Rafael Hortencio Melo

@einstein.br

Critical Care Department
Hospital Municipal Gilson de Cássia Marques de Carvalho, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

Rafael Hortencio Melo


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https://researchid.co/rafaelhmelo

RESEARCH, TEACHING, or OTHER INTERESTS

Critical Care and Intensive Care Medicine, Cardiology and Cardiovascular Medicine
17

Scopus Publications

76

Scholar Citations

4

Scholar h-index

3

Scholar i10-index

Scopus Publications

  • Femoral vein Doppler ultrasound for assessing venous congestion and right heart function: a scoping review
    Rafael Hortêncio Melo, Adrian Wong, Abhilash Koratala, Eduardo Kattan, Rogério da Hora Passos
    Intensive Care Medicine Experimental, 2026
    Introduction Venous congestion is a major contributor to organ dysfunction in critically ill and perioperative patients. While Doppler-based ultrasound strategies such as VExUS are the focus of growing clinical and research interest, the common femoral vein (CFV) is a promising, easily accessible alternative window for assessing right heart function and volume status. Objective To map and synthesize current evidence on the use of common femoral vein (CFV) Doppler ultrasound to assess venous congestion, right heart function, and intravascular volume status in adult patients across perioperative, critical care, heart failure, and emergency care settings. Design Scoping review conducted according to the PRISMA-ScR guideline. Review methods PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to August 2025. We charted clinical setting, CFV Doppler/diameter parameters, acquisition protocol details, reference standards (invasive pressures and imaging-based surrogates), and reported associations with hemodynamic measures and clinical outcomes. Two reviewers independently screened records and extracted data. Results Nineteen observational studies ( n = 2146) were included. CFV pulsatility or waveform morphology was assessed in 10/19 studies; 5/19 reported quantitative pulsatility indices or retrograde-flow thresholds, 5/19 evaluated femoral vein diameter/collapsibility, and 1/19 proposed derived indices. Most studies compared CFV measures with invasive central venous pressure (CVP) or echocardiographic surrogates; when correlation coefficients were reported, associations were weak-to-moderate (e.g., r = 0.66 for CFV diameter vs CVP; r = − 0.476 for minimum velocity vs CVP). Only a minority of studies assessed clinical outcomes, and abnormal CFV patterns were variably associated with postoperative complications, including acute kidney injury, delirium and, in ICU cohorts, longer ICU length of stay or mortality. Acquisition protocols and waveform interpretation criteria varied across studies, with heterogeneous definitions and thresholds. Conclusions CFV Doppler is a feasible and accessible tool for congestion assessment, with promising correlations to invasive measures. However, variability in acquisition protocols, waveform definitions, and thresholds limits its current applicability. Standardization and prospective validation in high-risk populations are needed.
  • Perioperative fluid accumulation and clinical outcomes after cardiac surgery: a systematic review and Bayesian meta-analysis
    Rafael Hortêncio Melo, Anelise Poluboiarinov Cappellaro, Victor Gomez Galeano, Amanda Pascoal Valle Felicio, Adrian Wong, Rogerio da Hora Passos
    Journal of Anesthesia Analgesia and Critical Care, 2026
    Background Fluid accumulation is common in critically ill patients and has been associated with adverse outcomes. However, its impact on postoperative outcomes in cardiac surgery remains unclear. Purpose To assess the association between perioperative fluid accumulation and clinical outcomes in adults undergoing cardiac surgery. Methods We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials. PubMed, Embase, and the Cochrane Library were searched through February 2025. Eligible studies enrolled adults (≥ 18 years) undergoing cardiac surgery and compared liberal versus restrictive fluid strategies or fluid-positive versus fluid-restrictive states. Outcomes included all-cause mortality, acute kidney injury (AKI), hospital and intensive care unit (ICU) length of stay, duration of mechanical ventilation, ICU readmission, and postoperative atrial fibrillation (POAF). Certainty of evidence was assessed using the GRADE framework. Results Eighteen studies (15,052 patients) were included. In pooled analyses, fluid accumulation was associated with increased mortality (OR 1.65; 95% CI 1.03–2.63; p = 0.04), and fluid restriction was associated with decreased hospital stay (MD −1.02 days; 