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Rojas SSO, Ordinola AAM, Veiga VC, Souza JMD. The use of a noninvasive intracranial pressure monitoring method in the intensive care unit to improve neuroprotection in postoperative cardiac surgery patients after extracorporeal circulation. Rev Bras Ter Intensiva 2021; 33:469-476. [PMID: 35107560 PMCID: PMC8555399 DOI: 10.5935/0103-507x.20210066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/09/2021] [Indexed: 12/04/2022] Open
Abstract
Desde a instituição da circulação
extracorpórea, há cinco décadas, a lesão cerebral
decorrente desse procedimento durante cirurgias cardiovasculares tem sido uma
complicação frequente. Não existe uma causa única de
lesão cerebral pelo uso de circulação extracorpórea,
porém se sabe que acomete cerca de 70% dos pacientes submetidos a esse
procedimento. A avaliação da pressão intracraniana é
um dos métodos que podem orientar os cuidados com os pacientes submetidos
a procedimentos associados com distúrbios neurológicos. Este
artigo descreve dois casos de pacientes submetidos à cirurgia
cardiovascular com circulação extracorpórea, para os quais
os procedimentos de neuroproteção na fase
pós-operatória foram guiados pelos achados relacionados ao formato
das ondas de pressão intracraniana, obtidos por meio de um método
não invasivo de monitoramento.
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Affiliation(s)
| | | | - Viviane Cordeiro Veiga
- Unidade de Terapia Intensiva Neurológica, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Januário Manoel de Souza
- Unidade de Terapia Intensiva Neurológica, BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
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2
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Ordinola AAM, Osmar SS, Marussi VHR, Rojas SSO, Baeta AM, Chaddad Neto FE, Veiga VC. Cerebral hemorrhage during the active phase of SARS-CoV-2 infection in a patient with amyloid angiopathy: case report. Rev Bras Ter Intensiva 2021; 32:603-605. [PMID: 33470362 PMCID: PMC7853683 DOI: 10.5935/0103-507x.20200098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/25/2020] [Indexed: 11/20/2022] Open
Abstract
The neurological changes associated with COVID-19 have been frequently described, especially in cases of greater severity, and are related to multifactorial causes, such as endothelial dysfunction, inflammatory mediator release (cytokine storm), endothelial dysfunction and hypoxemia. We report the case of a female patient, 88 years old, with cerebral hemorrhage associated with amyloid angiopathy in the context of SARS-CoV-2 infection.
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Affiliation(s)
| | - Samir Sari Osmar
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | - Viviane Cordeiro Veiga
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICnet) - São Paulo (SP), Brasil
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3
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Veiga VC, Silva LMCJ, Sady ERR, Fernandes PV, Rojas SSO. Apnea test for the diagnosis of brain death in a patient undergoing extracorporeal membrane oxygenation. Rev Bras Ter Intensiva 2020; 32:468-473. [PMID: 33053038 PMCID: PMC7595728 DOI: 10.5935/0103-507x.20200077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/10/2020] [Indexed: 11/20/2022] Open
Abstract
Extracorporeal membrane oxygenation is used as extracirculatory support for the care of patients with severe and reversible cardiac and/or respiratory failure. Neurological complications may be related to the procedure. Given the unfavorable neurological evolution and the need to perform a brain death protocol, the performance of an apnea test in this context remains a challenge. We report the use of an apnea test for the diagnosis of brain death post-cardiac surgery in a patient receiving venoarterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Viviane Cordeiro Veiga
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brasil
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4
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Soldatelli MD, do Amaral LF, Veiga VC, Rojas SSO, Omar S, Marussi VHR. Neurovascular and perfusion imaging findings in coronavirus disease 2019: Case report and literature review. Neuroradiol J 2020; 33:368-373. [PMID: 32666873 PMCID: PMC7482048 DOI: 10.1177/1971400920941652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Central nervous system involvement in severe acute respiratory syndrome caused by coronavirus disease 2019 (COVID-19) has increasingly been recognised in the literature, and possible mechanisms of neuroinvasion, neurotropism and neurovirulence have been described. Neurological signs have been described in 84% of COVID-19 intensive care unit patients, and haemostatic abnormalities in such patients may play an important role, with a broad spectrum of neuroimaging findings. This report describes the magnetic resonance imaging neurovascular findings in an acutely ill patient with COVID-19, including perfusion abnormalities depicted in the arterial spin labelling technique.
