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Eficácia de terapias ventilatórias não invasivas por diferentes interfaces no pós-operatório de cirurgia cardíaca

2026-10-27T18:56:02Z

Título: Eficácia de terapias ventilatórias não invasivas por diferentes interfaces no pós-operatório de cirurgia cardíaca Autor(es): Okubo, Bruno Memória Rodrigues Abstract: BACKGROUND: Worldwide, cardiac surgery remains one of the most frequently performed major procedures, with an estimated 1 to 1.5 million procedures performed each year. Postoperative pulmonary complications continue to affect a substantial share of these patients, driving longer hospital stays, higher costs, and added perioperative morbidity. Although noninvasive mechanical ventilation and high-flow nasal cannula therapy are established tools for respiratory support after extubation, how the choice of interface shapes their effectiveness has received comparatively little attention, especially after cardiac surgery. OBJECTIVES: To prospectively, randomly, and in a controlled manner assess the efficacy of different noninvasive ventilatory strategies in patients with heart disease undergoing elective cardiac surgery, comparing perceived comfort, postoperative pulmonary complications, ventilatory and hemodynamic parameters, arterial oxygenation, early mobilization levels, and muscle function at ICU discharge. METHOD: Randomized controlled trial conducted in the high-complexity intensive care unit of Hospital Regional Unimed in Fortaleza, Brazil, between July 2023 and May 2026. Following ICU admission and eligibility screening, 196 patients were randomized to one of six treatment groups, of whom 172 comprised the final per-protocol analyzed sample: noninvasive ventilation via conventional oronasal mask (G-FA), noninvasive ventilation via conventional full-face mask (G-FULL), noninvasive ventilation via Wolf Mask full-face interface (G-WOLF), CPAP via ELMO helmet (G-ELMO), high-flow nasal cannula therapy (G-TAF), and conventional physiotherapy without active ventilatory support (G-CONTR). Comfort was assessed by a Visual Analog Scale, pulmonary complications by an adapted score based on Kroenke and Hulzebos criteria, mobilization progression by a linear mixed-effects model, and muscle function by the Medical Research Council scale at ICU discharge. RESULTS: The Wolf Mask produced the best overall comfort profile (9.41 ± 0.68) while demanding the least inspiratory pressure support to reach the target tidal volume, and recorded the lowest pulmonary complication rate of any group, with no patient developing bibasal atelectasis, an exploratory finding, since the formal between-group comparison of pulmonary complications did not reach statistical significance. Comfort and sustained arterial oxygenation were next best with the conventional full-face mask. The high-flow nasal cannula behaved as a safe option without outperforming the full-face interfaces on pulmonary or functional endpoints. ELMO helmet CPAP kept hemodynamics stable and caused no hypercapnia throughout follow-up, but showed the weakest oxygenation profile of any group across the ICU stay. The conventional oronasal mask (G-FA) recorded the lowest comfort score of any group and the highest pulmonary complication rate in the study, including the highest rate of bibasal atelectasis, with therapy sessions cut short early because of discomfort. Patients in the control arm mobilized the least across the ICU stay and were least likely to reach mobilization level 3 by discharge. A linear mixed-effects model singled out interface comfort as an independent, positive predictor of mobilization progression. CONCLUSIONS: Interfaces enclosing the full face, above all the Wolf Mask, stood out for comfort and for the lower pressure support needed to reach target tidal volume, and comfort with the interface independently predicted how well patients mobilized. High-flow nasal cannula held up as a safe option without surpassing full-face noninvasive ventilation. ELMO helmet CPAP, despite its hemodynamic safety and freedom from hypercapnia, showed the weakest oxygenation profile among the groups, while the conventional oronasal mask (G-FA) left patients least comfortable and accumulated the highest pulmonary complication rate of the entire study. The pulmonary and oxygenation findings remain exploratory and hypothesis-generating, since the formal between-group comparisons for these outcomes did not reach statistical significance. Taken together, these findings support deliberately favoring full-face interfaces that patients tolerate well in postoperative cardiac care. Developed in Brazil, the Wolf Mask shows a profile worth confirming in larger, multicenter trials with extended follow-up. Tipo: Tese

Impacto da idade do doador na sobrevida do paciente em 964 transplantes de fígado