95% CI −1.67 to −0.37; p = 0.002). Bayesian analysis supported these findings, showing a 98.8% probability that restrictive fluid strategies reduce mortality and a 98.6% probability of shorter hospital stay. For AKI, the Bayesian model showed an 84.7% probability of benefit despite non-significant frequentist results. No significant associations were found for POAF, ICU stay, mechanical ventilation duration, or ICU readmissions. The certainty of evidence was low for randomized evidence and very low for observational data when assessed with GRADE. Conclusions Perioperative fluid accumulation may be associated with worse postoperative outcomes, but the certainty of evidence is limited by heterogeneity and methodological variability across studies. These findings should be interpreted as hypothesis-generating and underscore the need for high-quality randomized trials to clarify safe fluid exposure thresholds and the role of individualized perioperative fluid management.
  • Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort
    Rafael Hortêncio Melo, João Galantier, Marcelo Luz Pereira Romano, Edson Renato Romano, Amanda Pascoal Valle Felicio, Rogerio da Hora Passos, Luciana Gioli-Pereira, Luciano Cesar Pontes de Azevedo
    Journal of Critical Care, 2026
    BACKGROUND AND AIMS: Septic shock is associated with high mortality, yet evidence supporting adjunctive therapies remains limited. Methylene blue (MB) has been proposed as a rescue therapy targeting catecholamine-resistant vasodilation, but its impact on clinically meaningful outcomes is uncertain. Oncologic patients represent a clinically distinct subgroup with high disease severity and are underrepresented in prior studies. We evaluated the association between MB and outcomes in oncologic patients with septic shock requiring multiple vasopressors. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, including adult oncologic patients with septic shock between January 1, 2015, and December 31, 2025. Septic shock requiring multiple vasopressors was defined as septic shock requiring norepinephrine plus at least one additional vasopressor (vasopressin or epinephrine). MB recipients were matched 1:1 with non-recipients using propensity score matching. The primary outcome was 30-day all-cause mortality. Secondary outcomes included acute kidney injury (AKI), renal replacement therapy (RRT), invasive mechanical ventilation, and vasopressor escalation within 7 days. RESULTS: Among 266 MB-treated patients and 10,163 controls, 262 balanced pairs were analyzed after matching. MB was associated with lower 30-day mortality (risk ratio [RR] 0.80, 95% CI 0.66-0.97). Favorable associations were observed for AKI and vasopressor escalation, whereas invasive mechanical ventilation did not differ between groups. CONCLUSIONS: In oncologic patients with septic shock requiring multiple vasopressors, MB use was associated with lower 30-day mortality; however, within the limitations of this retrospective study, these findings should be interpreted cautiously. Prospective randomized trials are warranted to clarify the role of MB in this high-risk population.
  • Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery: Systematic Review and Meta-analysis
    Mariana Merighi Moreira Salles, Ricardo Ormanes Massoud, Pedro Lawall de Carvalho, Joao Silva Correia, Rafael Hortencio Melo
    Journal of Cardiothoracic and Vascular Anesthesia, 2026
  • 891: METHYLENE BLUE IN CANCER PATIENTS WITH DISTRIBUTIVE SHOCK: A TARGET TRIAL EMULATION
    Rafael Melo, Silvana Ribeiro Papp, Gabriel de Arruda, Amanda Pascoal Valle Felicio, Luciana Gioli-Pereira
    Critical Care Medicine, 2026
    Introduction: Methylene blue (MB) has emerged as a potential adjunctive therapy in distributive shock due to its inhibition of nitric oxide–mediated vasodilation. However, data on its effectiveness and safety in patients with cancer remain limited. Methods: We conducted a target trial emulation using real-world data from the TriNetX Global Collaborative Network, comprising 152 healthcare organizations. Adults aged 18–80 years with cancer and distributive shock who received norepinephrine and vasopressin were included. Patients were divided into two cohorts: those who received MB (n = 4,167) and those who did not (n = 55,238). After 1:1 propensity score matching, 4,427 patients remained in each group. Outcomes were assessed over a 30-day follow-up using risk difference, risk ratio, and Kaplan-Meier survival estimates. Results: MB use was associated with significantly lower 30-day mortality (24.5% vs. 33.1%; risk difference −8.6%; p < 0.001; risk ratio 0.739; hazard ratio 0.697 [95% CI: 0.641–0.757]). Fewer patients required mechanical ventilation between 24–96 hours in the MB group (3.1% vs. 4.1%; p = 0.016). No cases of methemoglobinemia or hemolytic anemia were documented among MB recipients. Conclusions: In this target trial emulation, MB was associated with improved survival and reduced need for mechanical ventilation in cancer patients with distributive shock. However, adverse events may have been underreported, limiting the safety assessment. Randomized controlled trials are needed to confirm efficacy and further evaluate safety.
