Alexandre R. Felipe

Instituto Nacional de Cardiologia

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Renato Vieira Gomes

University of Beira Interior

Luiz Antônio de Almeida Campos

Sociedade Brasileira de Pediatria

Marco Aurélio Fernandes

Universidade de Brasília

Pedro M. Nogueira

Hôpital du Valais

Hans F. Dohmann

Hospital Pró-Cardíaco

José Rodolfo Rocco

Universidade Federal do Rio de Janeiro

Fernando Graça Aranha

Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina

Otavio Celso Euf Gebara

Leonardo Diniz Correa Pinto

Hospital Sírio-Libanês

Javier Sobrino

Hospital de l'Esperança

Cooperative Institutions

Hospital Pró-Cardíaco

Instituto Nacional de Cardiologia

Universidade do Estado do Rio de Janeiro

Universidade Federal do Rio de Janeiro

Universitat Autònoma de Barcelona

Universitat de Barcelona

Universidade de São Paulo

Centro de Investigación Biomédica en Red

Hospital Clínic de Barcelona

Fundação Oswaldo Cruz

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Candidemia in critically ill patients admitted to a cardiothoracic intensive care unit: a retrospective, observational study

Heart Vessels and Transplantation (2018)

José Moreira Thiago Moreira Peixoto Jaime Antonio Abrantes Sergio Olival Marcelo Goulart Correia

Objective: Candidemia is a severe condition, with high mortality.Objectives: To estimate the incidence, predictors, and the outcomes of candidemia in adult patients admitted to a cardiothoracic intensive care unit.Methods: A retrospective study using a cardiothoracic intensive care unit database prospectively implemented in a tertiary referral center for cardiac surgery.Patients with candidemia were identified by microbiology laboratory reports.Survival was compared between groups with and without candidemia.Univariate and multivariate analysis were performed to determine factors associated with candidemia outcomes.Results: There were 21 adult patients with candidemia in the 2997 adult patients admitted during the 6-year period (2009)(2010)(2011)(2012)(2013)(2014)(2015), with an incidence of 1.1 cases per 1000 patients-day.Candidemia was an independent predictor of mortality (HR: 2.67, CI 1.54-4.62).Cases had higher pulmonary artery systolic pressure, PASP (28.57% vs. 11.50%,p=0.03) and Euroscore (4.76 vs. 2.85, p<.0001); more infective endocarditis (14.29% vs. 2.76%, p<0.02) and mediastinitis (23.81% vs. 2.22%, p<0.0001).Cardiopulmonary bypass times differed between groups (124 vs. 100 minutes, p=0.02).Postoperatively, the candidemia group had more cardiogenic shock (38.10% vs. 9.55%, p<0.0001); hemodialysis (42.86% vs. 3.31%; p<0.0001), and higher sequential organ failure assessment (SOFA) scores (4 [3-5] vs. 3 [1-4], p<0.02).Mortality at 30 and 60-days was 28.5% and 47.6%, in the candidemia group compared to 10.3% and 11.1% in the control group, respectively (p<.0001).C. parapsilosis (50%) and C. albicans (18%) were the most prevalent species.Conclusions: Candidemia was an uncommon infectious complication, but associated with a significant mortality.Our data support the identification of high-risk cardiac surgery patients who may benefit from empirical antifungal therapy.

Univariate analysis

Tertiary referral hospital

SOFA score

SAPS II

10.24969/hvt.2017.44

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Citations (1)

IN-HOSPITAL EVOLUTION OF PATIENTS WITH AN CENTRAL VENOUS OXYGEN SATURATION GREATER THAN OR EQUAL TO 70% IN THE POSTOPERATIVE PERIOD OF CARDIAC SURGERY

CHEST Journal (2005)

Pedro Miguel d. Nogueira Alexandre R. Felipe Renato Vieira Gomes Marco Aurélio Fernandes Leonardo Diniz Correa Pinto

Oxygen Saturation

10.1378/chest.128.4_meetingabstracts.275s-a

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INFLUENCE OF THE USE OF VASOACTIVE AMINES ON B-TYPE NATRIURETIC PEPTIDE LEVELS MEASURED IN PATIENTS UNDERGOING CARDIAC SURGERY

CHEST Journal (2005)

Alexandre R. Felipe Renato Vieira Gomes Pedro M. Nogueira Marco Aurélio Fernandes Gustavo Rodrigues

Vasoactive

10.1378/chest.128.4_meetingabstracts.275s

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PREVALENCE OF DIASTOLIC DYSFUNCTION IN NEW DIAGNOSED HYPERTENSIVE PATIENTS

Journal of Hypertension (2004)

J. Plana Teresa Poblet Joaquı́n Romá Javier Sobrino G. Pou

Plana, J.1; Poblet, T.2; Roma, J.3; Sobrino, J.2; Pou, G.4; Vila, J.5; Felipé, A.6; Minguez, A.7; Modol, J.8; Coca, A.9 Author Information

Coca

10.1097/00004872-200406002-00839

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Central Venous Saturation: A Prognostic Tool in Cardiac Surgery patients

