric capnography and spirometry. Results: Phase III slope (SIII), SIII standardized by exhaled tidal volume (SIII/TV) and capnographic index (SIII/SII) × 100 (KPIv) were different among the three groups assessed, with highest values for CF. The relation between the forced expiratory volume in one second and the forced vital capacity (FEV1/FVC) was the only spirometric marker that presented difference on the three groups. On individuals with normal spirometry, KPIv and FEV1/FVC were different among the three groups. The ROC curve identified the individuals with asthma or CF from the control group, both through volumetric capnography (better to identify CF in relation to the control using KPIv) and through spirometry (better to identify asthma in relation to the control). KPIv was the best parameter to distinguish asthma from CF, even in individuals with normal spirometry. Conclusion: Volumetric capnography and spirometry identified different alterations in lung function on asthma, CF, and healthy controls, allowing the three groups to be distinguished.

https://doi.org/10.1016/j.jped.2018.10.008 725 downloads

Model of single-sized endotracheal tube for adults
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Calderon, Luiz Guilherme

; Moreira, Marcos Mello

; Barreto, Gilson

; Tincani, Alfio José

einstein (São Paulo)

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2020, Volume 18 elocation eAO4805

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Simular diferentes diâmetros de tubos endotraqueais e verificar os aspectos fluidinâmicos, considerando medições de fluxo e resistência. Métodos Foi utilizado um software de fluidinâmica para calcular o fluxo médio e a resistência das vias aéreas nos tubos endotraqueais com diâmetro de 6,0, 7,0, 7,5, 8,0, 9,0 e 10,0mm, em temperatura corporal normal e pressão constante. As mesmas medidas foram realizadas na fusão dos primeiros 22cm de um tubo endotraqueal de 9,0 e 10,0mm de diâmetro, com a parte terminal em 12cm de um tubo endotraqueal de 6,0 e 7,0mm de diâmetro. Resultados A fusão dos primeiros 22cm de um tubo endotraqueal de diâmetro 10,0 mm com a parte terminal em 12cm de um tubo endotraqueal de 6,0mm de diâmetro, preservando o comprimento total de 34cm, gerou fluxo médio e resistência de vias aéreas semelhantes aos de um tubo endotraqueal convencional de 7,5mm. Conclusão Um tubo endotraqueal de tamanho único pode facilitar a intubação endotraqueal, sem causar aumento de resistência na via aérea.

ABSTRACT Objective To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. Methods Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. Results The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. Conclusion This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.

https://doi.org/10.31744/einstein_journal/2020ao4805 2946 downloads

Respiratory evaluation through volumetric capnography among grade III obese and eutrophic individuals: a comparative study
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Modena, Débora Aparecida Oliveira

; Moreira, Marcos Mello

; Paschoal, Ilma Aparecida

; Pereira, Mônica Corso

; Martins, Luiz Cláudio

; Cazzo, Everton

; Chaim, Elinton Adami

Sao Paulo Medical Journal

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apr 2019, Volume 137 N. 2 Pages 177 - 183

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Excess trunk body fat in obese individuals influences respiratory physiological function. The aims of this study were to compare volumetric capnography findings (VCap) between severely obese patients and normal-weight subjects and to assess whether there is any association between neck circumference (NC), waist-hip ratio (WHR) and VCap among grade III obese individuals. DESIGN AND SETTING: Analytical observational case-matched cross-sectional study, University of Campinas. METHODS: This cross-sectional study compared VCap variables between 60 stage III obese patients and 60 normal-weight individuals. RESULTS: In comparison with the normal-weight group, obese patients presented higher alveolar minute volume (8.92 ± 4.94 versus 6.09 ± 2.2; P = < 0.0001), CO2 production (278 ± 91.0 versus 209 ± 60.23; P < 0.0001), expiratory tidal volume (807 ± 365 versus 624 ± 202; P = 0.005), CO2 production per breath (21.1 ± 9.7 versus 16.7 ± 6.16; P = 0.010) and peak expiratory flow (30.9 ± 11.9 versus 25.5 ± 9.13; P = 0.004). The end-expiratory CO2 (PetCO2) concentration (33.5 ± 4.88 versus 35.9 ± 3.79; P = 0.013) and the phase 3 slope were normalized according to expired tidal volume (0.02 ± 0.05 versus 0.03 ± 0.01; P = 0.049) were lower in the obese group. CONCLUSIONS: The greater the NC was, the larger were the alveolar minute volume, anatomical dead space, CO2 production per minute and per breath and expiratory volume; whereas the smaller were the phase 2 slope (P2Slp), phase 3 slope (P3Slp) and pressure drop in the mouth during inspiration.

https://doi.org/10.1590/1516-3180.2017.0085011017 555 downloads

Near-fatal pulmonary embolism: capnographic perspective
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Moreira, Marcos Mello

; Martins, Luiz Claudio

; Metze, Konradin

; Pereira, Marcus Vinicius

; Paschoal, Ilma Aparecida

Jornal Brasileiro de Pneumologia

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dec 2018, Volume 44 N. 6 Pages 525 - 528

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1806-37562018000000080 1069 downloads

10.