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Affiliation(s)
| | | | | | | | - Samir Omar
- Department of Neuroradiology, Beneficência Portuguesa de São Paulo, Brazil
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5
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Sady ERR, Junqueira L, Veiga VC, Rojas SSO. Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review. Rev Bras Ter Intensiva 2020; 32:312-318. [PMID: 32667442 PMCID: PMC7405745 DOI: 10.5935/0103-507x.20200048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/28/2020] [Indexed: 12/05/2022] Open
Abstract
Among the potential complications of extracorporeal membrane oxygenation, neurological dysfunctions, including brain death, are not negligible. In Brazil, the diagnostic process of brain death is regulated by Federal Council of Medicine resolution 2,173 of 2017. Diagnostic tests for brain death include the apnea test, which assesses the presence of a ventilatory response to hypercapnic stimulus. However, gas exchange, including carbon dioxide removal, is maintained under extracorporeal membrane oxygenation, making the test challenging. In addition to the fact that the aforementioned resolution does not consider the specificities of the diagnostic process under extracorporeal membrane oxygenation, studies on the subject are scarce. This review aims to identify case studies (and/or case series) published in the PubMed® and Cochrane databases describing the process of brain death diagnosis. A total of 17 publications (2011 - 2019) were identified. The practical strategies described were to provide pretest supplemental oxygenation via mechanical ventilation and extracorporeal membrane oxygenation (fraction of inspired oxygen = 1.0) and, at the beginning of the test, titrate the sweep flow (0.5 - 1.0L/minute) to minimize carbon dioxide removal. It is also recommended to increase blood flow and/or sweep flow in the presence of hypoxemia and/or hypotension, which may be combined with fluid infusion and/or the escalation of inotropic/vasoactive drugs. If the partial pressure of carbon dioxide threshold is not reached, repeating the test under supplementation of carbon dioxide exogenous to the circuit is an alternative. Last, in cases of venoarterial extracorporeal membrane oxygenation, to measure gas variation and exclude differential hypoxia, blood samples of the native and extracorporeal (post-oxygenator) circulations are recommended.
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Affiliation(s)
| | - Lígia Junqueira
- Unidade de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa, São Paulo, SP, Brasil
| | - Viviane Cordeiro Veiga
- Unidade de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa, São Paulo, SP, Brasil
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6
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de Farias DLC, Prats J, Cavalcanti AB, Rosa RG, Machado FR, Berwanger O, de Azevedo LCP, Lopes RD, Avezum Á, Kawano-Dourado L, Damiani LP, Rojas SSO, de Oliveira CZ, Andrade LEC, Sandes AF, Pintão MC, de Castro Júnior CG, Scheinberg P, Veiga VC. Rationale and design of the "Tocilizumab in patients with moderate to severe COVID-19: an open-label multicentre randomized controlled" trial (TOCIBRAS). Rev Bras Ter Intensiva 2020; 32:337-347. [PMID: 32965395 PMCID: PMC7595725 DOI: 10.5935/0103-507x.20200060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Pro-inflammatory markers play a significant role in the disease severity of patients with COVID-19. Thus, anti-inflammatory therapies are attractive agents for potentially combating the uncontrolled inflammatory cascade in these patients. We designed a trial testing tocilizumab versus standard of care intending to improve the outcomes by inhibiting interleukin-6, an important inflammatory mediator in COVID-19. METHODS AND ANALYSIS This open-label multicentre randomized controlled trial will compare clinical outcomes of tocilizumab plus standard of care versus standard of care alone in patients with moderate to severe COVID-19. Two of the following four criteria are required for protocol enrolment: D-dimer > 1,000ng/mL; C reactive protein > 5mg/dL, ferritin > 300mg/dL, and lactate dehydrogenase > upper limit of normal. The primary objective will be to compare the clinical status on day 15, as measured by a 7-point ordinal scale applied in COVID-19 trials worldwide. The primary endpoint will be assessed by an ordinal logistic regression assuming proportional odds ratios adjusted for stratification variables (age and sex). ETHICS AND DISSEMINATION The TOCIBRAS protocol was approved by local and central (national) ethical committees in Brazil following current national and international guidelines/directives. Each participating center had the study protocol approved by their institutional review boards before initiating protocol enrolment. The data derived from this trial will be published regardless of the results. If proven active, this strategy could alleviate the consequences of the inflammatory response in COVID-19 patients and improve their clinical outcomes.
