Eduardo Leite Vieira Costa

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

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Marcelo B. P. Amato

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Carlos Roberto Ribeiro de Carvalho

Universidade de São Paulo

Mauro R. Tucci

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Luciano César Pontes Azevedo

Brazilian Research in Intensive Care Network

Tilo Winkler

Massachusetts General Hospital

Guido Musch

University of Massachusetts Chan Medical School

R. Scott Harris

Massachusetts General Hospital

Marcos F. Vidal Melo

Columbia University

Tyler J. Wellman

Massachusetts General Hospital

João Batista Borges

Charles University

Cooperative Institutions

Universidade de São Paulo

278

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

244

Harvard University

130

Inserm

122

Hospital Sírio-Libanês

Massachusetts General Hospital

Assistance Publique – Hôpitaux de Paris

Hospital São Paulo

Istituti di Ricovero e Cura a Carattere Scientifico

Hospital Israelita Albert Einstein

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QUANTIFICATION OF LUNG COLLAPSE DURING PEEP-TITRATION BY ELECTRICAL IMPEDANCE TOMOGRAPHY IN EXPERIMENTAL ARDS - COMPARISON WITH QUANTITATIVE CT ANALYSIS

Intensive Care Medicine Experimental (2015)

Sören Hammermüller Eduardo Leite Vieira Costa Marcelo B. P. Amato Katharina Noreikat Walter Brehm

Tidal recruitment of nonaerated lung is a main cause of ventilator associated lung injury. CT as the gold standard for quantifying lung collapse (CT-collapse) is associated with certain risks for the patient (e.g. radiation exposure or transportation) and cannot be used for repeated assessments. Electrical impedance tomography (EIT) instead is a bed-side non-invasive radiation-free continuous technique for monitoring of changes in thoracic air content and distribution. EIT may also allow quantification of recruitable lunge collapse (EIT-collapse) [1].

Electrical Impedance Tomography

10.1186/2197-425x-3-s1-a995

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Citations (1)

What is the optimal large airway size reduction value to determine malacia: exploratory bronchoscopic analysis in patients in Mounier-Kuhn syndrome

Journal of Thoracic Disease (2021)

Evelise Lima Pedro R. Genta Rodrigo Abensur Athanazio Ascédio José Rodrigues Maria Aparecida Miyuki Nakamura

Malacia

Value (mathematics)

Tracheomalacia

10.21037/jtd-20-2395

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Citations (1)

Mechanical ventilation during thoracic surgery: towards individualized medicine

Annals of Translational Medicine (2020)

Mauro R. Tucci Sérgio M. Pereira Eduardo Leite Vieira Costa Joaquim Edson Vieira

Cardiothoracic surgery

10.21037/atm-20-2005

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Citations (1)

Improving Airways Patency and Ventilation Through Optimal Positive Pressure Identified by Noninvasive Mechanical Ventilation Titration in Mounier-Kuhn Syndrome: Protocol for an Interventional, Open-Label, Single-Arm Clinical Trial

JMIR Research Protocols (2020)

Evelise Lima Maria Aparecida Miyuki Nakamura Pedro R. Genta Ascédio José Rodrigues Rodrigo Abensur Athanazio