  • 480: HYPERNATREMIA IN ACUTE TRAUMATIC BRAIN INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS
    Ricardo Massoud, João Correia, Mariana Salles, Pedro Carvalho, Rafael Melo
    Critical Care Medicine, 2026
    Introduction: Traumatic brain injury (TBI) may impair sodium regulation due to hypothalamic-pituitary axis dysfunction, potentially leading to hypernatremia. This sodium imbalance has been associated with adverse outcomes in critically ill patients. We conducted a systematic review and meta-analysis to assess whether hypernatremia in TBI is associated with worse clinical outcomes compared to normal or low sodium levels. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify observational studies comparing outcomes in TBI patients with hypernatremia versus normonatremia or hyponatremia. Outcomes included mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Data were pooled using random-effects models, and results were presented as odds ratios (OR) or mean differences with 95% confidence intervals (CI). Risk of bias was assessed using the ROBINS-I tool. Results: Eight observational studies were included, involving 93,696 patients, of whom 5,559 developed hypernatremia. Hypernatremia was significantly associated with increased mortality (OR: 1.59; 95% CI: 1.17–2.17; P = 0.01). No significant differences were observed in ICU LOS (mean difference: 1.07 days; 95% CI: –2.09 to 4.24; P = 0.36) or hospital LOS (mean difference: 1.31 days; 95% CI: –24.14 to 26.77; P = 0.84). Sensitivity analysis for ICU LOS showed that excluding one study yielded a significant result (OR: 2.40; 95% CI: 1.29–3.50; P = 0.01). All studies had a moderate risk of bias. Conclusions: Hypernatremia in patients with TBI is associated with increased mortality. However, evidence for its impact on ICU and hospital LOS remains inconclusive. Further studies are warranted to better understand the prognostic implications of hypernatremia in this population.
  • 689: CORTICOSTEROIDS AND SURVIVAL: 30-DAY OUTCOMES IN CRITICALLY ILL CANCER PATIENTS WITH PNEUMONIA
    Silvana Ribeiro Papp, Rafael Melo, Gabriela Bezerra de Freitas Diniz, Amanda Pascoal Valle Felicio, Gokul Karthikeyan, Luciana Gioli-Pereira
    Critical Care Medicine, 2026
    Introduction: The use of corticosteroids is recommended in the management of severe pneumonia in critically ill non-cancer patients; however, their role in oncologic populations remains uncertain. This study aimed to evaluate the association between corticosteroid use and short-term outcomes in critically ill cancer patients with pneumonia using a target trial emulation approach. Methods: We conducted a retrospective target trial emulation using the TriNetX Global Research Network. Adults (18 - 80 years) with cancer and a diagnosis of pneumonia, requiring intensive care interventions (e.g., vasopressors, mechanical ventilation), were included. Patients with asthma, COPD, or COVID-19 were excluded. The intervention group received systemic corticosteroids (dexamethasone, hydrocortisone, methylprednisolone, prednisolone, or prednisone) within 1 month after pneumonia diagnosis; the control group did not. Propensity score matching (1:1) was performed. The primary outcome was 30-day all-cause mortality. Secondary outcomes included mechanical ventilation (MV) for 24–96h, intubation and hemodialysis. Results: After propensity score matching, 25,362 patients were included in each cohort. The use of corticosteroids was associated with a higher 30-day mortality rate (17.8% vs. 13.6%; RR 1.31; 95% CI: 1.26–1.37; HR 1.33; 95% CI: 1.27–1.39; p< 0.001). The need for mechanical ventilation between 24 - 96 hours was also more frequent in the corticosteroid group (2.8% vs. 1.6%; RR 1.73; p< 0.001). Intubation occurred in 6.3% of patients receiving corticosteroids compared to 3.3% in the control group (RR 1.92; p< 0.001). Additionally, hemodialysis was slightly more common among corticosteroid users (0.2% vs. 0.1%; p=0.050). Conclusions: In this large, real-world target trial emulation, corticosteroid use was associated with increased 30-day mortality and greater need for respiratory support among critically ill cancer patients with pneumonia.
