LIM/51 - Laboratório de Emergências Clínicas
URI Permanente desta comunidade
O Laboratório de Emergências Clínicas é ligado ao Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: lesão de isquemia-reperfusão; fisiopatologia da sepse; mecanismos inflamatórios na aterosclerose; sinalização celular por espécies reativas de nitrogênio; arritmias cardíacas; interação entre receptores nucleares e inflamatórios.
Site oficial: http://limhc.fm.usp.br/portal/lim51-laboratorio-de-emergencias-clinicas/
Linhas de pesquisa: lesão de isquemia-reperfusão; fisiopatologia da sepse; mecanismos inflamatórios na aterosclerose; sinalização celular por espécies reativas de nitrogênio; arritmias cardíacas; interação entre receptores nucleares e inflamatórios.
Site oficial: http://limhc.fm.usp.br/portal/lim51-laboratorio-de-emergencias-clinicas/
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- LIM/51 - Laboratório de Emergências Clínicas
- LIM/51 - Laboratório de Emergências Clínicas
- LIM/51 - Laboratório de Emergências Clínicas
Submissões Recentes
Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic
(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, Geraldo
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
Application of thermography to estimate respiratory rate in the emergency room: The journal Temperature toolbox
(2023) ALDRED, A.; RIBEIRO, J. A. S.; BEZERRA, P. M. S.; ANTUNES, A. C. M.; GOULART, A. C.; DESUó, I. C.; GOMES, G.
Among the vital signs collected during hospital triage, respiratory rate is an important parameter associated with physiological, pathophysiological, and emotional changes. In recent years, the importance of its verification in emergency centers due to the severe acute respiratory syndrome 2 (SARS2) pandemic has become very clear, although it is still one of the least evaluated and collected vital signs. In this context, infrared imaging has been shown to be a reliable estimator of respiratory rate, with the advantage of not requiring physical contact with patients. The objective of this study was to evaluate the potential of analyzing a sequence of thermal images as an estimator of respiratory rate in the clinical routine of an emergency room. We used an infrared thermal camera (T540, Flir Systems) to obtain the respiratory rate data of 136 patients, based on nostrils’ temperature fluctuation, during the peak of the COVID-19 pandemic in Brazil and compared it with the chest incursion count method, commonly employed in the emergency screening procedures. We found a good agreement between both methods, with Bland-Altman limits of agreement ranging from −4 to 4 min−1, no proportional bias (R2 = 0.021, p = 0.095), and a strong correlation between them (r = 0.95, p < 0.001). Our results suggest that infrared thermography has potential to be a good estimator of respiratory rate in the routine of an emergency room.
Exploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation
(2023) MELRO, L. M. Garcia; SANTOS, Y. de Albuquerque Pessoa dos; JúNIOR, L. C. M. Cardozo; BESEN, B. A. Maccagnan Pinheiro; ZIGAIB, R.; FORTE, D. N.; MENDES, P. V.; PARK, M.
Objective: To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support. Methods: Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators. Results: Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact. Conclusion: Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.
Capillary leak syndrome during continuous renal replacement therapy after renal hilum ligation in a hypercapnic landrace pig
(2023) SANTOS, Y. A. P. Dos; JúNIOR, L. C. M. C.; MENDES, P. V.; BESEN, B. A. M. P.; PARK, M.
Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis
(2023) ADIGBLI, D.; YANG, L.; HAMMOND, N.; ANNANE, D.; ARABI, Y.; BILOTTA, F.; BOHé, J.; BRUNKHORST, F. M.; CAVALCANTI, A. B.; COOK, D.; ENGEL, C.; GREEN-LAROCHE, D.; HE, W.; HENDERSON, W.; HOEDEMAEKERS, C.; IAPICHINO, G.; KALFON, P.; ROSA, G. de La; MACKENZIE, I.; MéLOT, C.; MITCHELL, I.; OKSANEN, T.; POLLI, F.; PREISER, J.-C.; SORIANO, F. G.; WANG, L.-C.; YUAN, J.; DELANEY, A.; TANNA, G. L. D.; FINFER, S.
Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/ dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, ‘what is the best blood glucose target for critically ill patients overall?’.
Brazilian Airway Registry COoperation: The First 1,000 Emergency Intubations of the BARCO Study
(2023) MAIA, I. W. A.; ALENCAR, J.; MARCHINI, J.; SILVA, E. L. O. J.; GOMES, L.; MARINO, L.; VAISBERG, V.; STANZANI, G.; NOGUEIRA, C.; KROEFF, B.; SOUZA, H.
Association of Lipoprotein Subfractions With Atherosclerosis in the Baseline Sample of ELSA-Brasil Cohort Study - A Cross-Sectional Analysis
(2023) TEBAR, William R.; MENEGHINI, Vandrize; GOULART, Alessandra C.; SANTOS, Itamar S.; SANTOS, Raul D.; BITTENCOURT, Marcio S.; GENEROSO, Giuliano; PEREIRA, Alexandre; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; OTVOS, James D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.
GlycA, but Not C-reactive Protein is Associated With Baseline Carotid Artery Plaque in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
(2023) TEBAR, William R.; MENEGHINI, Vandrize; GOULART, Alessandra C.; SANTOS, Itamar S.; SANTOS, Raul D.; BITTENCOURT, Marcio S.; GENEROSO, Giuliano; PEREIRA, Alexandre C.; BLAHA, Michael J.; JONES, Steven R.; TOTH, Peter P.; OTVOS, James D.; LOTUFO, Paulo A.; BENSENOR, Isabela M.
Brazilian Airway Registry COoperation: Comparison Between Intubations Performed With or Without Videolaryngoscope
(2023) OLIVEIRA, G.; MAIA, I. W. A.; ALENCAR, J.; ALONSO, G.; BETONI, H.; GOMES, L.; MARCHINI, J.; MARINO, L.; SOUZA, H.; VAISBERG, V.; STANZANI, G.
Potential Determinants Are Associated With Thyroid Peroxidase Antibodies Titers in Men and Women Participants of the ELSA-Brasil Study
(2023) MENEGHINI, Vandrize; TEBAR, William; SANTOS, Itamar S.; JANOVSKY, Carolina; LOTUFO, Paulo A.; GOULART, Alessandra C.; BENSENOR, Isabela M.