A fatal and metabolic experimental hemorrhagic shock in immature swine
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Ferreira, Simone Alves dos Santos

; Moraes, Ana Cristina de

; Terzi, Renato Giuseppe Giovanni

; Ferreira, Evandro Luis Assis

; Silva, William Adalberto

; Moreira, Marcos Mello

Acta Cirúrgica Brasileira

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dec 2017, Volume 32 N. 12 Pages 1036 - 1044

Abstract: En | Text: En | PDF: En

Abstract Purpose: To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock. Methods: Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes. Hemodynamic and metabolic data were recorded at Baseline, at 30, 60 and 120 minutes after Baseline. The animals were intubated in spontaneous breathing (FIO2=0.21) with halothane. Results: Group I all survived. In Group II all died; no mortality occurred before a BL<10mM/L. Beyond the end-point all animals exhibited severe acidemia, hyperventilation and clinical signs of shock. Without treatment all animals died within 70.43±24.51 min of hypotension shortly after reaching an average level of BL 17.01±3.20mM/L. Conclusions: Swine’s breathing room air spontaneously in hemorrhagic shock not treated a blood lactate over 10mM/L results fatal. The predictable outcome of this shock model is expected to produce consistent information based on possible different metabolic and hemodynamic patterns as far as the type of fluid and the timing of resuscitation in near fatal hemorrhagic shock.

https://doi.org/10.1590/s0102-865020170120000005 1029 downloads

11.

PetCO2, VCO2 and CorPP Values in the Successful Prediction of the Return of Spontaneous Circulation: An Experimental Study on Unassisted Induced Cardiopulmonary Arrest
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Macedo, Ana Carolina Longui

; Martins, Luiz Claudio

; Paschoal, Ilma Aparecida

; Ovalle, Carlos Cesar Ivo Sant'Ana

; Araújo, Sebastião

; Moreira, Marcos Mello

Brazilian Journal of Cardiovascular Surgery

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dec 2016, Volume 31 N. 6 Pages 468 - 473

Abstract: En | Text: En | PDF: En

https://doi.org/10.5935/1678-9741.20160093 4998 downloads

12.

Evaluation of the Efficiency of the Atraumatic Endotracheal Tube in the Pulmonary-Gas Exchange: an Experimental Study
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Antonelli, Raíssa Quaiatti

; Moreira, Marcos Mello

; Martins, Luiz Claudio

; Negro, Maíra Soliani Del

; Baldasso, Tiago Antonio

; Tincani, Alfio José

Brazilian Journal of Cardiovascular Surgery

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dec 2015, Volume 30 N. 6 Pages 668 - 672

Abstract: En | Text: En | PDF: En

ABSTRACT OBJECTIVE: Mechanical ventilation is frequently necessary, in which case the use of an endotracheal tube is mandatory. The tube has an inflatable balloon in its distal extremity, whose aim is, among other functions, an efficient arterialization. However, serious injuries in the place of contact of the balloon with the trachea can be frequent. Some studies point out that balloons with permanent pressure may reduce this complication. Nevertheless, air scape, expressed by the inspiratory (IV) and expiratory volume (EV) variation (Δ IV-EV), may occur, possibly leading to hypoxemia. Thus, the goal of this study was to verify the efficiency of a modified endotracheal tube on arterializations compared to the traditional endotracheal tube. METHODS: The modified endotracheal tube presents intermittent insufflation, with three drillings in the internal region of the cuff, allowing for insufflation in the inspiratory phase of the mechanical ventilation. Three animals were used for the control group, with a cuff pressure of 30 cmH2O, and seven pigs had the modified endotracheal tube. Each animal was kept under mechanical ventilation (FIO2=0.21) for 6 hours. Arterial and venous gases were measured every three hours (T0; T3; T6). RESULTS: The gases confirmed the lack of hypoxia between the Groups, with a difference in the ΔIV-EV at T0 (P=0.0486). CONCLUSIONS: In this study, the lack of hypoxia showed the efficiency of the modified endotracheal tube. However, new studies are necessary, particularly in diseased lungs, in order to evaluate the real efficiency of the mentioned device on the pulmonary gas exchange.

https://doi.org/10.5935/1678-9741.20150089 957 downloads

13.

