Papers by ROSENY DOS REIS RODRIGUES
PROTERAPÊUTICA: PROGRAMA DE ATUALIZAÇÃO EM TERAPÊUTICA: Ciclo10: Volume1
Journal of Thrombosis and Haemostasis, 2019
Blood transfusion prior to invasive procedures in coagulopathic cirrhosis patients is 4 empirical... more Blood transfusion prior to invasive procedures in coagulopathic cirrhosis patients is 4 empirical 5 Randomized trial that compared transfusion strategies prior to central venous 6 catheterization in cirrhosis 7 Restrictive strategy significantly reduced blood transfusion and costs in critically ill 8 cirrhosis patients 9 Thromboelastometry-based strategy was no different from usual care in use of 10 blood components
Journal of Clinical Trials, 2016
Background: Trauma is a leading cause of death worldwide and massive bleeding is the main cause o... more Background: Trauma is a leading cause of death worldwide and massive bleeding is the main cause of death in the first 24 hours after injury. Patients with large blood volume loss should undergo the massive transfusion protocol to quickly restore the blood volume and the clotting factors that were lost during bleeding. There are two common strategies regarding transfusion therapy for multiple trauma patients with severe bleeding. The fixed ratio strategy is based on the proportional transfusion of packed red blood cells, fresh frozen plasma and platelets (fixed ratio 1:1:1). The thromboelastometry guide approach is based on the physiopathology of the trauma coagulopathy is a phenomenon that occurs in the early stages of trauma, with hyperfibrinolysis and fibrinogen consumption. Blood products are given based on viscoelastic tests. Methods/design: This study is a prospective, single-center, open-label, randomized trial. Males and females between 18 and 80 years old, with severe trauma and a high Injury Severity Score (ISS-greater or equal than 15) admitted to trauma emergency room are included. To be included, patients require is bleeding actively, with inclusion criteria's to massive transfusion protocol. Patients are randomly allocated to one of the two strategies for massive transfusion (Group A-fixed ratio 1:1:1 or group B-thromboelastometry guided). The primary outcome is the incidence of organ dysfunction on the first, 5th, and 7th day until 28 days post. The secondary outcome are the consumption of blood products within 48 hours, the length of stay in the hospital, days without mechanical ventilation and the financial costs in both groups. Discussion: This trial was proposed to answer questions about the outcomes related to these two strategies of transfusion. This study is important because there is a lack of prospective studies with the subject proposed.
Einstein (São Paulo)
Objective: To describe the implementation of a care protocol based on rapid response teams, for m... more Objective: To describe the implementation of a care protocol based on rapid response teams, for management and resolution of bleeding. Methods: A hospital protocol called Hemorrhage Code (Code H) was devised and developed. In a flow line, a multidisciplinary team provides comprehensive, fast and effective care to the patient with a severe hemorrhagic condition. In another flow line, professionals based at the hospital pharmacy focus on identifying patients at risk of bleeding, to avoid this event. Several hospital professionals and sectors were trained, each with specific roles, ensuring full support to the medical and nursing staffs. Results: After implementing this protocol, we were able to significantly reduce the number of catastrophic events related to failure in bleeding management. Conclusion: Code H is an example of a value-based medicine and precision medicine project by delivering comprehensive and multidisciplinary care, in addition to point-of-care testing introduced in clinical practice, optimizing patient safety and care practices at the hospital. Furthermore, it will be possible to minimize the risk of lawsuits for the hospital and physicians, as well as rationalizing resources with benefits for administrators and payers.
PLOS ONE
Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objec... more Background Coagulation abnormalities in COVID-19 patients have not been addressed in depth. Objective To perform a longitudinal evaluation of coagulation profile of patients admitted to the ICU with COVID-19. Methods Conventional coagulation tests, rotational thromboelastometry (ROTEM), platelet function, fibrinolysis, antithrombin, protein C and S were measured at days 0, 1, 3, 7 and 14. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10. Results Thirty patients were studied. Some conventional coagulation tests, as aPTT, PT and INR remained unchanged during the study period, while alterations on others coagulation laboratory tests were detected. Fibrinogen levels were increased in both groups. ROTEM maximum clot firmness increased in both groups from Day 0 to Day 14. Moreover, ROTEM–FIBTEM maximum clot firmness was high in both groups, with a slight decrease from day 0 to day 14 in group SOFA ≤ 10 and a slight increase during t...