Background Mounier-Kuhn syndrome or congenital tracheobronchomegaly is a rare disease characterized by dilation of the trachea and the main bronchi within the thoracic cavity. The predominant signs and symptoms of the disease include coughing, purulent and abundant expectoration, dyspnea, snoring, wheezing, and recurrent respiratory infection. Symptoms of the disease in some patients are believed to be pathological manifestations arising due to resident tracheobronchomalacia. Although treatment options used for the management of this disease include inhaled bronchodilators, corticosteroids, and hypertonic solution, there is no consensus on the treatment. The use of continuous positive airway pressure (CPAP) has been reported as a potential therapeutic option for tracheobronchomalacia, but no prospective studies have demonstrated its efficacy in this condition. Objective The purpose of this is to identify the presence of tracheobronchomalacia and an optimal CPAP pressure that reduces the tracheobronchial collapse in patients with Mounier-Kuhn syndrome and to analyze the repercussion in pulmonary ventilation. In parallel, we aim to evaluate the prevalence of obstructive sleep apnea/hypopnea syndrome. Methods This interventional, open-label, single-arm clinical trial will enroll patients who are diagnosed Mounier-Kuhn syndrome. Patient evaluation will be conducted in an outpatient clinic and involve 3 visits. Visit 1 will involve the collection and registration of social demographic, clinical, and functional data. Visit 2 will entail polysomnography, bronchoscopy for the evaluation of tracheobronchomalacia, titration of the optimal pressure that reduces the degree of collapse of the airway, and electrical impedance tomography. In visit 3, patients exhibiting a reduction in collapse areas will be requested to undergo chest computed tomography during inspiration and forced expiration with and without positive pressure (titrated to determine optimal CPAP pressure). Results This protocol is a doctorate project. The project was submitted to the institutional review board on January 24, 2017, and approval was granted on February 2, 2017 (Brazilian Research database number CAAE 64001317.4.000.0068). Patient evaluations started in April 2018. Planned recruitment is based on volunteers’ availability and clinical stability, and interventions will be conducted at least once a month to finish the project at the end of 2020. A preliminary analysis of each case will be performed after each intervention, but detailed results are expected to be reported in the first quarter of 2021. Conclusions There is no consensus on the best treatment options for managing Mounier-Kuhn syndrome. The use of positive pressure could maintain patency of the collapsed airways, functioning as a “pneumatic stent” to reduce the degree of airflow obstruction. This, in turn, could promote mobilization of thoracic secretion and improve pulmonary ventilation. Trial Registration ClinicalTrails.gov NCT03101059; https://clinicaltrials.gov/ct2/show/NCT03101059. International Registered Report Identifier (IRRID) DERR1-10.2196/14786

Tracheobronchomalacia

Positive airway pressure

10.2196/14786

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Citations (3)

COVID-19-associated ARDS treated with DEXamethasone (CoDEX): study design and rationale for a randomized trial

Figshare (2021)

Bruno Martins Tomazini Israel Silva Maia Flávia Regina Bueno Maria Vitoria Aparecida Oliveira Silva Franca Pellison Baldassare

Abstract Objective: The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads worldwide and is considered a pandemic. The most common manifestation of SARS-CoV-2 infection (coronavirus disease 2019 - COVID-19) is viral pneumonia with varying degrees of respiratory compromise and up to 40% of hospitalized patients might develop acute respiratory distress syndrome. Several clinical trials evaluated the role of corticosteroids in non-COVID-19 acute respiratory distress syndrome with conflicting results. We designed a trial to evaluate the effectiveness of early intravenous dexamethasone administration on the number of days alive and free of mechanical ventilation within 28 days after randomization in adult patients with moderate or severe acute respiratory distress syndrome due to confirmed or probable COVID-19. Methods: This is a pragmatic, prospective, randomized, stratified, multicenter, open-label, controlled trial including 350 patients with early-onset (less than 48 hours before randomization) moderate or severe acute respiratory distress syndrome, defined by the Berlin criteria, due to COVID-19. Eligible patients will be randomly allocated to either standard treatment plus dexamethasone (Intervention Group) or standard treatment without dexamethasone (Control Group). Patients in the intervention group will receive dexamethasone 20mg intravenous once daily for 5 days, followed by dexamethasone 10mg IV once daily for additional 5 days or until intensive care unit discharge, whichever occurs first. The primary outcome is ventilator-free days within 28 days after randomization, defined as days alive and free from invasive mechanical ventilation. Secondary outcomes are all-cause mortality rates at day 28, evaluation of the clinical status at day 15 assessed with a 6-level ordinal scale, mechanical ventilation duration from randomization to day 28, Sequential Organ Failure Assessment Score evaluation at 48 hours, 72 hours and 7 days and intensive care unit -free days within 28.

Pandemic

2019-20 coronavirus outbreak

10.6084/m9.figshare.14304336

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Citations (0)

Regional Tidal Expansion And Ventilator-Induced Lung Injury (VILI) In Supine And Prone Positions: Is There A Common Threshold?

