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Terapia intensiva

Terapia intensiva

Parte integrante do IDOR desde sua fundação, a área de terapia intensiva se concentra em cinco linhas principais de pesquisa: sepse; avaliação de multirresistência de bactérias e outros patógenos; pacientes com câncer e terapia intensiva; neurologia e terapia intensiva; qualidade e eficiência em cuidados intensivos.

A sepse ou infecção generalizada é um dos principais desafios enfrentados nas unidades de terapia intensiva e, no Brasil, é responsável por altas taxas de mortalidade. Por isso, os cientistas do IDOR se dedicam ao estudo das relações entre a sepse e o quadro geral de saúde dos pacientes, investigando que comorbidades podem aumentar o risco de morte por infecção generalizada e como manejar esse risco. A resistência bacteriana é outro tema de destaque, pois constitui um desafio crescente de saúde pública, com impacto no desfecho de pacientes já fragilizados e internados nas UTIs. Cientistas do IDOR investigam o problema por meio da análise do registro de prescrições e dispensação de antibióticos nos hospitais, combinada a dados de microbiologia.

Já a terceira linha de pesquisa, ligada ao atendimento de pacientes oncológicos internados em UTIs, analisou informações de mais de 30 mil pacientes, que possibilitaram aos cientistas observar, entre outras coisas, que os desfechos desses pacientes melhoraram substancialmente nos últimos anos: para pacientes com diferentes tipos de câncer, observou-se uma redução progressiva da mortalidade.

Na área de neurologia e terapia intensiva, um dos principais objetos de pesquisa é o delirium, disfunção cerebral aguda e grave que acomete pacientes internados em UTIs. Desde 2008, a equipe do IDOR estuda o problema e vem desenvolvendo, com a ajuda da inteligência artificial, modelos preditivos para identificar os pacientes com maior risco de apresentar a condição.

Por fim, a quinta linha de pesquisa, que tem como objetivo avaliar o atendimento em serviços de terapia intensiva e propor estratégias para melhoria de sua qualidade, usa grandes quantidades de dados obtidos nos hospitais da RDSL e em instituições parceiras para avaliar como algumas intervenções – por exemplo, protocolos para tratamento de condições frequentes, como a insuficiência respiratória, ou para prevenção de complicações, como infecções hospitalares – podem mudar o desfecho dos pacientes. A partir de informações de 330 mil pacientes de cerca de 100 hospitais, os pesquisadores desenvolvem modelos preditivos capazes de identificar pacientes de alto risco ou auxiliar na reorganização das estruturas das UTIs, com vistas ao aumento da eficiência desses serviços.

Pesquisadores
Notícias Relacionadas
Principais Publicações

Devereaux PJ, Lamy A, Chan MTV, Allard RV, Lomivorotov VV, Landoni G, Zheng H, Paparella D, McGillion MH, Belley-Côté EP, Parlow JL, Underwood MJ, Wang CY, Dvirnik N, Abubakirov M, Fominskiy E, Choi S, Fremes S,Monaco F, Urrútia G, Maestre M, Hajjar LA, Hillis GS, Mills NL, Margari V, Mills JD, Billing JS, Methangkool E, Polanczyk CA, Sant’Anna R, Shukevich D, Conen D, Kavsak PA, McQueen MJ, Brady K, Spence J, Le Manach Y, Mian R, Lee SF, Bangdiwala SI, Hussain S, Borges FK, Pettit S, Vincent J, Guyatt GH, Yusuf S, Alpert JS, White HD, Whitlock RP; VISION Cardiac Surgery Investigators. High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality. N Engl J Med 2022; 386:827-836

Hajjar LA, Costa IBSDS, Rizk SI, Biselli B, Gomes BR, Bittar CS, de Oliveira GQ, de Almeida JP, de Oliveira Bello MV, Garzillo C, Leme AC, Elena M, Val F, de Almeida Lopes M, Lacerda MVG, Ramires JAF, Kalil Filho R, Teboul JL, Landoni G. Intensive care management of patients with COVID-19: a practical approach. Ann Intensive Care. 2021, p. 36

