Daily Chlorhexidine Bathing for the Prevention of Nosocomial Infections in Critically Ill Patients (CLEAN-IT): a multicentre, cluster-randomised, crossover trial Bruno M. Tomazini, Bruno A.M.P. Besen, Ana C. Gales, Larissa Bianchini, Thiago Lisboa, Israel S. Maia, Thabata S. Veiga, Renato H.N. Santos, Elton S. Santos, Samira M. Tokunaga, Leticia G. Barbante, Viviane B. Campos, Flavia C.S. Kojima, Tamiris A. Miranda, Nayane C. Ramos, Rejane M. Prestes, Valéria P. Lima, Priscilla Freitas, Claudia F.L. Vidal, Raquel C.B. Santiago, Marianna D.A. Dracoulakis, Marcelo Romano, Rodrigo M.V. Melo, Francielle C. Pereira, Cindy M.T. Rozetti, Roberta M. Souza, Fabio H. Lacerda, Isabele R. Berti, Vivian Irineu, Rodrigo C. Figueiredo, Maitê S. Magdalena, Vicente C. Dantas, Beatriz Arns, Giovanna Marssola, Viviane C. Veiga, Adriano J. Pereira, Antonio P. Nassar, Alexandre B. Cavalcanti Lancet Regional Health Americas, 2026 Background: Critically ill patients are at risk of nosocomial infections, acquisition of multidrug-resistant pathogens, and substantial antimicrobial consumption. We assessed whether bathing with chlorhexidine reduces these outcomes compared to standard practices. Methods: We conducted an open-label, cluster-randomised crossover trial in 22 Brazilian intensive care units comparing daily chlorhexidine bathing versus soap and water bathing (control). Centres were randomised to 3- or 6-months chlorhexidine or control periods, separated by a 1-month washout. Primary outcome was nosocomial infection rate (central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia) during ICU stay. Secondary outcomes included specific nosocomial infections incidence, multi-drug resistant cultures, antibiotic use, length of stay, and mortality. This completed trial is registered at ClinicalTrials.gov, NCT05485051. Findings: From August 1st, 2022 to December 31, 2023, we included 15,935 patients (8247 chlorhexidine and 7688 control group). Mean age was 64·4 years (SD 17·3) in the chlorhexidine group [4315 (52·3%) male] and 64·2 years (SD 17·4) in the control group [4035 (52·5%) male]. A total of 201 nosocomial infections occurred in the chlorhexidine group, compared to 165 in the control group. There was no statistically significant difference in the overall nosocomial infections rate between groups [3·99 per 1000 patient-days in the chlorhexidine group and 3·45 per 1000 patient-days in the control group (rate-ratio, 1·09; 95% CI 0·95-1·25; p = 0·22)]. Patients in the chlorhexidine group had lower rates of multi-drug resistant cultures compared to the control group (14·42 vs. 20·13 per 1000 patient-days, rate-ratio, 0·73; 95% CI 0·59-0·91; p = 0·0092). Although overall antimicrobial consumption defined by WHO's DDD did not differ between groups (rate-ratio, 0·91; 95% CI 0·80-1·03; p = 0·14), there was a statistically significant difference in the consumption of antimicrobials in the Reserve group of WHO's AWaRe classification (rate-ratio, 0·73; 95% CI 0·59-0·90; p = 0·0071) in the chlorhexidine group. This reduction was not associated with higher mortality. Interpretation: Chlorhexidine bathing did not reduce the incidence of nosocomial infections in a general ICU population, but contributed to lower rates of multi-drug resistant pathogen isolation, and lower use of Reserve antimicrobials, potentially leading to a qualitative modification of antimicrobial use. Funding: This study was funded by the Brazilian Health Ministry through the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS).
