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Article ; Online: Trends in perioperative practices of high-risk surgical patients over a 10-year interval.

Gomes, Brenno Cardoso / Lobo, Suzana Margareth Ajeje / Sá Malbouisson, Luiz Marcelo / de Freitas Chaves, Renato Carneiro / Domingos Corrêa, Thiago / Prata Amendola, Cristina / Silva Júnior, João Manoel

PloS one

2023 Volume 18, Issue 9, Page(s) e0286385

Abstract: Introduction: In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients ... ...

Abstract	Introduction: In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. Methods: The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. Results: After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. Conclusion: In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
MeSH term(s)	Adult ; Humans ; Creatinine ; Brazil/epidemiology ; Hospital Mortality ; Hospitalization ; Hypotension
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2023-09-19
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286385
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Postoperative hypothermia following non-cardiac high-risk surgery: A prospective study of temporal patterns and risk factors.

Sabbag, Itajiba Paternosti / Hohmann, Fabio Barlem / Assunção, Murillo Santucci Cesar / de Freitas Chaves, Renato Carneiro / Corrêa, Thiago Domingos / Menezes, Pedro Ferro L / Neto, Ary Serpa / Sá Malbouisson, Luiz Marcelo / Lobo, Suzana Margareth Ajeje / Amendola, Cristina Prata / de Aguilar-Nascimento, Jose Eduardo / Silva, João Manoel

PloS one

2021 Volume 16, Issue 11, Page(s) e0259789

Abstract: Background and objectives: Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries.: Methods: This prospective, ... ...

Abstract	Background and objectives: Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods: This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients' characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan-Meier curve was generated and adjusted using a Cox regression model. Results: In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3-34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1-22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0-35.8°C]) was 64% (95% CI = 58.3-70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15-2.0), especially coagulation and infection. Conclusions: Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications.
MeSH term(s)	Aged ; Aged, 80 and over ; Humans ; Hypothermia/epidemiology ; Hypothermia/etiology ; Middle Aged ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Risk Factors ; Temperature
Language	English
Publishing date	2021-11-15
Publishing country	United States
Document type	Journal Article
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0259789
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Article ; Online: Obesity and its implications on cerebral circulation and intracranial compliance in severe COVID-19.

Brasil, Sérgio / Renck, Alessandra Covallero / Taccone, Fabio Silvio / Fontoura Solla, Davi Jorge / Tomazini, Bruno Martins / Wayhs, Sâmia Yasin / Fonseca, Sérgio / Bassi, Estevão / Lucena, Bruno / De Carvalho Nogueira, Ricardo / Paiva, Wellingson / Teixeira, Manoel Jacobsen / Frade Costa, Elaine Maria / Sá Malbouisson, Luiz Marcelo

Obesity science & practice

2021 Volume 7, Issue 6, Page(s) 751–759

Abstract: Objective: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID-19. Thus, the hypothesis of severe acute ... ...

Abstract	Objective: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID-19. Thus, the hypothesis of severe acute respiratory syndrome (SARS) conducing to cerebral hemodynamic disorders (CHD) able to worsen ICCI and play an additional role on prognosis determination for COVID-19 among obese patients becomes suitable. Methods: 50 cases of SARS by COVID-19 were evaluated, for the presence of ICCI and cerebrovascular circulatory disturbances in correspondence with whether unfavorable outcomes (death or impossibility for mechanical ventilation weaning [MVW]) within 7 days after evaluation. The objective was to observe whether obese patients (BMI ≥ 30) disclosed worse outcomes and tests results compared with lean subjects with same clinical background. Results: 23 (46%) patients among 50 had obesity. ICCI was verified in 18 (78%) obese, whereas in 13 (48%) of 27 non-obese ( Conclusion: In the present study, intracranial compliance impairment was significantly more observed among obese subjects and may have contributed for SARS COVID-19 worsen prognosis.
Language	English
Publishing date	2021-05-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2836381-4
ISSN	2055-2238 ; 2055-2238
ISSN (online)	2055-2238
ISSN	2055-2238
DOI	10.1002/osp4.534
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Article: Obesity and its implications on cerebral circulation and intracranial compliance in severe COVID‐19

Obesity science & practice. 2021 Dec., v. 7, no. 6

2021

Abstract: OBJECTIVE: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID‐19. Thus, the hypothesis of severe acute ... ...