2026-10-14T15:23:28Z

Título: Impacto da idade do doador na sobrevida do paciente em 964 transplantes de fígado Autor(es): Carvalho Filho, Luís Carlos Abstract: The good results of liver transplantation influenced the growth of directions and hence the number of patients on waiting lists for organ. On the other hand, there are not enough grafts to meet this demand, resulting in high mortality. The use of elderly donor livers may be a strategy to increase the pool of grafts and reduce mortality on the wait list. This study aimed to identify the relationship between donor age and survival of liver transplant recipients at the University Hospital Walter Cantídio, the Federal University of Ceará, from 2002 to 2014. It is a case control study, observational approach, longitudinal and retrospective, which evaluated 964 subjects, divided into groups: group 1, age graft recipients <60 years; Group 2, graft recipients aged ≥ 60 years. Data collection was based on information described in records and survival was estimated by Kaplan Meier analysis and Cox regression. For all tests, we used 5% significance level. In group 1, the majority of the population was male (72.1%), mean age 49.5 ± 14.0 years, blood group type not O (51.7%), Child-Turcotte-Pugh B (55.0%), with MELD score <25 (84.7%), with no occurrence of chronic hepatitis C (66.5%), with degree of steatosis graft <30.0% (93.1 %) and average cold ischemia time (THF) 5.7 ± 1.9 hours. In group 2, there was a higher prevalence of males (76.7%), mean age 51.8 ± 12.5 years, blood group type O (51.1%), Child-Turcotte-Pugh B (54, 1%), MELD score <25 (84.4%), non- occurrence of chronic hepatitis C (72.2%), degree of steatosis graft <30.0% (87.8%) and average TIF 5.7 ± 1.6 hours. Survival at 30 days, 1.3 and 5 years was respectively 85.9%, 79.3%, 75.0% and 75.0% in group 1 and 87.8%, 79.3% , 75.3% and 69.0% in group 2. In the Cox regression, it was observed that the recipients with MELD score ≥ 25, were 57.0% more likely to die than the receivers with pure MELD <25. Similarly, the graft recipients with time cold ischemia> 6 hours, were 66.0% more likely to die compared to graft recipients with cold ischemia time <6 hours. In survival analysis, in terms of age of the graft, the overall survival between the two groups showed no difference in the survival curve, proving the safe use of older grafts. Tipo: Dissertação

Avaliação da dimensão fractal e lacunaridade do pré-condicionamento com metalofarmaco rutbpy em modelo experimental de isquemia cerebral

2026-08-13T11:32:33Z

Título: Avaliação da dimensão fractal e lacunaridade do pré-condicionamento com metalofarmaco rutbpy em modelo experimental de isquemia cerebral Autor(es): Leão Filho, Carmelo Silveira Carneiro Abstract: Background and purpose - The fractal dimension (DF) and lacunarity (LAC) have been able to characterize the structural complexity of the brain and function as a potential marker of brain damage. Nitrosyl ruthenium is an NO donor drug capable of decreasing neuronal damage during ischemia and reperfusion (I / R). The objective of this study is to evaluate if the fractal dimension and lacunarity can be used as a means of evaluating brain lesions of ischemia and reperfusion and if the neuroprotective effect of ruthenium preserves the spatial cytoarchitecture of the neural tissue.Methods - A total of 36 male Wistar rats with a mean weight of 250.7 g were distributed in three groups: Sham (SS), saline + ischemia / reperfusion (SS + I / R), Rut-bpy + ischemia / reperfusion (Rut-bpy + I / R). The incomplete global cerebral ischemia model was used, with bilateral carotid artery occlusion and SF or Rut-bpy administration in their respective intraperitoneal groups. At the end of the experiment the animals were decapitated and the brain removed to be assessed to the lesion area by H & E histology, immunohistochemistry (TTC). The H & E-stained hypothalamus laminae and those of the brain analyzed by the TTC were analyzed by the computer program Image J to determine the fractal dimension and lacunarity. Results: There was a statistical difference in FD and LAC between the SHAM and SF + I / R groups as well as between the RUT-bpy + I / R groups. Conclusion: The fractal dimension and lacunarity were effective in demonstrating ischemia and reperfusion lesions as well as the neuroprotective effect of ruthenium on the spatial architecture of neural tissue. Tipo: Tese

Associação entre espessura médio-intimal arterial e marcadores inflamatórios em diferentes territórios vasculares

2026-07-30T14:05:29Z

Título: Associação entre espessura médio-intimal arterial e marcadores inflamatórios em diferentes territórios vasculares Autor(es): Themótheo, Florice de Matos Abstract: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide and results from a chronic inflammatory process characterized by progressive thickening and remodeling of the arterial wall. Intima–media thickness (IMT) is a recognized noninvasive marker used to identify subclinical atherosclerosis. Simple inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), reflect systemic inflammation and have been associated with plaque instability and worse prognosis. Integrating IMT with inflammatory markers may improve cardiovascular risk stratification. The objective was to compare IMT across different arterial territories in individuals with and without cardiovascular risk factors, assessing its association with inflammatory markers (neutrophils, lymphocytes, platelets, and derived indices). A cross-sectional study was conducted with 75 individuals: 50 with classical cardiovascular risk factors and 25 healthy subjects. IMT of the carotid, brachial, and femoral arteries was assessed by ultrasound, and a complete blood count was performed to calculate NLR. The risk group was significantly older (66.2 vs. 49.3 years; p<0.001) and presented higher IMT in all arterial segments (p<0.001), with confidence intervals not crossing zero, indicating diffuse atherosclerosis. The group without risk factors exhibited lower values and less variability. NLR was markedly higher in the risk group (5.15 vs. 1.34; p<0.001), while platelets and monocytes did not differ. In the risk group, right carotid IMT correlated positively with age, neutrophils, and NLR, and slightly negatively with lymphocytes. In multiple regression analysis, age, neutrophils, and NLR were independent predictors of IMT (R²≈0.32). Age-stratified analysis showed a progressive increase in IMT with aging in both groups, though more pronounced in the risk group; young individuals with risk factors displayed IMT values equal to or greater than those of older adults without risk, indicating premature vascular aging. Age was the strongest determinant of IMT; however, subclinical inflammation, reflected by NLR, amplified this vascular damage. The combination of imaging (IMT) and inflammatory biomarkers provides greater sensitivity for detecting early cardiovascular risk than either method alone. The combination of IMT and NLR is a simple and effective method for stratifying and preventing cardiovascular events. Tipo: Dissertação