Fujii T, Luethi N, Young PJ, Frei DR, Eastwood GM, French CJ, Deane AM, Shehabi Y, Hajjar LA, Oliveira G, Udy AA, Orford N, Edney SJ, Hunt AL, Judd HL, Bitker L, Cioccari L, Naorungroj T, Yanase F, Bates S, McGain F, Hudson EP, Al-Bassam W, Dwivedi DB, Peppin C, McCracken P, Orosz J, Bailey M, Bellomo R; VITAMINS Trial Investigators. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020 Feb 4;323(5):423-431. PMID: 31950979; PMCID: PMC7029761.

Hajjar LA, Vincent JL, Galas FRBG, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leão WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler Júnior JOC. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010, p. 1559-67. PMID: 20940381.

Scanavini-Filho MA, Berwanger O, Matthias W, Aguiar MO, Chiang HP, Azevedo L, Baracioli LM, Lima FG, Furtado RHM, Dalcoquio TF, Menezes FR, Ferrari AG, de Luca F, Giugliano RP, Goodman S, Nicolau JC. Effects of Ticagrelor and Clopidogrel on Coronary Microcirculation in Patients with Acute Myocardial Infarction. Adv Ther. 2022 Apr;39(4):1832-1843. Epub 2022 Feb 26. PMID: 35218519; PMCID: PMC8989815.

Lopes RD, Macedo AVS, de Barros E Silva PGM, Moll-Bernardes RJ, Dos Santos TM, Mazza L, Feldman A, D’Andréa Saba Arruda G, de Albuquerque DC, Camiletti AS, de Sousa AS, de Paula TC, Giusti KGD, Domiciano RAM, Noya-Rabelo MM, Hamilton AM, Loures VA, Dionísio RM, Furquim TAB, De Luca FA, et al.; BRACE CORONA Investigators. Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial. JAMA. 2021 Jan 19;325(3):254-264. PMID: 33464336; PMCID: PMC7816106.

De Luca FA, Garrido AG, Prist R, Gutierrez PS, Rocha-e-Silva M, Cruz RJ Jr. Short-term effects of hydroxyethylstarch resuscitation on systemic and regional hemodynamics and metabolism in a brain-dead canine model. J Surg Res. 2011 Jul;169(1):132-8. Epub 2009 Dec 21. PMID: 20338587.

De Luca FA, Cruz RJ Jr, Garrido Adel P, Prist R, Rocha-E-Silva M. Initial hepatosplanchnic blood flow distribution and oxygen metabolism in experimental model of hypotensive brain death. Ann Transplant. 2009 Jan-Mar;14(1):38-46. PMID: 19289995.

Berwanger O, Nicolau JC, Carvalho AC, Jiang L, Goodman SG, Nicholls SJ, Parkhomenko A, Averkov O, Tajer C, Malaga G, Saraiva JFK, Fonseca FA, De Luca FA, et al. Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Cardiol. 2018 May 1;3(5):391-399. Erratum in: JAMA Cardiol. 2018 May 1;3(5):445. PMID: 29525822; PMCID: PMC5875327.

Viana LA, Cristelli MP, Santos DW, Tavares MG, Dantas MTC, Felipe CR, Silva HT, Pestana JM. Influence of epidemiology, immunosuppressive regimens, clinical presentation, and treatment on kidney transplant outcomes of patients diagnosed with tuberculosis: A retrospective cohort analysis. Am J Transplant. 2019 May;19(5):1421-1431.

Queiroz-Telles F, de Hoog S, Santos DW, Salgado CG, Vicente VA, Bonifaz A, Roilides E, Xi L, Azevedo CM, da Silva MB, Pana ZD, Colombo AL, Walsh TJ. Chromoblastomycosis. Clin Microbiol Rev. 2017 Jan;30(1):233-276.