Guido Musch Tyler J. Wellman Eduardo Leite Vieira Costa Tilo Winkler R. Scott Harris

Supine position

Prone position

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5444

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Hereditary Breast Cancer in the Brazilian State of Ceará (The CHANCE Cohort): Higher-Than-Expected Prevalence of Recurrent Germline Pathogenic Variants

Frontiers in Oncology (2022)

Ana Carolina Leite Vieira Costa Gifoni Markus Andret Cavalcante Gifoni Camila Martins Wotroba Edenir Inêz Palmero Eduardo Leite Vieira Costa

There is a significant lack of epidemiological data on hereditary cancer in Northeast Brazil. This is the largest study on the prevalence and mutational spectrum of cancer predisposition genes conducted in this region and the first in the State of Ceará.Patients ≥18 years of age that were referred to CHANCE (Grupo de Câncer Hereditário do Ceará) from March 2014 to December 2020 with testing criteria for breast cancer susceptibility genes according to NCCN v.1.2021 were eligible to participate. The inclusion of patients was limited to one individual per family and to those born in the State of Ceará. All patients underwent a hereditary cancer panel testing with at least 30 genes.A total of 355 patients were included, and 97 (27.3%) carried a P/LP germline variant in 18 different genes. Among the 97 P/LP carriers, BRCA1 (31, 31.9%) and BRCA2 (25, 25.7%) were the most frequently mutated genes, followed by PALB2 (10, 10.3%), CHEK2 (7, 7.2%) and ATM (4, 4.1%). A small number of recurrent variants (detected in three or more individuals) in BRCA1, BRCA2, CHEK2 and ATM represented the majority of the P/LP variants described in this cohort.In this cohort, the prevalence of L/PL was high, particularly involving the BRCA1, BRCA2, PALB2, CHEK2 and ATM genes and, to a lesser extent than expected, the TP53 gene. A high frequency of recurrent variants was also observed, for which further and larger analyses should clarify the presence of any possible founder effect. Characterizing the mutational profile of cancer predisposition genes in diverse populations may contribute to cancer prevention and therapeutic management.

CHEK2

PALB2

Founder effect

10.3389/fonc.2022.932957

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Citations (4)

INFLUENCE OF BODY DIMENSIONS IN THE ANALYSIS OF PULMONARY PULSATILITY BY ELECTRICAL IMPEDANCE TOMOGRAPHY

Fernando José da Silva Ramos Lucas Azevedo Guilherme Schettino Marcelo B. P. Amato Eduardo Leite Vieira Costa

Electrical Impedance Tomography

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Molecular Imaging In An Animal Model Of ARDS: Rethinking The Lung-Protective Mechanical Ventilation Strategy

João Batista Borges Eduardo Leite Vieira Costa Charles Widström Enn Maripuu Maria Bergquist

Animal model

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5441

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Expiratory Muscle Activity Counteracts Positive End-Expiratory Pressure and Is Associated with Fentanyl Dose in Patients with Acute Respiratory Distress Syndrome

American Journal of Respiratory and Critical Care Medicine (2024)

Glauco Cabral Marinho Plens Maddalena Teggia Droghi Glasiele Cristina Alcala Sérgio M. Pereira Iuri Christmann Wawrzeniak

Rationale: Hypoxemia during mechanical ventilation might be worsened by expiratory muscle activity, which reduces end-expiratory lung volume through lung collapse. A proposed mechanism of benefit from neuromuscular blockade (NMBA) in acute respiratory distress syndrome (ARDS) is abolition of expiratory efforts. This may contribute to restoration of lung volumes. The prevalence of this phenomenon, however, is unknown. Objectives: To investigate the incidence and amount of end-expiratory lung impedance (EELI) increase after NMBA, clinical factors associated with this phenomenon, its impact on regional lung ventilation, and association with changes in pleural pressure. Methods: We included mechanically ventilated ARDS patients monitored with electrical impedance tomography (EIT) who received NMBA in two centers. We measured changes in EELI, a surrogate for end-expiratory lung volume, before and after NMBA. In additional 10 patients, we investigated characteristic signatures of expiratory muscle activity depicted by EIT and esophageal catheters simultaneously. Clinical factors associated with EELI changes were assessed. Measurements and Main Results: We included 46 patients, half of whom increased EELI by more than 10% of the corresponding tidal volume (46.2% [23.9–60.9%]). Degree of EELI increase correlated positively with fentanyl dosage and negatively with changes in end-expiratory pleural pressures. This suggests expiratory muscle activity might exert strong counter-effects against PEEP, which are possibly aggravated by fentanyl. Conclusions: Administration of NMBA during EIT monitoring disclosed activity of expiratory muscles in half of ARDS patients. The resultant increase in EELI had a dose-response relationship with fentanyl dosage. This suggests a potential side-effect of fentanyl during protective ventilation.

Positive End-Expiratory Pressure

10.1164/rccm.202308-1376oc

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Citations (15)