Journal of Intensive Care Medicine (2009)

Pedro M. Nogueira Hugo Tourinho Filho Luiz Antônio de Almeida Campos Renato Vieira Gomes Alexandre R. Felipe

Background: Central venous oxygen saturation (ScvO 2 ) is a valuable prognostic marker in sepsis. However, its value in cardiac surgery has not been assessed yet. This study aimed at evaluating ScvO 2 as a tool for predicting short-term organ dysfunction (OD) after cardiac surgery. Methods: A prospective cohort including cardiac surgery patients submitted to a goal-oriented therapy to maintain ScvO 2 above 70% was studied. Postoperative blood samples collected at 30 minutes (T1), 6 hours (T2), and 24 hours (T3) for ScvO 2 measurement were selected to further analysis. Two groups were formed according to the absence (G0) or presence (G1) of OD defined as a Sequential Organ Failure Assessment (SOFA) score ≥5 on the third postoperative day. A logistic regression analysis was performed to identify the variables independently associated with OD on the third postoperative day. Results: From the 246 patients included, 54 (22%) developed OD and were defined as G1. The mortality rates in G0 and G1 were 1.6% and 31.5%, respectively (P < .001). In the comparative analysis between G0 and G1, the ScvO 2 values were remarkably lower in G1 at T1 (66.2 ± 9.2 vs 62.3 ± 11.6; P = .009), T2 (69.6 ± 5.9 vs 63.5 ± 9.4; P ≤ .001), and T3 (69.6 ± 5.6 vs 64.6 ± 6.4; P ≤ .001). The variables independently associated with OD in the final logistic regression model were Cleveland score (95% CI: 1.13-1.44; OR: 1.27; P < .001), lactate at T3 (95% CI:1.21-3.15; OR 1.95; P = .006), BE at T3 (95% CI:0.69-0.93; OR 0.80; P = .005); ScvO 2 at T2 (95% CI:0.86-0.96; OR 0.91; P = .002), and ScvO 2 at T3 (95% CI:0.83-0.95; OR 0.89; P = .002). Conclusion: Postoperative ScvO 2 can be a valuable tool to predict OD after major cardiac surgeries. Its kinetics should be carefully followed in that setting.

10.1177/0885066609355398

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Citations (18)

CAN B-TYPE NATRIURETIC PEPTIDE LEVELS PREDICT THE OCCURRENCE OF ATRIAL FIBRILLATION IN THE POSTOPERATIVE PERIOD OF CARDIAC SURGERY?

CHEST Journal (2005)

Alexandre R. Felipe Renato Vieira Gomes Pedro M. Nogueira Marco Aurélio Fernandes J Sabino

Atrial natriuretic peptide

10.1378/chest.128.4_meetingabstracts.272s-a

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Efeito da terapia de reposição hormonal na complacência vascular em mulheres na pós-menopausa

Arquivos Brasileiros de Cardiologia (2004)

Lilian Soares de Costa Mônica Amorim de Oliveira Alexandre R. Felipe Cantídio Drumond Neto José Mendes Aldrighi

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Characterization of surgical procedures in patients with mucopolysaccharidosis

Molecular Genetics and Metabolism (2021)

M. Camprodon A. Tigri D. Moreno Alexandre R. Felipe Mauricio Pellicer

Mucopolysaccharidosis

10.1016/j.ymgme.2020.12.032

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Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery

Arquivos Brasileiros de Cardiologia (2017)

José Guilherme Cazelli Gabriel Camargo Dany David Kruczan Clara Weksler Alexandre R. Felipe

Background: The prevalence of coronary artery disease (CAD) in valvular patients is similar to that of the general population, with the usual association with traditional risk factors. Nevertheless, the search for obstructive CAD is more aggressive in the preoperative period of patients with valvular heart disease, resulting in the indication of invasive coronary angiography (ICA) to almost all adult patients, because it is believed that coronary artery bypass surgery should be associated with valve replacement. Objectives: To evaluate the prevalence of obstructive CAD and factors associated with it in adult candidates for primary heart valve surgery between 2001 and 2014 at the National Institute of Cardiology (INC) and, thus, derive and validate a predictive obstructive CAD score. Methods: Cross-sectional study evaluating 2898 patients with indication for heart surgery of any etiology. Of those, 712 patients, who had valvular heart disease and underwent ICA in the 12 months prior to surgery, were included. The P value < 0.05 was adopted as statistical significance. Results: The prevalence of obstructive CAD was 20%. A predictive model of obstructive CAD was created from multivariate logistic regression, using the variables age, chest pain, family history of CAD, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed excellent correlation and calibration (R² = 0.98), as well as excellent accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877; 95%CI: 0.830 - 0.923) in different valve populations. Conclusions: Obstructive CAD can be estimated from clinical data of adult candidates for valve repair surgery, using a simple, accurate and validated score, easy to apply in clinical practice, which may contribute to changes in the preoperative strategy of acquired heart valve surgery in patients with a lower probability of obstructive disease.

valvular heart disease

Dyslipidemia

Bypass surgery

10.5935/abc.20170135

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Citations (11)