Santos DW, Camargo LF, Gonçalves SS, Ogawa MM, Tomimori J, Enokihara MM, Medina-Pestana JO, Colombo AL. Melanized fungal infections in kidney transplant recipients: contributions to optimize clinical management. Clin Microbiol Infect. 2017 May;23(5):333.e9-333.e14. Epub 2017 Jan 3. PMID: 28062320.

Santos DWCL, Hagen F, Meis JF, Cristelli MP, Viana LA, Bernardi FDC, Tedesco-Silva H, Medina-Pestana JO, Colombo AL. Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients. Emerg Infect Dis. 2020 Jun;26(6):1329-1331. PMID: 32441623; PMCID: PMC7258454.

Santos DWCL, de Azevedo CMPES, Vicente VA, Queiroz-Telles F, Rodrigues AM, de Hoog GS, Denning DW, Colombo AL. The global burden of chromoblastomycosis. PLoS Negl Trop Dis. 2021 Aug 12;15(8):e0009611. PMID: 34383752; PMCID: PMC8360387.

Santos-Teles, AG; Ramalho, C; Ramos, JGR; Passos, RDH; Gobatto, A; Farias, S; Batista, PBP; Caldas, JR. (2021). Efficacy and safety of milrinone in the treatment of cerebral vasospasm after subarachnoid hemorrhage: a systematic review. Revista Brasileira de Terapia Intensiva, 32, 592-602, 2020. PMID: 33470361; PMCID: PMC7853682.

Ramos, JGR; Hernandes, SC; Pereira, TTT; Oliveira, S; Soares, DM; Passos, RH; Caldas, JR; Guarda, SNF; Batista, PBP; Mendes, AVA. Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before-after study. International Journal for Quality in Health Care, v. 33, p. mzab011, 2021. PMID: 33515245.

Silveira MAD, De Jong D, Berretta AA, Galvão EBDS, Ribeiro JC, Cerqueira-Silva T, Amorim TC, Conceição LFMRD, Gomes MMD, Teixeira MB, Souza SP, Santos MHCAD, San Martin RLA, Silva MO, Lírio M, Moreno L, Sampaio JCM, Mendonça R, Ultchak SS, Amorim FS, Ramos JGR, Batista PBP, Guarda SNFD, Mendes AVA, Passos RDH; BeeCovid Team. Efficacy of Brazilian green propolis (EPP-AF®) as an adjunct treatment for hospitalized COVID-19 patients: A randomized, controlled clinical trial. Biomed Pharmacother. 2021 Jun;138:111526. Epub 2021 Mar 20. PMID: 34311528; PMCID: PMC7980186.

Ramos JGR, Dos Santos GMN, Bispo MCC, de Almeida Matos RC, de Carvalho GMLS, Passos RDH, Caldas JR, Gobatto ALN, da Guarda SNF, Batista PBP. Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study. Am J Crit Care. 2021 Sep 1;30(5):397-400. PMID: 34467384.

Farias DA, Guarda SN, Santos JPS, Reis MSM, Passos RDH, Correia LC, Caldas JR, Gobatto ALN, Teixeira M, Oliveira A, Ribeiro MP, Batista PBP, Calderaro M, Paschoal Junior F, Pontes-Neto OM, Ramos JGR. Realistic simulation is associated with healthcare professionals’ increased self-perception of confidence in providing acute stroke care: a before-after controlled study. Arq Neuropsiquiatr. 2021 Jan;79(1):2-7. PMID: 33656107.

da Hora Passos R, Caldas J, Ramos JGR, Dos Santos Galvão de Melo EB, Ribeiro MPD, Alves MFC, Batista PBP, Messeder OHC, de Carvalho de Farias AM, Macedo E, Rouby JJ. Ultrasound-based clinical profiles for predicting the risk of intradialytic hypotension in critically ill patients on intermittent dialysis: a prospective observational study. Crit Care. 2019 Dec 2;23(1):389. PMID: 31791373; PMCID: PMC6889608.

da Hora Passos R, Ramos JGR, Gobatto A, Caldas J, Macedo E, Batista PB. Inclusion and definition of acute renal dysfunction in critically ill patients in randomized controlled trials: a systematic review. Crit Care. 2018 Apr 24;22(1):106. PMID: 29690893; PMCID: PMC5979001.

da Hora Passos R, Ramos JG, Mendonça EJ, Miranda EA, Dutra FR, Coelho MF, Pedroza AC, Correia LC, Batista PB, Macedo E, Dutra MM. A clinical score to predict mortality in septic acute kidney injury patients requiring continuous renal replacement therapy: the HELENICC score. BMC Anesthesiol. 2017 Feb 7;17(1):21. PMID: 28173756; PMCID: PMC5297177.