  • 778: CONTINUOUS VS INTERMITTENT RENAL THERAPY IN CRITICALLY ILL CANCER PATIENTS WITH AKI
    Silvana Ribeiro Papp, Rafael Melo, Pedro Bribean Rogovschi, Rogerio da Hora Passos, Gokul Karthikeyan, Amanda Pascoal Valle Felicio, Luciana Gioli-Pereira
    Critical Care Medicine, 2026
    Introduction: Continuous renal replacement therapy (CRRT) is typically favored over tent hemodialysis (IHD) in hemodynamically unstable critically ill patients. Its comparative effectiveness in critically ill cancer patients with acute kidney injury (AKI), however, remains uncertain. We aimed to emulate a randomized trial using real-world data to compare CRRT and IHD in critically ill cancer patients. Methods: This retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adult patients (18 - 80 years) with active malignancy and AKI, without prior advanced chronic kidney disease, who underwent either CRRT or IHD, were included. After 1:1 propensity score matching, 660 patients remained in each group. The primary outcome was 90-day all-cause mortality. Secondary outcomes included new-onset advanced CKD and duration of mechanical ventilation. Outcomes were assessed using risk ratios (RR), hazard ratios (HR), and Kaplan-Meier survival analysis. Results: CRRT was associated with higher 90-day mortality compared to IHD (55.5% vs. 42.4%; RR 1.31, 95% CI 1.17–1.47; HR 1.52, 95% CI 1.30–1.78; p < 0.001). In contrast, CRRT was associated with a lower incidence of progression to advanced CKD (2.0% vs. 9.3%; RR 0.22, 95% CI 0.12–0.40; HR 0.22, 95% CI 0.11–0.40; p < 0.001). No significant differences were observed in the need for mechanical ventilation. Conclusions: In this emulated trial using real-world data, CRRT was associated with increased short-term mortality but reduced risk of progression to advanced CKD when compared to IHD in critically ill cancer patients with AKI. These findings highlight the need for prospective trials to determine optimal renal replacement strategies in this population.
  • Hemodynamic monitoring strategies in cardiac surgery: an update systematic review
    Rafael Melo, Vinicius Galindo, Luciana Gioli-Pereira, Daniel Joelsons, Murillo Assunção, Barbara Alves, Guilherme Souza, Bruno Bravim, Rogerio Passos
    Journal of Clinical Monitoring and Computing, 2026
    Hemodynamic monitoring is a cornerstone of perioperative care in cardiac surgery, where patients are at high risk of cardiovascular instability and organ hypoperfusion. In recent years, goal-directed therapy (GDT) protocols have increasingly incorporated advanced monitoring technologies to optimize perfusion and improve outcomes. This systematic review aims to critically appraise contemporary hemodynamic monitoring strategies and their integration into GDT protocols in adult patients undergoing cardiac surgery. A systematic review of studies published between January 2015 and May 2025 was conducted using PubMed, Embase, Scopus, and the Cochrane Library. The last search was conducted on 17 May 2025 in all databases. Eligible studies included adult cardiac surgical patients managed with perioperative hemodynamic monitoring strategies that incorporated cardiac output assessment and structured GDT protocols. A qualitative synthesis of monitoring modalities, targeted hemodynamic endpoints, and reported clinical outcomes was performed. Our analysis included 15 studies comprising 4,224 patients. Monitoring strategies ranged from pulmonary artery catheters to minimally invasive and noninvasive tools such as FloTrac/EV1000 and esophageal Doppler. Cardiac index and stroke volume variation were the most frequently targeted parameters, often in combination with perfusion markers such as mean arterial pressure or central venous oxygen saturation. GDT protocols were associated with reductions in AKI, duration of mechanical ventilation, and ICU/hospital stay. Mortality benefits were inconsistently reported and not predefined in most studies. Current evidence supports the physiological rationale for GDT guided by advanced hemodynamic monitoring in cardiac surgery. Nonetheless, substantial heterogeneity in strategies and outcomes highlights the need for standardized protocols and high-quality multicenter trials to determine the most effective, patient-centered approaches. Trial registration: PROSPERO registration number: CRD420251102582, retrospectively registered on 11 July 2025.
  • The role of thoracic ultrasound in fluid management in critical care: a narrative review
    Rogerio da Hora Passos, Leonardo Van De Wiel Barros Urbano Andari, Marcela de Almeida Lopes, Vinicius Barbosa Galindo, Uri Adrian Prync Flato, Roberto Camargo Narciso, Carolina de Moraes Pellegrino, Thais Dias Midega, Renan Sandoval de Almeida, Fernanda Oliveira Coelho, Bruno Zawadzki, Rafael Hortêncio Melo, Bruno de Arruda Bravim