Effects of dapagliflozin on urinary output, fluid balance, and biochemistry in critically ill patients: a post-hoc secondary analysis of the DEFENDER trial Fernando G. Zampieri, Luciano C. P. Azevedo, Ary Serpa Neto, Álvaro Rea-Neto, Paula G. David-João, Cristina P. Amendola, Amanda C. Kozesinski-Nakatani, Thiago C. Filiponi, Guacyra M. B. Almeida, Ricardo R. Bergo, Rodrigo C. Figueiredo, Clewer J. Schuler, Glauco A. Westphal, Rodrigo S. Biondi, Adriano J. Pereira, Thiago D. Correa, Otavio Berwanger, Sean M. Bagshaw, Rinaldo Bellomo, Caio A. M. Tavares Critical Care, 2025 BACKGROUND: Sodium-glucose cotransport-2 inhibitors (SGLT2i) have established benefits in diabetes mellitus, heart failure, and chronic kidney disease, but their physiological effects during critical illness remain unclear. We explored whether dapagliflozin affected urinary output, fluid balance, and other physiological parameters in critically ill patients with acute organ dysfunction. METHODS: This secondary analysis of the DEFENDER trial included 401 critically ill patients with acute organ dysfunction randomized to receive dapagliflozin 10 mg daily or standard care. We analyzed urinary output, fluid balance, electrolytes, acid-base status, glycemia, and vasopressor requirements over the first five days using Bayesian models. RESULTS: Dapagliflozin progressively increased urinary output (day 5: + 157 mL/day, 95% CrI -90 to 386, probability 90%) and decreased fluid balance (day 5: -290 mL/day, 95% CrI -564 to -27, probability 98%). Furosemide use was lower in the dapagliflozin group (overall -3%, 95% CrI -7% to 1%, probability 90%). Dapagliflozin had minimal effects on creatinine and electrolytes but was associated with progressive small decreases in pH (day 5: -0.02, probability 96%). Maximum glucose levels were consistently lower with dapagliflozin (-9 mg/dL overall, probability 83%). Norepinephrine requirements showed a time-dependent increase in the dapagliflozin group, with the expected dose difference reaching 0.034 mcg/kg/min by day 5 (probability 94%), and heterogeneity analysis revealed larger effects in patients with sepsis or on mechanical ventilation. CONCLUSION: This exploratory analysis suggests dapagliflozin may enhance diuresis and reduce loop diuretic requirements in critically ill patients, potentially at the cost of increased vasopressor needs. Glucose levels were likely slightly lower with dapagliflozin. Given the study's limitations and heterogeneous treatment effects, these findings should be considered hypothesis-generating pending confirmation in prospective trials.
Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort Bruno Martins Tomazini, Bruno Adler Maccagnan Pinheiro Besen, Renato Hideo Nakagawa Santos, Antonio Paulo Nassar, Thabata Silva Veiga, Viviane Bezerra Campos, Samira Martins Tokunaga, Elton Sousa Santos, Leticia Galvão Barbante, Renato da Costa Maia, Flavia Cristina Soares Kojima, Ligia Nasi Laranjeira, Leandro Utino Taniguchi, Roberta Muriel Longo Roepke, Cristiano Augusto Franke, Luciana Coelho Sanches, Livia Maria Garcia Melro, Israel Silva Maia, Vicente Cés de Souza Dantas, Rodrigo Cruvinel Figueiredo, Meton Soares de Alencar Filho, Vivian Menezes Irineu, Wilson José Lovato, Cassio Luis Zandonai, Flávia Ribeiro Machado, Beatriz Arns, Giovanna Marsola, Viviane Cordeiro Veiga, Adriano José Pereira, Alexandre Biasi Cavalcanti, , Silvana Soares dos Santos, Juliana Coelho, Michelle Tereza Sousa, Bruna Azevedo, Luciana Macedo da Silva Gavinho, Alaís Brito Nascimento, Rodrigo Barbosa Cerantola, Itallo de Lima Neves, Vanessa Cristina de Aquino Leão, Rodrigo Morel Vieira de Melo, Luane Lopes Cavalcante Gomes, Vladimir Miguel Spirale, Roberta Schiavon Nogueira, Lúcio Couto de Oliveira Junior, Daniela Cunha de Oliveira, Marianna Deway Andrade Dracoulakis, Natália