Brazilian Journal of Anesthesiology
Background: Coagulation abnormalities in severe COVID-19 patients have not been addressed in dept... more Background: Coagulation abnormalities in severe COVID-19 patients have not been addressed in depth. Methods: Prospective longitudinal single-center study involving COVID-19 patients admitted to the ICU. Conventional coagulation tests (prothrombin time, international normalized ratio and activated partial thromboplastin time), rotational thromboelastometry (ROTEM), platelet function, plasma fibrinolysis markers, antithrombin, protein C and S were measured at the time of study inclusion (baseline), and at days 1, 3, 7 and 14 after enrollment. Based on median total maximum SOFA score, patients were divided in two groups: SOFA ≤ 10 and SOFA > 10.Results: From March, 2020 through May, 2020, 30 patients [median (IQR) age: 61 (52-83) yrs; SAPS III score: 49 (41-61) points] were included in this study. Conventional coagulation tests remained unchanged during the study period, while the majority of patients exhibited a hypercoagulability state based on ROTEM. Fibrinogen levels were increa...
Brazilian Journal of Anesthesiology (English Edition)
Arquivos Brasileiros de Cardiologia
Einstein (São Paulo)
In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei prov... more In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).
Einstein (São Paulo)
Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intens... more Severe hemorrhage with necessity of allogeneic blood transfusion is common complication in intensive care unit and is associated with increased morbidity and mortality. Prompt recognition and treatment of bleeding causes becomes essential for the effective control of hemorrhage, rationalizing the use of allogeneic blood components, and in this way, preventing an occurrence of their potential adverse effects. Conventional coagulation tests such as prothrombin time and activated partial thromboplastin time present limitations in predicting bleeding and guiding transfusion therapy in critically ill patients. Viscoelastic tests such as thromboelastography and rotational thromboelastometry allow rapid detection of coagulopathy and goal-directed therapy with specific hemostatic drugs. The new era of thromboelastometry relies on its efficacy, practicality, reproducibility and cost-effectiveness to establish itself as the main diagnostic tool and transfusion guide in patients with severe ac...
BMC infectious diseases, Jan 19, 2017
Dengue virus infection (DVI) is a prevalent and potentially fatal viral disease associated with c... more Dengue virus infection (DVI) is a prevalent and potentially fatal viral disease associated with coagulopathy. So far, the coagulation profile of DVI patients with thrombocytopenia has not been assessed through a viscoelastic test such as rotational thromboelastometry. We aimed to describe the prevalence and characteristics of coagulation abnormalities in dengue fever outpatients with thrombocytopenia, addressed by both rotational thromboelastometry and conventional coagulation tests. This was a cross-sectional study conducted between April 6(th) and May 5(th) 2015 in São Paulo, Brazil during a dengue outbreak. Thromboelastometry (ROTEM®) and the conventional coagulation tests prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT), platelet count and fibrinogen levels were performed in 53 patients with DVI and thrombocytopenia. Despite a median interquartile range (IQR) platelet count of 77 (63-88) x 10(9)/L in DV...
Revista brasileira de anestesiologia, Jan 6, 2016
Condutas Em Anestesia Trauma, 2014
Arquivos brasileiros de cardiologia, 2007
Revista Brasileira de Anestesiologia, 2008
JUSTIFICATIVA E OBJETIVOS: O colapso pulmonar intra-operatório é uma complicação de elevada incid... more JUSTIFICATIVA E OBJETIVOS: O colapso pulmonar intra-operatório é uma complicação de elevada incidência em pacientes submetidos à intervenção cirúrgica sob anestesia geral com relaxamento/paralisia da musculatura. Essa complicação está associada à piora das trocas gasosas no intra-operatório e, em alguns casos, necessidade de suporte respiratório prolongado no período pós-operatório. Os objetivos deste estudo foram revisar os aspectos fisiopatológicos da formação de atelectasias durante anestesia geral e as possíveis manobras terapêuticas para prevenir e tratar essa complicação. CONTEÚDO: Nesta revisão, os conceitos sobre a incidência de atelectasias intra-operatórias, os fatores relacionados com o seu desenvolvimento, tanto mecânicos quanto associados ao ajuste do respirador durante procedimento cirúrgico, os aspectos do diagnóstico e as estratégias de prevenção e tratamento foram abordados de maneira sistemática. CONCLUSÕES: A compreensão dos mecanismos relacionados com o desenvolvimento do colapso pulmonar durante o período intra-operatório, assim como o seu tratamento, pode contribuir para a redução da incidência de complicações pulmonares pós-operatórias, o tempo de recuperação e os custos hospitalares. Unitermos: COMPLICAÇÕES: atelectasia; colapso pulmonar; VEN-TILAÇÃO: controlada mecânica, manobra de recrutamento alveolar, pressão positiva ao final da expiração.
Brazilian journal of anesthesiology (Elsevier)
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Papers by ROSENY DOS REIS RODRIGUES