    Journal of Thoracic Disease, 2026
    Background and Objective: Fluid management remains central to critical care, requiring a careful balance between early resuscitation and the prevention or reversal of pulmonary and systemic congestion. Thoracic ultrasound (TUS) offers real-time, organ-specific assessment of extravascular lung water (EVLW) and pleural effusion, helping clinicians recognize both fluid responsiveness and fluid intolerance-an increasingly relevant distinction in acute respiratory distress syndrome (ARDS), acute heart failure, kidney replacement therapy, and shock. This review synthesizes current evidence on TUS-guided fluid administration and removal and introduces the Fluid Responsiveness & Tolerance, Lung Congestion, Ultrafiltration Optimization, Individualized Therapy, Differentiating Shock (FLUID) framework as a practical bedside reasoning tool emphasizing repeated reassessment rather than prescriptive thresholds. Methods: Narrative review of PubMed, Scopus, and Embase (January 2015 to January 2025), supplemented by landmark earlier articles when clinically relevant. Eligible studies included adult human research, systematic reviews, randomized trials, and consensus statements. Editorials, pediatric, and veterinary studies were excluded. Selection and full-text appraisal were performed independently by two reviewers. Key Content and Findings: TUS provides bedside visualization of pulmonary congestion through B-lines, lung ultrasound scoring, and effusion monitoring, improving detection of EVLW compared with physical examination or central venous pressure. Integrated with focused cardiac and venous Doppler evaluation, TUS supports decisions regarding resuscitation, diuretic escalation, ultrafiltration, or fluid removal in ARDS, heart failure, and shock. Evidence suggests TUS-guided strategies may reduce cumulative fluid balance and rehospitalization in heart failure and may facilitate ventilator liberation, though definitive outcome effects remain under investigation. The FLUID framework structures iterative bedside reasoning without functioning as a prescriptive protocol. Conclusions: TUS is a practical and repeatable tool that enhances individualized fluid management by identifying evolving pulmonary congestion and estimating fluid tolerance. The FLUID framework supports structured clinical integration of ultrasound findings but requires further prospective validation. Future trials and artificial intelligence (AI)-assisted quantification tools may help standardize practice and clarify outcome benefits.
  • Impact of antithrombin III deficiency on clinical outcomes in trauma patients: a systematic review and meta-analysis
    Joao Victor Silva Correia, Pedro Lawall de Carvalho, Mariana Merighi Moreira Salles, Ricardo Ormanes Massoud, Rafael Hortêncio Melo
    Journal of Thrombosis and Thrombolysis, 2026
  • Effectiveness of noninvasive ventilation for preoxygenation in emergency intubation: a systematic review and meta-analysis
    Luciana Gioli-Pereira, Victor A Gomez Galeano, Rafael Hortencio Melo, Camila Campos Grisa Padovese, Edielle Sant’Anna Melo, Ary Serpa
    Critical Care Science, 2026
  • Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies
    Rafael Hortêncio Melo, Luciana Gioli-Pereira, Edielle Melo, Philippe Rola
    Ultrasound Journal, 2025
  • Diagnostic accuracy of multi-organ point-of-care ultrasound for pulmonary embolism in critically ill patients: a systematic review and meta-analysis
    Rafael Hortêncio Melo, Luciana Gioli-Pereira, Igor Dovorake Lourenço, Rogério Da Hora Passos, Adriana Tumba Bernardo, Giovanni Volpicelli
    Critical Care, 2025
  • Optic Nerve Sheath Diameter Sonography for the Diagnosis of Increased Intracranial Pressure in Nontraumatic Neurocritically Ill Patients: a Diagnostic Accuracy Systematic Review and Meta-Analysis
    Rafael Hortêncio Melo, Luciana Gioli-Pereira, Fábio Santana Machado, Chiara Robba
    Neurocritical Care, 2025
  • Natriuretic Peptide-Guided Therapy in Acute Decompensated Heart Failure: An Updated Systematic Review and Meta-Analysis
    Luciana Gioli‐Pereira, Eric Shih Katsuyama, Christian Ken Fukunaga, Wilson Falco, Camila Campos Grisa Padovese, Rafael Hortencio Melo, Edielle de Sant'Anna Melo, Silvana E. Ribeiro Papp, Fernando Bacal
    Clinical Cardiology, 2025
  • Beyond fluid responsiveness: the concept of fluid tolerance and its potential implication in hemodynamic management
    Rafael Hortêncio Melo, Mauricio Henrique Claro dos Santos, Fernando José da Silva Ramos
    Critical Care Science, 2023