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Affiliation(s)
| | - João Prats
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Research Institute, HCor-Hospital do Coração - São Paulo (SP), Brazil
| | - Regis Goulart Rosa
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Hospital Moinhos de Vento - Porto Alegre (RS), Brazil
| | | | - Otávio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein - São Paulo (SP), Brazil
| | - Luciano César Pontes de Azevedo
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
- Hospital Sírio-Libanês - São Paulo (SP), Brazil
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, Estados Unidos
- Brazilian Clinical Research Institute - São Paulo (SP), Brazil
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brazil
| | | | | | | | | | | | | | | | - Claudio Galvão de Castro Júnior
- Academic Research Organization, Hospital Israelita Albert Einstein - São Paulo (SP), Brazil
- Santa Casa de Porto Alegre - Porto Alegre (RS), Brazil
| | | | - Viviane Cordeiro Veiga
- BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brazil
- Brazilian Research in Intensive Care Network (BRICNet) - São Paulo (SP), Brazil
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7
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Silva Júnior JM, Chaves RCDF, Corrêa TD, Assunção MSCD, Katayama HT, Bosso FE, Amendola CP, Serpa Neto A, Malbouisson LMS, Oliveira NED, Veiga VC, Rojas SSO, Postalli NF, Alvarisa TK, Lucena BMND, Oliveira RAGD, Sanches LC, Silva UVDAE, Nassar Junior AP. Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil. Rev Bras Ter Intensiva 2020; 32:17-27. [PMID: 32401988 PMCID: PMC7206944 DOI: 10.5935/0103-507x.20200005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
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Affiliation(s)
| | | | | | | | | | | | | | - Ary Serpa Neto
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Neymar Elias de Oliveira
- Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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8
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Veiga VC, Postalli NF, Alvarisa TK, Travassos PP, Vale RTDS, Oliveira CZD, Rojas SSO. Adverse events during intrahospital transport of critically ill patients in a large hospital. Rev Bras Ter Intensiva 2019; 31:15-20. [PMID: 30843950 PMCID: PMC6443312 DOI: 10.5935/0103-507x.20190003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the incidence of clinical and non-clinical events during
intrahospital transport of critically ill patients and to analyze the
associated risk factors. Methods Cohort study with retrospective data collected from October 2016 to October
2017. All cases of intrahospital transport for diagnostic and therapeutic
purposes in a large hospital with six adult intensive care units were
analyzed, and the adverse events and related risk factors were
evaluated. Results During the study period, 1,559 intrahospital transports were performed with
1,348 patients, with a mean age of 66 ± 17 years and a mean transport
time of 43 ± 34 minutes. During transport, 19.8% of the patients were
using vasoactive drugs; 13.7% were under sedation; and 10.6% were under
mechanical ventilation. Clinical events occurred in 117 transports (7.5%),
and non-clinical events occurred in 125 (8.0%) transports. Communication
failures were prevalent; however, the multivariate analysis showed that the
use of sedatives, noradrenaline and nitroprusside and a transport time
greater than 36.5 minutes were associated with adverse clinical events. The
use of dobutamine and a transport time greater than 36.5 minutes were
associated with non-clinical events. At the end of transport, 98.1% of the
patients presented unchanged clinical conditions compared with baseline. Conclusion Intrahospital transport is related to a high incidence of adverse events, and
transport time and the use of sedatives and vasoactive drugs were related to
these events.