Adjustable inspiratory occlusion valve in experimental bronchopleural fistula. A new therapeutic perspective
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Toneloto, Maria Gabriela Cavicchia

; Moreira, Marcos Mello

; Bustorff-Silva, Joaquim Murray

; Souza, Gabriel Franco de

; Martins, Luiz Claudio

; Dragosavac, Desanka

; Falcão, Antonio Luis Eiras

Acta Cirúrgica Brasileira

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aug 2015, Volume 30 N. 8 Pages 561 - 567

Abstract: En | Text: En | PDF: En

PURPOSE: To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation.METHODS:We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve.RESULTS:When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage.CONCLUSION: The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.

https://doi.org/10.1590/S0102-865020150080000007 1660 downloads

14.

Risk factors for transient dysfunction of gas exchange after cardiac surgery
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Rodrigues, Cristiane Delgado Alves

; Moreira, Marcos Mello

; Lima, Núbia Maria Freire Vieira

; Figueirêdo, Luciana Castilho de

; Falcão, Antônio Luis Eiras

; Petrucci Junior, Orlando

; Dragosavac, Desanka

Brazilian Journal of Cardiovascular Surgery

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feb 2015, Volume 30 N. 1 Pages 24 - 32

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo: Estudo de coorte retrospectivo com objetivo de verificar a presença de disfunção transitória da troca gasosa no pós-operatório de cirurgia cardíaca e determinar se esse transtorno está relacionado a eventos cardiorrespiratórios. Métodos: Foram incluídos 942 pacientes consecutivos submetidos à cirurgia cardíaca e procedimentos cardíacos, encaminhados para a Unidade de Terapia Intensiva, entre junho de 2007 e novembro de 2011. Resultados: A síndrome do desconforto respiratório agudo foi observada em 15 (2%) pacientes, 199 (27,75%) pacientes apresentaram disfunção transitória da troca gasosa leve, disfunção transitória da troca gasosa moderada foi observada em 402 (56,1%) pacientes e disfunção transitória da troca gasosa grave em 39 (5,4%). A presença de hipertensão arterial sistêmica e choque cardiogênico foi associada ao surgimento de disfunção transitória da troca gasosa moderada no período pós-operatório (P=0,02 e P=0,019, respectivamente) e foram considerados fatores de risco para essa disfunção (P=0,0023 e P=0,0017, respectivamente). A presença de diabetes mellitus também foi considerada um fator de risco para disfunção transitória da troca gasosa (P=0,03). Houve correlação entre a presença de pneumonia e a presença de disfunção transitória da troca gasosa moderada em 8,9% dos casos (P=0,001). A presença de disfunção transitória da troca gasosa grave foi associada a pacientes que necessitaram de hemodiálise (P=0,0005), hemoterapia (P=0,0001), nutrição enteral (P=0,0012), ou arritmia cardíaca (P=0,0451). Conclusão: A presença de hipertensão arterial sistêmica pré-operatória e choque cardiogênico foi associada à ocorrência de disfunção transitória da troca gasosa pós-operatória. Os fatores de risco pré-operatórios foram hipertensão arterial sistêmica, choque cardiogênico e diabetes. No pós-operatório, pneumonia, pneumonia associada à ventilação, hemodiálise, hemoterapia e arritmia cardíaca foram associadas com certo grau de disfunção transitória da troca gasosa, que foi fator de risco para reintubação, pneumonia, pneumonia associada à ventilação e hemodiálise no pós-operatório de cirurgia cardíaca.

Objective: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results: Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

https://doi.org/10.5935/1678-9741.20140103 1996 downloads

15.

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula
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Oliveira, Douglas Guimaraes de

; Toneloto, Maria Gabriela Cavicchia

; Moreira, Marcos Mello

; Bustorff-Silva, Joaquim Murray

; Souza, Gabriel Franco de

; Martins, Luiz Claudio

; Kosour, Carolina

; Dragosavac, Desanka

; Falcão, Antonio Luis Eiras

Acta Cirúrgica Brasileira

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jan 2015, Volume 30 N. 1 Pages 1 - 5

Abstract: En | Text: En | PDF: En

PURPOSE:To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal.METHODS :Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF.RESULTS:Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p< 0.05.CONCLUSION: Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.

https://doi.org/10.1590/S0102-86502015001000001 2198 downloads

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