RECENT SCHOLAR PUBLICATIONS

  • Femoral vein Doppler ultrasound for assessing venous congestion and right heart function: a scoping review
    RH Melo, A Wong, A Koratala, E Kattan, R da Hora Passos
    Intensive Care Medicine Experimental 14 (1), 4 , 2026
    2026
  • Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort
    RH Melo, J Galantier, MLP Romano, ER Romano, APV Felicio, ...
    Journal of Critical Care 94, 155607 , 2026
    2026
  • Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort
    LCPA Rafael Hortêncio Melo , João Galantier , Marcelo Luz Pereira Romano ...
    https://doi.org/10.1016/j.jcrc.2026.155607 94 , 2026
    2026
  • Representation and reporting of patients with cancer in mortality-focused adult ICU randomized trials: a systematic review
    RH Melo, L Gioli-Pereira, MR Bustamante, GP Gonçalves, VU Orias, ...
    BMC anesthesiology , 2026
    2026
  • 778: CONTINUOUS VS INTERMITTENT RENAL THERAPY IN CRITICALLY ILL CANCER PATIENTS WITH AKI
    S Ribeiro Papp, R Melo, P Bribean Rogovschi, R da Hora Passos, ...
    Critical care medicine 54 (3S) , 2026
    2026
  • 480: HYPERNATREMIA IN ACUTE TRAUMATIC BRAIN INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS
    R Massoud, J Correia, M Salles, P Carvalho, R Melo
    Critical Care Medicine 54 (3S) , 2026
    2026
  • 891: METHYLENE BLUE IN CANCER PATIENTS WITH DISTRIBUTIVE SHOCK: A TARGET TRIAL EMULATION
    R Melo, S Ribeiro Papp, G de Arruda, AP Valle Felicio, L Gioli-Pereira
    Critical Care Medicine 54 (3S) , 2026
    2026
  • 689: CORTICOSTEROIDS AND SURVIVAL: 30-DAY OUTCOMES IN CRITICALLY ILL CANCER PATIENTS WITH PNEUMONIA
    S Ribeiro Papp, R Melo, G Bezerra de Freitas Diniz, AP Valle Felicio, ...
    Critical Care Medicine 54 (3S) , 2026
    2026
  • Effectiveness of noninvasive ventilation for preoxygenation in emergency intubation: a systematic review and meta-analysis
    L Gioli-Pereira, VAG Galeano, RH Melo, CCG Padovese, ESA Melo, ...
    Critical Care Science 38, e20260128 , 2026
    2026
  • The role of thoracic ultrasound in fluid management in critical care: a narrative review
    R da Hora Passos, LVDWB Urbano, M de Almeida Lopes, VB Galindo, ...
    Journal of Thoracic Disease 18 (1), 40 , 2026
    2026
  • Hemodynamic monitoring strategies in cardiac surgery: an update systematic review
    R Melo, V Galindo, L Gioli-Pereira, D Joelsons, M Assunção, B Alves, ...
    Journal of Clinical Monitoring and Computing, 1-14 , 2026
    2026
    Citations: 2
  • Perioperative fluid accumulation and clinical outcomes after cardiac surgery: a systematic review and Bayesian meta-analysis
    RH Melo, AP Cappellaro, VG Galeano, APV Felicio, A Wong, ...
    Journal of Anesthesia, Analgesia and Critical Care , 2026
    2026
  • Impact of antithrombin III deficiency on clinical outcomes in trauma patients: a systematic review and meta-analysis
    JV Silva Correia, PL de Carvalho, MMM Salles, RO Massoud, RH Melo
    Journal of Thrombosis and Thrombolysis 59 (1), 179-187 , 2026
    2026
  • Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery: Systematic Review and Meta-analysis
    MMM Salles, RO Massoud, PL de Carvalho, JS Correia, RH Melo
    Journal of Cardiothoracic and Vascular Anesthesia , 2025
    2025
  • Association Between Liberal Fluid Strategy and Postoperative Outcomes in Cardiac Surgery: A Systematic Review and Bayesian Meta-Analysis
    R Melo, A Cappellaro, L Almeida, V Gomez
    Circulation 152 (Suppl_3), A4348297-A4348297 , 2025
    2025
  • Enhancing Offshore Production Allocation with Virtual Flow Metering: A Comprehensive Methodology
    R Passos, M Gamboa, F Almeida, B Guillermou, R Melo, B Wills
    Offshore Technology Conference Brasil, D021S016R005 , 2025
    2025
  • Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure in nontraumatic neurocritically ill patients: a diagnostic accuracy systematic …
    RH Melo, L Gioli-Pereira, FS Machado, C Robba
    Neurocritical Care 43 (2), 659-670 , 2025
    2025
    Citations: 6
  • Underreporting of Acute Kidney Injury in Randomized Trials of ARDS with Mortality Endpoints: A Systematic Review
    P RdH, B Zawadzki, LCS Pinto, RH Melo, TD Midega, B BdA, J VPdC, ...
    2025
  • Underreporting of Acute Kidney Injury in Randomized Trials of ARDS with Mortality Endpoints: A Systematic Review
    R da Hora Passos, B Zawadzki, LCS Pinto, RH Melo, TD Midega, ...
    2025
  • Natriuretic Peptide‐Guided Therapy in Acute Decompensated Heart Failure: An Updated Systematic Review and Meta‐Analysis
    L Gioli‐Pereira, ES Katsuyama, CK Fukunaga, W Falco, CCG Padovese, ...
    Clinical Cardiology 48 (6), e70165 , 2025
    2025
    Citations: 4