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Affiliation(s)
- Viviane Cordeiro Veiga
- Grupo de Transporte, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Natalia Fioravanti Postalli
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Thais Kawagoe Alvarisa
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Phillipe Pereira Travassos
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Raquel Telles da Silva Vale
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Cleyton Zanardo de Oliveira
- Bioestatística, Centro de Ensino e Pesquisa, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
| | - Salomón Soriano Ordinola Rojas
- Grupo de Transporte, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil
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9
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Veiga VC, Rojas SSO. Analgosedation and delirium in intensive care units in Brazil: current status. ASDUTI study. Rev Bras Ter Intensiva 2019; 30:246-248. [PMID: 29995093 PMCID: PMC6031417 DOI: 10.5935/0103-507x.20180025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/03/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Viviane Cordeiro Veiga
- Unidade de Terapia Intensiva Neurológica, Hospital BP - A Beneficência Portuguesa de São Paulo - São Paulo (SP), Brasil e Comitê de Neurointensivismo, Associação de Medicina Intensiva Brasileira - São Paulo (SP), Brasil.,Comitê de Neurointensivismo, Associação de Medicina Intensiva Brasileira - São Paulo (SP), Brasil
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10
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Veiga VC, Rojas SSO. Performance of the Rapid Response Systems in Health Care Improvement: Benefits and
Perspectives. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Miguel GAS, Rojas SSO, Vieira RW, Silva JPD, Abensur H. Role of echocardiography in the ventricular assessment of the transplanted heart versus heart rejection. Arq Bras Cardiol 2012; 99:1031-9. [PMID: 23138670 DOI: 10.1590/s0066-782x2012005000099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/04/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Heart transplantation is an alternative for individuals with end-stage heart disease. However, episodes of heart rejection (HR) are frequent and increase morbidity and mortality, requiring the use of an accurate non-invasive exam for their diagnosis, since endomyocardial biopsy (EMB) is not a complication-free procedure. OBJECTIVE To compare the parameters obtained by use of Doppler echocardiography in a group of transplanted patients with HR (TX1) and another group of transplanted patients without rejection (TX0), having as reference a control group (CG) and observing the behavior of the left ventricular systo-diastolic function expressed as the myocardial performance index (MPI) METHODS: Transthoracic echocardiographies were performed from January 2006 to January 2008 to prospectively assess 47 patients divided into three groups: CG (36.2%); TX0 (38.3%); and TX1 (25.5%). The MPI was compared between the groups, and data were analyzed by use of Fisher exact test and nonparametric Kruskal-Wallis test, both with significance level of 5%. RESULTS The groups did not differ regarding age, weight, height, and body surface. When compared to GC, TX0 and TX1 showed a change in the left ventricular systo-diastolic function, expressed as an increase in MPI, which was greater in TX1 [0.38 (0.29 - 0.44); 0.47 (0.43 - 0.56); 0.58 (0.52 - 0.74), respectively; p < 0.001]. CONCLUSION Echocardiography was a very accurate test to detect changes in the systo-diastolic function of the transplanted heart; however, it did not prove to be reliable to replace BEM in the safe diagnosis of HR.
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12
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13
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Veiga VC, Carvalho JCD, Amaya LEC, Martins MS, Rojas SSO. Meningitis as a complication of infective endocarditis. Rev Bras Ter Intensiva 2012; 24:308-311. [PMID: 23917834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 08/01/2012] [Indexed: 06/02/2023] Open
Abstract
Although approximately 30% of patients with endocarditis present with neurological complications, the development of meningitis in these patients is rare. This case report describes a female patient who developed meningitis as a complication of mitral valve endocarditis, and surgery was required for this patient due to acute heart failure resulting from the rupture of the chordae tendineae.