Abstract	OBJECTIVE: Multiple factors have been identified as causes of intracranial compliance impairment (ICCI) among patients with obesity. On the other hand, obesity has been linked with worst outcomes in COVID‐19. Thus, the hypothesis of severe acute respiratory syndrome (SARS) conducing to cerebral hemodynamic disorders (CHD) able to worsen ICCI and play an additional role on prognosis determination for COVID‐19 among obese patients becomes suitable. METHODS: 50 cases of SARS by COVID‐19 were evaluated, for the presence of ICCI and cerebrovascular circulatory disturbances in correspondence with whether unfavorable outcomes (death or impossibility for mechanical ventilation weaning [MVW]) within 7 days after evaluation. The objective was to observe whether obese patients (BMI ≥ 30) disclosed worse outcomes and tests results compared with lean subjects with same clinical background. RESULTS: 23 (46%) patients among 50 had obesity. ICCI was verified in 18 (78%) obese, whereas in 13 (48%) of 27 non‐obese (p = 0,029). CHD were not significantly different between groups, despite being high prevalent in both. 69% unfavorable outcomes were observed among obese and 44% for lean subjects (p = 0,075). CONCLUSION: In the present study, intracranial compliance impairment was significantly more observed among obese subjects and may have contributed for SARS COVID‐19 worsen prognosis.
Keywords	COVID-19 infection ; compliance ; death ; hemodynamics ; obesity ; prognosis
Language	English
Dates of publication	2021-12
Size	p. 751-759.
Publishing place	John Wiley & Sons, Ltd
Document type	Article
Note	JOURNAL ARTICLE
ZDB-ID	2836381-4
ISSN	2055-2238
ISSN	2055-2238
DOI	10.1002/osp4.534
Database	NAL-Catalogue (AGRICOLA)

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Article: Comparison between Brain Computed Tomography Scan and Transcranial Sonography to Evaluate Third Ventricle Width, Peri-Mesencephalic Cistern, and Sylvian Fissure in Traumatic Brain-Injured Patients.

Oliveira, Raphael A G / de Oliveira Lima, Marcelo / Paiva, Wellingson Silva / de Sá Malbouisson, Luiz Marcelo / Teixeira, Manuel Jacobsen / Bor-Seng-Shu, Edson

Frontiers in neurology

2017 Volume 8, Page(s) 44

Abstract: Introduction: Transcranial color-coded duplex sonography (TCCS) may help guide multimodal monitoring in the neurocritical setting. It may provide indirect information about intracranial hypertension, such as midline shift, third ventricle width, and ... ...

Abstract	Introduction: Transcranial color-coded duplex sonography (TCCS) may help guide multimodal monitoring in the neurocritical setting. It may provide indirect information about intracranial hypertension, such as midline shift, third ventricle width, and peri-mesencephalic cistern obliteration. We aim to assess the agreement between brain computed tomography scan (CT scan) and TCCS in traumatic brain injury (TBI) patients. Methods: In this retrospective cross-sectional observational study, TCCS was performed within 6 h before a brain CT scan. Only the first CT and TCCS after ICU admission were included. The agreement between the CT scan and TCCS was assessed by Bland-Altman plots and evaluating the intraclass correlation coefficient. Results: Overall, 15 consecutive patients were included (80% male, 42 ± 23 years of age, Glasgow Coma Score 5 [4,6]). The mean difference between the brain CT scan and TCCS in measuring the midline shift was 0.30 ± 2.1 mm (intraclass correlation coefficient: 0.93; Conclusion: TCCS is a promising tool and may be an alternative to CT scans for evaluating TBI patients.
Language	English
Publishing date	2017-02-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2017.00044
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Article ; Online: Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil.

Vane, Matheus Fachini / do Prado Nuzzi, Rafael Ximenes / Aranha, Gustavo Fabio / da Luz, Vinicius Fernando / Sá Malbouisson, Luiz Marcelo / Gonzalez, Maria Margarita Castro / Auler, José Otávio Costa / Carmona, Maria José Carvalho

Revista brasileira de anestesiologia

2016 Volume 66, Issue 2, Page(s) 176–182

Abstract: Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been ... ...

Title translation	Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil.
Abstract	Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. Objectives: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. Contents: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. Conclusions: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.
Language	Portuguese
Publishing date	2016-03
Publishing country	Brazil
Document type	English Abstract ; Journal Article
ZDB-ID	604154-1
ISSN	1806-907X ; 0034-7094
ISSN (online)	1806-907X
ISSN	0034-7094
DOI	10.1016/j.bjan.2016.01.001
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Article ; Online: Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil.