MOST CITED SCHOLAR PUBLICATIONS

  • Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies
    RH Melo, L Gioli-Pereira, E Melo, P Rola
    The ultrasound journal 17 (1), 16 , 2025
    2025
    Citations: 29
  • Beyond fluid responsiveness: the concept of fluid tolerance and its potential implication in hemodynamic management
    RH Melo, MHC Santos, FJS Ramos
    Critical Care Science 35 (2), 226-229 , 2023
    2023
    Citations: 23
  • Diagnostic accuracy of multi-organ point-of-care ultrasound for pulmonary embolism in critically ill patients: a systematic review and meta-analysis
    RH Melo, L Gioli-Pereira, ID Lourenço, R Da Hora Passos, AT Bernardo, ...
    Critical Care 29 (1), 162 , 2025
    2025
    Citations: 11
  • Optic nerve sheath diameter sonography for the diagnosis of increased intracranial pressure in nontraumatic neurocritically ill patients: a diagnostic accuracy systematic …
    RH Melo, L Gioli-Pereira, FS Machado, C Robba
    Neurocritical Care 43 (2), 659-670 , 2025
    2025
    Citations: 6
  • Natriuretic Peptide‐Guided Therapy in Acute Decompensated Heart Failure: An Updated Systematic Review and Meta‐Analysis
    L Gioli‐Pereira, ES Katsuyama, CK Fukunaga, W Falco, CCG Padovese, ...
    Clinical Cardiology 48 (6), e70165 , 2025
    2025
    Citations: 4
  • Hemodynamic monitoring strategies in cardiac surgery: an update systematic review
    R Melo, V Galindo, L Gioli-Pereira, D Joelsons, M Assunção, B Alves, ...
    Journal of Clinical Monitoring and Computing, 1-14 , 2026
    2026
    Citations: 2
  • Além da fluido-responsividade: o conceito de fluido-tolerância e sua potencial implicação no manejo hemodinâmico
    RH Melo, MHC Santos, FJS Ramos
    Critical Care Science 35, 226-229 , 2023
    2023
    Citations: 1
  • Femoral vein Doppler ultrasound for assessing venous congestion and right heart function: a scoping review
    RH Melo, A Wong, A Koratala, E Kattan, R da Hora Passos
    Intensive Care Medicine Experimental 14 (1), 4 , 2026
    2026
  • Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort
    RH Melo, J Galantier, MLP Romano, ER Romano, APV Felicio, ...
    Journal of Critical Care 94, 155607 , 2026
    2026
  • Methylene blue for septic shock in oncologic patients: A propensity score-matched cohort
    LCPA Rafael Hortêncio Melo , João Galantier , Marcelo Luz Pereira Romano ...
    https://doi.org/10.1016/j.jcrc.2026.155607 94 , 2026