Rocha Ferreira GS, de Almeida JP, Landoni G, Vincent JL, Fominskiy E, Gomes Galas FRB, Gaiotto FA, Dallan LO, Franco RA, Lisboa LA, Palma Dallan LR, Fukushima JT, Rizk SI, Park CL, Strabelli TM, Gelas Lage SH, Camara L, Zeferino S, Jardim J, Calvo Arita ECT, Caldas Ribeiro J, Ayub-Ferreira SM, Costa Auler JO Jr, Filho RK, Jatene FB, Hajjar LA. Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial. Crit Care Med. 2018 Aug;46(8):e742-e750. PMID: 29727370.

Caldas JR, Panerai RB, Bor-Seng-Shu E, Ferreira GSR, Camara L, Passos RH, de-Lima-Oliveira M, Galas FRBG, Almeida JP, Nogueira RC, Mian N, Gaiotto FA, Robinson TG, Hajjar LA. Dynamic cerebral autoregulation: A marker of post-operative delirium? Clin Neurophysiol. 2019 Jan;130(1):101-108. Epub 2018 Nov 22. PMID: 30503909; PMCID: PMC7106549.

Caldas JR, Panerai RB, Bor-Seng-Shu E, Ferreira GSR, Camara L, Passos RH, Salinet AM, Azevedo DS, de-Lima-Oliveira M, Galas FRBG, Fukushima JT, Nogueira R, Taccone FS, Landoni G, Almeida JP, Robinson TG, Hajjar LA. Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial. Ann Intensive Care. 2019 Nov 27;9(1):130. PMID: 31773324; PMCID: PMC6879692.

Caldas JR, Passos RH, Ramos JGR, Ramalho C, Sancho LS, Salinet AM, Farias S, Gobatto A, Bombonato G, Benigno P, Taccone FS, Panerai RB. Dynamic Autoregulation is Impaired in Circulatory Shock. Shock. 2020 Aug;54(2):183-189. PMID: 31764617.

Caldas JR, Panerai RB, Passos R, Hajjar LA. Is there still a place for transcranial Doppler in patients with IABP? Crit Care. 2020 Oct 23;24(1):625. PMID: 33097067; PMCID: PMC7585289.

Soares M, Bozza FA, Azevedo LC, Silva UV, Corrêa TD, Colombari F, Torelly AP, Varaschin P, Viana WN, Knibel MF, Damasceno M, Espinoza R, Ferez M, Silveira JG, Lobo SA, Moraes AP, Lima RA, de Carvalho AG, do Brasil PE, Kahn JM, Angus DC, Salluh JI. Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units. J Clin Oncol. 2016 Sep 20;34(27):3315-24. Epub 2016 Jul 18. PubMed PMID: 27432921.

Zampieri FG, Iwashyna TJ, Viglianti EM, Taniguchi LU, Viana WN, Costa R, Corrêa TD, Moreira CEN, Maia MO, Moralez GM, Lisboa T, Ferez MA, Freitas CEF, de Carvalho CB, Mazza BF, Lima MFA, Ramos GV, Silva AR, Bozza FA, Salluh JIF, Soares M. Association of frailty with short-term outcomes, organ support and resource use in critically ill patients. Intensive Care Med. 2018 Sep;44(9):1512-1520. Epub 2018 Aug 13. PubMed PMID: 30105600.