Brazilian journal of anesthesiology (Elsevier)

2016 Volume 66, Issue 2, Page(s) 176–182

Abstract	Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. Objectives: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. Contents: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. Conclusions: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.
MeSH term(s)	Anesthesia/adverse effects ; Anesthesia/methods ; Brazil/epidemiology ; Heart Arrest/epidemiology ; Humans ; Incidence ; Intraoperative Complications/epidemiology ; Tertiary Care Centers
Language	English
Publishing date	2016-03
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	1142792-9
ISSN	0104-0014 ; 0104-0014
ISSN (online)	0104-0014
ISSN	0104-0014
DOI	10.1016/j.bjane.2014.06.007
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Article ; Online: Computed tomography angiography accuracy in brain death diagnosis.

Brasil, Sergio / Bor-Seng-Shu, Edson / de-Lima-Oliveira, Marcelo / Taccone, Fabio Silvio / Gattás, Gabriel / Nunes, Douglas Mendes / Gomes de Oliveira, Raphael A / Martins Tomazini, Bruno / Tierno, Paulo Fernando / Becker, Rafael Akira / Bassi, Estevão / Sá Malbouisson, Luiz Marcelo / da Silva Paiva, Wellingson / Teixeira, Manoel Jacobsen / de Carvalho Nogueira, Ricardo

Journal of neurosurgery

2019 , Page(s) 1–9

Abstract: Objective: The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this ... ...

Abstract	Objective: The present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest. Methods: A unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score ≤ 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally. Results: A total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS. Conclusions: CTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.Clinical trial registration no.: 12500913400000068 (clinicaltrials.gov).
Language	English
Publishing date	2019-09-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
DOI	10.3171/2019.6.JNS191107
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Article ; Online: Evaluation of exhaled nitric oxide in patients undergoing myocardial revascularization with cardiopulmonary bypass.

de Amorim, Célio Gomes / Sá Malbouisson, Luiz Marcelo / Saraiva, Beatriz Mangueira / Pedro, Fernanda Maria da Silva / Martins, Milton Arruda / Carmona, Maria José Carvalho

Revista brasileira de anestesiologia

2009 Volume 59, Issue 3, Page(s) 286–296

Abstract: Background and objectives: Cardiopulmonary bypass (CPB) can cause pulmonary dysfunction. Inflammatory changes may affect the release of nitric oxide (NO). The objective of this study was to evaluate exhaled NO in patients undergoing myocardial ... ...

Abstract	Background and objectives: Cardiopulmonary bypass (CPB) can cause pulmonary dysfunction. Inflammatory changes may affect the release of nitric oxide (NO). The objective of this study was to evaluate exhaled NO in patients undergoing myocardial revascularization (MR) with CPB. Methods: This is a prospective study with nine adult patients undergoing MR with CPB. Initially, air samples were collected to analyze the presence of NO in the system that feeds the anesthesia equipment. Intravenous anesthesia was then initiated with ethomidate (0.3 mg x kg-1), sufentanil (0.3 microg x kg-1), and pancuronium (0.08 mg x kg-1), and maintained with isoflurane (MAC from 0.5 to 1.0) and sufentanil (5 microg x kg-1 x h-1). Tidal volume was fixed at 8 mL.kg-1 and FiO2 0.6, except during CPB. Thirty minutes after induction and 30 minutes after CPB, three sequential samples of exhaled air were collected for NO analysis by chemiluminescence. Data were analyzed by the Student t test. Results: The level of NO in room air was 5.05 +/- 3.37 ppb. Levels of exhaled NO decreased after CPB, varying from 11.25 +/- 5.65 ppb to 8.37 +/- 3.71 ppb (p = 0.031). Conclusions: The reduction of exhaled NO after CPB observed in this study does not confirm the role of this molecule as a marker of pulmonary lesion. However, the different degrees of pulmonary parenchymal collapse, the method used to collect the data, and the drugs, among others, could have contributed for this reduction.
MeSH term(s)	Adolescent ; Adult ; Aged ; Breath Tests ; Cardiopulmonary Bypass ; Humans ; Middle Aged ; Myocardial Revascularization ; Nitric Oxide/analysis ; Prospective Studies ; Young Adult
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	Portuguese
Publishing date	2009-06-01
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	604154-1
ISSN	1806-907X ; 0034-7094
ISSN (online)	1806-907X
ISSN	0034-7094
DOI	10.1590/s0034-70942009000300003
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