Oliveira Santos Alvaia, Andre Luiz Nunes Gobatto, Carolaine Bomfim de Oliveira, Cintia Magalhães Carvalho Grion, Claudia Maria Dantas de Maio Carrilho, Claudia Fernanda de Lacerda Vidal, Fernanda Lopes de Albuquerque Rodrigues, Thiago Costa Lisboa, Cristofer Farias da Silva, Leticia Pierini, Antônio Carlos da Silva, Sheila Mara Bezerra de Oliveira, Maria Brandão Tavares, Igor das Virgens Santana, Tatiana Gozzi Pancev Toledo, Fabio de Carvalho Mauricio, Bianca Ramos Ferronato, André Sant’Ana Machado, Leticia Capeletti, Marina Peres Bainy, Gabriela Martins Teixeira, Dagoberta Alves Vieira Beduhn, Durval Ferreira Fonseca Pedroso, Priscilla Yoshiko Sawada, Caio Cesar Ferreira Fernandes, Juliana Mazzei Garcia, Rafael Nunes Malta, Cindy Medici Toscano Rozetti, Pedro Aniceto Nunes Neto, Valéria Chagas Pereira, Emerson Boschi, Viviane Buffon, Tássio Breno de Sousa Lopes Lavôr, Marcela Dutra, Maria Eduarda Kretzer Silva, Leila Rezegue de Moraes Rego, Adria Vanessa da Silva, Vivian Menezes Irineu, Viviane Aparecida L. S. Correa, Rodrigo Cruvinel Figueiredo, Jackelyne Lopes Silva, Jussara Alencar Arraes, Meton Soares de Alencar Filho, Mariana de Souza Medeiros, Francielle Constantino Pereira, Fernanda Borges Salgado, Vicente Cés de Souza Dantas, Priscilla Alves Barreto, Israel Silva Maia, Cassio Luis Zandonai, Fábio Holanda Lacerda, Rene Rodrigues, Luana Pontes Oliveira, Eliene Sá Sodré Filho, João Lucidio Lobato Paes, Marielle Crsitina Mendes Silva, Debora Maria Brito Pinho, Carolina Miranda, Livia Maria Garcia Melro, Priscila Freitas das Neves Gonçalves, Anelise Franklin, Rafael Botelho Foernges, Maite Souza Magdalena, Felipe Dal Pizzol, Danusa de Castro Damasio, Roberta Machado de Souza, Larissa Liz Cardoso de Araújo, Flávia Ribeiro Machado, Maria Aparecida de Souza, Nicole Alberti Golin, Juliana Giacomazzi, Joana D’arc Vila Nova Jatobá, Maria Tereza Farias de Moura, Luis Eduardo Miranda Paciência, Elaine Silva Bueno, Eliana Bernadete Caser, Larissa Zuqui Ribeiro, Diego Meireles Duarte, Rejane Martins Prestes, Glícia Cardoso Nascimento, Valéria Paes Lima, Kamilla Grasielle Nunes da Silva, Roberta Lacerda Almeida de Miranda Dantas, Eliane Pereira Silva, Hugo Corrêa de Andrade Urbano, Danielle Conceição Aparecida Moreira, Pedro Martins Pereira Kurtz, Cássia Righy Shinotsuka, Everton Macêdo Silva, Julival Ribeiro, Cláudio Dornas de Oliveira, Raquel Caldeira Brant Santiago, Jorge Luiz da Rocha Paranhos, Iany Grinezia da Silva Wiermann, Thiago Gomes Romano, Daniel Cubos, and Critical Care, 2025 BACKGROUND: Limited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil. METHODS: Multicenter cohort study from September 2019 to December 2023 with prospective individual patient data collection. VAP, CLABSI, and CAUTI were diagnosed by each center in accordance with Brazilian regulatory agency guidance. If a patient fulfilled all diagnostic criteria, he was deemed to have Confirmed HAI. An adjusted disability multistate model was used to evaluate the population attributable in-hospital mortality fraction (PAF) and the absolute in-hospital mortality difference (AMD). RESULTS: A total of 128,247 patients were included. 4066 (3.2%) distinct patients had at least one diagnosis of HAI (1493 CLABSI, 433 CAUTI, 2742 VAP, and 435 patients with more than one HAI) during the ICU stay. The PAF was 3.89% (95% CI 3.68-4.11%) for HAI, 2.16% (2.05-2.33%) for VAP, 1.2% (1.08-1.32%) for CLABSI, 0.11% (0.07-0.16%) for CAUTI, and 0.33% (0.26-0.4%) for ≥ 2 HAI. The AMD for HAI was 33.69% (95% CI 32.27-35.33%), 29.01% (27.15-30.98%) for VAP, 31.64% (29.3-34.81%) for CLABSI, 9.94% (3.88-15.54%) for CAUTI and 35.6% (28.93-42.99%) for ≥ 2 HAI. CONCLUSIONS: Device-associated HAI significantly contribute to hospital mortality and impose a high excess risk of death for critically ill patients.
