Júlio Pereira
www.weneuro.com
www.linkedin.com/in/juliommais
lattes.cnpq.br/7687651239699170
Consultório (11)3141-9550/3141-9553
Júlio Pereira
www.weneuro.com
www.linkedin.com/in/juliommais
lattes.cnpq.br/7687651239699170
Consultório (11)3141-9550/3141-9553
Objective: To evaluate the efficacy of IV iron supplementation of anemic, critically ill trauma patients. Design: Multicenter, randomized, single-blind, placebo-controlled trial. Setting: Four trauma ICUs. Patients: Anemic (hemoglobin < 12 g/dL) trauma patients enrolled within 72 hours of ICU admission and with an expected ICU length of stay of more than or equal to 5 days. Interventions: Randomization to iron sucrose 100 mg IV or placebo thrice weekly for up to 2 weeks. Measurements and Main Results: A total of 150 patients were enrolled. Baseline iron markers were consistent with functional iron deficiency: 134 patients (89.3%) were hypoferremic, 51 (34.0%) were hyperferritinemic, and 64 (42.7%) demonstrated iron-deficient erythropoiesis as evidenced by an elevated erythrocyte zinc protoporphyrin concentration. The median baseline transferrin saturation was 8% (range, 2–58%). In the subgroup of patients who received all six doses of study drug (n = 57), the serum ferritin concentration increased significantly for the iron as compared with placebo group on both day 7 (808.0 ng/mL vs 457.0 ng/mL, respectively, p < 0.01) and day 14 (1,046.0 ng/mL vs 551.5 ng/mL, respectively, p < 0.01). There was no significant difference between groups in transferrin saturation, erythrocyte zinc protoporphyrin concentration, hemoglobin concentration, or packed RBC transfusion requirement. There was no significant difference between groups in the risk of infection, length of stay, or mortality. Conclusions: Iron supplementation increased the serum ferritin concentration significantly, but it had no discernible effect on transferrin saturation, iron-deficient erythropoiesis, hemoglobin concentration, or packed RBC transfusion requirement. Based on these data, routine IV iron supplementation of anemic, critically ill trauma patients cannot be recommended (NCT 01180894).Júlio Pereira
www.weneuro.com
www.linkedin.com/in/juliommais
lattes.cnpq.br/7687651239699170
Consultório (11)3141-9550/3141-9553
Objectives: Guidelines for post–cardiac arrest care recommend blood pressure optimization as one component of neuroprotection. Although some retrospective clinical studies suggest that postresuscitation hypotension may be harmful, and laboratory studies suggest that a postresuscitation hypertensive surge may be protective, empirical data are few. In this study, we prospectively measured blood pressure over time during the postresuscitation period and tested its association with neurologic outcome. Design: Single center, prospective observational study from 2009 to 2012. Patients: Inclusion criteria were age 18 years old or older, prearrest independent functional status, resuscitation from cardiac arrest, and comatose immediately after resuscitation. Measurements and Main Results: Our research protocol measured blood pressure noninvasively every 15 minutes for the first 6 hours after resuscitation. We calculated the 0- to 6-hour time-weighted average mean arterial pressure and used multivariable logistic regression to test the association between increasing time-weighted average mean arterial pressures and good neurologic outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Among 151 patients, 44 (29%) experienced good neurologic outcome. The association between blood pressure and outcome appears to have a threshold effect at time-weighted average mean arterial pressure value of 70 mm Hg. This threshold (mean arterial pressure > 70 mm Hg) had the strongest association with good neurologic outcome (odds ratio, 4.11; 95% CI, 1.34–12.66; p = 0.014). A sustained intrinsic hypertensive surge was relatively uncommon and was not associated with neurologic outcome. Conclusions: We found that time-weighted average mean arterial pressure was associated with good neurologic outcome at a threshold of mean arterial pressure greater than 70 mm Hg.Júlio Pereira
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www.linkedin.com/in/juliommais
lattes.cnpq.br/7687651239699170
Consultório (11)3141-9550/3141-9553
Objectives: Lactate clearance has been widely investigated for its prognostic value in critically ill patients. However, the results are conflicting. The present study aimed to explore the diagnostic accuracy of lactate clearance in predicting mortality in critically or acutely ill patients. Data Sources: Databases of Medline, Embase, Scopus, and Web of Knowledge were searched from inception to June 2013. Study Selection: Studies investigating the prognostic value of lactate clearance were defined as eligible. The searched item consisted of terms related to critically ill patients and terms related to lactate clearance. Data Extraction: The following data were extracted: the name of the first author, publication year, subjects and setting, mean age of study population, sample size, male percentage, mortality of study cohort, definition of clearance, and the initial lactate level. Relative risk was reported to estimate the predictive value of lactate clearance on mortality rate, with relative risk less than 1 indicating that lactate clearance was a protective factor. Meta-analysis of diagnostic accuracy of lactate clearance in predicting mortality was performed by using hierarchical summary receiver operating characteristic model. Data Synthesis: A total of 15 original articles were included in the study. Because of the significant heterogeneity across studies (I 2 = 61.4%), random-effects model was used to pool relative risks. The pooled relative risk for mortality was 0.38 (95% CI, 0.29–0.50). The overall sensitivity and specificity for lactate clearance to predict mortality were 0.75 (95% CI, 0.58–0.87) and 0.72 (95% CI, 0.61–0.80), respectively. The diagnostic performance improved slightly when meta-analysis was restricted to ICU patients, with sensitivity and specificity of 0.83 (95% CI, 0.67–0.92) and 0.67 (95% CI, 0.59–0.75), respectively. Conclusion: Our study demonstrates that lactate clearance is predictive of lower mortality rate in critically ill patients, and its diagnostic performance is optimal for clinical utility.Júlio Pereira
www.weneuro.com
www.linkedin.com/in/juliommais
lattes.cnpq.br/7687651239699170
Consultório (11)3141-9550/3141-9553