    2026
  • Representation and reporting of patients with cancer in mortality-focused adult ICU randomized trials: a systematic review
    RH Melo, L Gioli-Pereira, MR Bustamante, GP Gonçalves, VU Orias, ...
    BMC anesthesiology , 2026
    2026
  • 778: CONTINUOUS VS INTERMITTENT RENAL THERAPY IN CRITICALLY ILL CANCER PATIENTS WITH AKI
    S Ribeiro Papp, R Melo, P Bribean Rogovschi, R da Hora Passos, ...
    Critical care medicine 54 (3S) , 2026
    2026
  • 480: HYPERNATREMIA IN ACUTE TRAUMATIC BRAIN INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS
    R Massoud, J Correia, M Salles, P Carvalho, R Melo
    Critical Care Medicine 54 (3S) , 2026
    2026
  • 891: METHYLENE BLUE IN CANCER PATIENTS WITH DISTRIBUTIVE SHOCK: A TARGET TRIAL EMULATION
    R Melo, S Ribeiro Papp, G de Arruda, AP Valle Felicio, L Gioli-Pereira
    Critical Care Medicine 54 (3S) , 2026
    2026
  • 689: CORTICOSTEROIDS AND SURVIVAL: 30-DAY OUTCOMES IN CRITICALLY ILL CANCER PATIENTS WITH PNEUMONIA
    S Ribeiro Papp, R Melo, G Bezerra de Freitas Diniz, AP Valle Felicio, ...
    Critical Care Medicine 54 (3S) , 2026
    2026
  • Effectiveness of noninvasive ventilation for preoxygenation in emergency intubation: a systematic review and meta-analysis
    L Gioli-Pereira, VAG Galeano, RH Melo, CCG Padovese, ESA Melo, ...
    Critical Care Science 38, e20260128 , 2026
    2026
  • The role of thoracic ultrasound in fluid management in critical care: a narrative review
    R da Hora Passos, LVDWB Urbano, M de Almeida Lopes, VB Galindo, ...
    Journal of Thoracic Disease 18 (1), 40 , 2026
    2026
  • Perioperative fluid accumulation and clinical outcomes after cardiac surgery: a systematic review and Bayesian meta-analysis
    RH Melo, AP Cappellaro, VG Galeano, APV Felicio, A Wong, ...
    Journal of Anesthesia, Analgesia and Critical Care , 2026
    2026
  • Impact of antithrombin III deficiency on clinical outcomes in trauma patients: a systematic review and meta-analysis
    JV Silva Correia, PL de Carvalho, MMM Salles, RO Massoud, RH Melo
    Journal of Thrombosis and Thrombolysis 59 (1), 179-187 , 2026
    2026
  • Intraoperative Hemoadsorption and Acute Kidney Injury in Cardiac Surgery: Systematic Review and Meta-analysis
    MMM Salles, RO Massoud, PL de Carvalho, JS Correia, RH Melo
    Journal of Cardiothoracic and Vascular Anesthesia , 2025
    2025