Hemodynamic effects of slower versus faster intravenous fluid bolus rates in critically ill patients: An observational study Daniere Yurie Vieira Tomotani, Flávio Geraldo Rezende Freitas, Alexandre Biasi Cavalcante, Ary Serpa Neto, Rodrigo Cruvinel Figueiredo, Rodrigo Santos Biondi, João Manoel Silva-Jr, Bruno Adler Maccagnan Pinheiro Besen, Jorge Luiz da Rocha Paranhos, Fernando José da Silva Ramos, Fernanda Chohfi Atallah, Thiago Miranda Lopes de Almeida, Maria Aparecida de Souza, Fernando Godinho Zampieri, Flávia Ribeiro Machado Journal of Critical Care, 2025
Effect of a driving pressure-limiting strategy for patients with acute respiratory distress syndrome secondary to community-acquired pneumonia: the STAMINA randomised clinical trial Israel Silva Maia, Alexandre Biasi Cavalcanti, Lucas Tramujas, Viviane Cordeiro Veiga, Júlia Souza Oliveira, Erica Regina Ribeiro Sady, Letícia Galvão Barbante, Marina Lazzari Nicola, Rodrigo Magalhães Gurgel, Lucas Petri Damiani, Karina Leal Negrelli, Tamiris Abait Miranda, Ligia Nasi Laranjeira, Bruno Tomazzini, Cassio Zandonai, Mariangela Pimentel Pincelli, Glauco Adrieno Westphal, Ruthy Perotto Fernandes, Rodrigo Figueiredo, Cíntia Loss Sartori Bustamante, Luiz Fernando Norbin, Emerson Boschi, Rafael Lessa, Marcelo Pereira Romano, Mieko Cláudia Miura, Meton Soares de Alencar Filho, Vicente Cés de Souza Dantas, Priscilla Alves Barreto, Mauro Esteves Hernandes, Cintia Grion, Alexandre Sanches Laranjeira, Ana Luiza Mezzaroba, Marina Bahl, Ana Carolina Starke, Rodrigo Biondi, Felipe Dal-Pizzol, Eliana Caser, Marlus Muri Thompson, Andrea Allegrini Padial, Rodrigo Thot Leite, Gustavo Araújo, Mário Guimarães, Priscilla Aquino, Fábio Lacerda, Conrado Roberto Hoffmann Filho, Livia Melro, Eduardo Pacheco, Gustavo Ospina-Táscon, Juliana Carvalho Ferreira, Fabricio Jocundo Calado Freires, Flávia Ribeiro Machado, Fernando Godinho Zampieri British Journal of Anaesthesia, 2025
Acetylsalicylic Acid Treatment in Patients With Sepsis and Septic Shock: A Phase 2, Placebo-Controlled, Randomized Clinical Trial Thiago M. L. Almeida, Flávio G. R. Freitas, Rodrigo C. Figueiredo, Sandra G. Houly, Luciano C. P. Azevedo, Alexandre B. Cavalcanti, Lucas P. Damiani, Bianca S. Svicero, Maria A. Souza, Cíntia L. S. Bustamante, Fernando J. S. Ramos, Rafael S. V. Alves, Fernanda C. Atallah, Míriam Jackiu, Eduardo S. Pacheco, Raysa C. Schmidt, Felipe S. C. Serra, Daniere Y. V. Tomotani, Fernando G. Zampieri, Flávia R. Machado, and Critical Care Medicine, 2025 OBJECTIVES: Platelets play a critical role in the inflammatory response and coagulation. We aimed to evaluate whether the use of acetylsalicylic acid (ASA) would reduce the intensity of organ dysfunction in septic patients. DESIGN: Randomized, blinded, parallel-group, placebo-controlled trial. SETTING: Five general ICUs in Brazil. PATIENTS: Adults with sepsis for no longer than 48 hours who had at least one severe organ dysfunction (lactate > 4 mmol/L, platelets < 100,000/mm3, Pao 2/Fio 2 ratio < 200, or septic shock). INTERVENTIONS: Patients were randomized to receive 200 mg of ASA or placebo for 7 days. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the change in the Sequential Organ Failure Assessment (SOFA) score between day 0 and day 7 or date of discharge/death. Safety outcomes were major bleeding and the number of blood transfusions within 14 days. The planned sample size was 218 with interim safety analyses after enrolling 109 and 163 patients. The study was discontinued due to higher frequency of major bleeding in the ASA group. We included 166 patients (ASA: 82 patients, placebo: 84). In the adjusted analysis, there was no difference in the SOFA change between the groups (mean placebo to ASA group difference, 0.60; 95% CI, –0.55 to 1.75; p = 0.30). There were no differences in any of the secondary outcomes. In the intervention group, there were a higher number of serious adverse events (9 [11%] vs. 1 [1.2%]; p = 0.009) and major bleeding (8 [8.5%] vs. 1 [1.2%]; p = 0.02). CONCLUSIONS: In this population of septic patients, ASA did not reduce the intensity of organ dysfunction. ASA increased the risk of severe bleeding compared with placebo.