Ranzani OT, Shankar-Hari M, Harrison DA, Rabello LS, Salluh JIF, Rowan KM, Soares M. A Comparison of Mortality From Sepsis in Brazil and England: The Impact of Heterogeneity in General and Sepsis-Specific Patient Characteristics. Crit Care Med. 2019 Jan;47(1):76-84. PMID: 30247269.

Zampieri FG, Salluh JIF, Azevedo LCP, Kahn JM, Damiani LP, Borges LP, Viana WN, Costa R, Corrêa TD, Araya DES, Maia MO, Ferez MA, Carvalho AGR, Knibel MF, Melo UO, Santino MS, Lisboa T, Caser EB, Besen BAMP, Bozza FA, Angus DC, Soares M. ICU staffing feature phenotypes and their relationship with patients’ outcomes: an unsupervised machine learning analysis. Intensive Care Med. 2019 Nov;45(11):1599-1607. Epub 2019 Oct 8. PubMed PMID: 31595349

Zampieri FG, Romano TG, Salluh JIF, Taniguchi LU, Mendes PV, Nassar AP Jr, Costa R, Viana WN, Maia MO, Lima MFA, Cappi SB, Carvalho AGR, De Marco FVC, Santino MS, Perecmanis E, Miranda FG, Ramos GV, Silva AR, Hoff PM, Bozza FA, Soares M. Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study. Intensive Care Med. 2021 Feb;47(2):170-179. Epub 2020 Aug 7. PubMed PMID: 32770267.

Salluh, JI, Ramos F, Chiche JD. Delivering evidence-based critical care for mechanically ventilated patients with COVID-19.  Lancet Respir Med. 2020 Aug;8(8):756-758. Epub 2020 Jun 16.

Soares M, Bozza FA, Angus DC, Japiassú AM, Viana WN, Costa R, Brauer L, Mazza BF, Corrêa TD, Nunes AL, Lisboa T, Colombari F, Maciel AT, Azevedo LC, Damasceno M, Fernandes HS, Cavalcanti AB, do Brasil PE, Kahn JM, Salluh JI. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Med. 2015 Dec;41(12):2149-60.

Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, Serafim RB, Stevens RD. Outcome of delirium in critically ill patients: systematic review and meta-analysis. BMJ. 2015 Jun 3;350:h2538.

Writing Group for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet), Cavalcanti AB, Bozza FA, Machado FR, Salluh JI, Campagnucci VP, Vendramim P, Guimaraes HP, Normilio-Silva K, Damiani LP, Romano E, Carrara F, Lubarino Diniz de Souza J, Silva AR, Ramos GV, Teixeira C, Brandão da Silva N, Chang CC, Angus DC, Berwanger O. Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients: A Randomized Clinical Trial. JAMA. 2016 Apr 12;315(14):1480-90.

Soares M, Bozza FA, Azevedo LC, Silva UV, Corrêa TD, Colombari F, Torelly AP, Varaschin P, Viana WN, Knibel MF, Damasceno M, Espinoza R, Ferez M, Silveira JG, Lobo SA, Moraes AP, Lima RA, de Carvalho AG, do Brasil PE, Kahn JM, Angus DC, Salluh JI. Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units. J Clin Oncol. 2016 Sep 20;34(27):3315-24.

Ranzani OT, Bastos LSL, Gelli JGM, Marchesi JF, Baião F, Hamacher S, Bozza FA. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021 Apr;9(4):407-418.

Peres IT, Bastos LSL, Gelli JGM, Marchesi JF, Dantas LF, Antunes BBP, Maçaira PM, Baião FA, Hamacher S, Bozza FA. Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil. Public Health. 2021 Mar;192:15-20.

Kurtz P, Bastos LSL, Dantas LF, Zampieri FG, Soares M, Hamacher S, Salluh JIF, Bozza FA. Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months. Intensive Care Med. 2021 May;47(5):538-548.

Bastos LS, Ranzani OT, Souza TML, Hamacher S, Bozza FA. COVID-19 hospital admissions: Brazil’s first and second waves compared. Lancet Respir Med. 2021 Aug;9(8):e82-e83.

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