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14
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Veiga VC, Rojas SSO, Souza FSOD, Vieira RW, Silva Junior A, Patrício ML, Marum ECH, Abensur H. Avaliação ecocardiográfica da terapia de ressincronização cardíaca: dois anos de seguimento. Arq Bras Cardiol 2010; 94:119-26. [DOI: 10.1590/s0066-782x2010000100018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 06/22/2009] [Indexed: 11/22/2022] Open
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15
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Veiga VC, Abensur H, Rojas SSO. O ecocardiograma na terapia de ressincronização cardíaca. Arq Bras Cardiol 2009; 93:441-5, 433-7. [DOI: 10.1590/s0066-782x2009001000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 12/11/2008] [Indexed: 11/22/2022] Open
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16
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Rojas SSO, Veiga VC, Carvalho JCD, Campodônico LEA, Assis FR, Shimizu SP, Morais EA, Buesio R, Marchesini AM, Junqueira LMC, Holanda CV. Trombólise intra-arterial pulmonar no pós-operatório de clipagem de aneurisma cerebral: relato de caso. Rev Bras Ter Intensiva 2008. [DOI: 10.1590/s0103-507x2008000300016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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17
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Rojas SSO, Veiga VC, Carvalho JCD, Campodônico LEA, Assis FR, Shimizu SP, Morais EA, Buesio R, Marchesini AM, Junqueira LMC, Holanda CV. Intra-arterial pulmonary thrombolysis at the postoperative period of brain aneurysm clamping: case report. Rev Bras Ter Intensiva 2008; 20:318-320. [PMID: 25307101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/14/2008] [Indexed: 06/04/2023] Open
Abstract
Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.
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Affiliation(s)
| | - Viviane Cordeiro Veiga
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Júlio César de Carvalho
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | | | - Fabrizio Rodrigues Assis
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Sandra Patrícia Shimizu
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Elaine Aparecida Morais
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Roberto Buesio
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | - Andréia Maria Marchesini
- Unidades de Terapia Intensiva Neurológica, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
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18
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Veiga VC, Rojas SSO, Silva Junior A, Patrício ML, Marum ECH, Abensur H. Aneurisma de apêndice atrial esquerdo: diagnóstico ecocardiográfico. Arq Bras Cardiol 2008; 90:e36-8. [DOI: 10.1590/s0066-782x2008000500014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 10/01/2007] [Indexed: 11/22/2022] Open
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Rojas SSO, Veiga VC, Carvalho JCD, Campodonico LEA, Silva LMJ, Mendonça JA, Chaddad FE, Oliveira ED. Transfusion-related acute lung injury em pós-operatório de neurocirurgia: relato de caso. Rev Bras Ter Intensiva 2008; 20:103-5. [DOI: 10.1590/s0103-507x2008000100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 02/01/2008] [Indexed: 11/22/2022] Open
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Rojas SSO, Veiga VC, Souza JMD, Berlinck MF, Senra DF, Vieira RW, Magna LA, Braile DM, Oliveira SAD. [Correction of thoracic and thoracoabdominal aortic aneurysms. Central cannulation technique]. Arq Bras Cardiol 2005; 84:297-303. [PMID: 15880202 DOI: 10.1590/s0066-782x2005000400005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To demonstrate the viability of the use of extracorporeal circulation established between the left atrium and ascending aorta to induce deep hypothermia for correcting thoracic and thoracoabdominal aortic aneurysms. METHODS From January 1994 to July 2001, 38 patients (mean age, 54.6 +/- 12.7 years) were operated on as follows: 12 (31.6%) patients underwent repair of thoracoabdominal aortic aneurysm, and 26 patients underwent repair of descending thoracic aneurysms. Deep hypothermia was induced by use of extracorporeal circulation, with pharyngeal temperature ranging from 15 to 25 degrees C (20.6 +/- 3.2 degrees C). RESULTS Of the neurological complications, paraplegia occurred in 2 (5.3%) patients. One patient developed paraparesis, and another evolved with convulsion. Twelve (31.6%) patients had respiratory complications, and 2 (16.7%) patients died. Two other patients were operated on on an emergency basis and ended up dying. Total mortality was 18.4% (7 patients). CONCLUSION Repair of descending thoracic and thoracoabdominal aortic aneurysms with deep hypothermia by use of extracorporeal circulation established between the left atrium and ascending aorta proved to be a viable method for correcting those aneurysms.
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