Dapagliflozin for Critically Ill Patients with Acute Organ Dysfunction: The DEFENDER Randomized Clinical Trial Caio A. M. Tavares, Luciano C. P. Azevedo, Álvaro Rea-Neto, Niklas S. Campos, Cristina P. Amendola, Amanda C. Kozesinski-Nakatani, Paula G. David-João, Suzana M. Lobo, Thiago C. Filiponi, Guacyra M. B. Almeida, Ricardo R. Bergo, Mário R. R. Guimarães-Júnior, Rodrigo C. Figueiredo, Joan R. Castro, Clewer J. Schuler, Glauco A. Westphal, Ana C. R. Carioca, Frederico Monfradini, Josue Nieri, Flavia M. O. Neves, Jaqueline A. Paulo, Camila S. N. Albuquerque, Mariana C. R. Silva, Mikhail N. Kosiborod, Adriano J. Pereira, Lucas P. Damiani, Thiago D. Corrêa, Ary Serpa-Neto, Otavio Berwanger, Fernando G. Zampieri, , Juliano Souza, Luciana Sanches, Maisa Castro, Mariana Cunha, Flávia Fagundes, Juan Siqueira, Glauco Westphal, Cristian Ospina, Evelin Silva, Juliano Ramos, Miriam Machado, Ruthy Fermamdes, Camila Lunardi, Luana Radun, Andervan Moura, Evanio Silva, Livia Dantas, Livia Gomes, Maria Luzia Silva, Yolanda Nunes, Ana Beatriz Lino, Gabrielly Barros, João Pedro Nunes, Marivalda Barbosa, Guilherme Souza, Hugo Duarte, Hannah Mota, Joan Castro, Mayler Olambrada, Rafael Borges, Luciana Barros, Nelson Pereira, Marcos Tavares, Gabriela Joia, Gabriella Cordeiro, Natalia Mattos, Vinicius Lanza, Victoria Silva, Marianna A Dracoulakis, Natalia Alvaia, Camilla Vieira, Izabela Freitas, Beatriz Conceição, Jaqueline Borges, Aline Silva, Thais Caroline, Josiane Jesus, Allan Santos, Bruno Vieira, Isabelle Guerreiro, Luciana Oliveira, Luiz Esteves, Rodrigo Bolini, Edmilson Carvalho, Adilson Lacerda, Aline Ferreira, Gustavo Sica, Lara Oliveira, Maria das Vitórias Guedes, Otavio Gebara, Ana Paula Espirito Santo, Ana Tarina Lopes, Hevelton Ribeiro, Pablo Tomba, Vislaine Morete, Joyce Almeida, Claudia Silva, Luana Gato, Leticia Inada, Claire Dias, Frederico Dall’Orto, Graziela Melo, Ana Roberta Silva, Gislayne Ribeiro, Kemilys Ferreira, Rodrigo Biondi, Sergio Ramalho, Derick Silva, Eduardo Garbin, Ingrid Pereira, Luana Nunes, Rayane Lacourt, Cintia Loss, Jackelyne Silva, Claudio Jorge, Graziela Denerdin, Karla Millani, Luana Machado, Ana Carolina Affonso, Juliane Garcia, Tatiane Oiafuso, Luana Camargo, Kaio Morais, Aline Angeli, Cassia Pradela, Gustava Marques, Joelma Silva, Maria Fernanda Santos, Marina Zini, Keulle Candido, Tamires Silva, Verônica Barros, Mariana Pool, Fabio Serra, Alef Coelho, Lea Vieira, Tamyres Galvao, Alexandre Tognon, Marcos Dozza, Sabrina Henrich, Andressa Giordani, Aloma Menegasso, Murillo Antunes, Nicoli Gosmano, Stefany Moura, Tiberio Costa, Vitoria Canato, Gabriela Queiroz, Mariana Gonçalvez, Mariana Zanona, Hellen Dias, Eduardo Bazanelli Junqueira Ferraz, Caroline Rossi, Leandro Pozzo, Diogo Moia, Ronaldo Vicente Pereira Soares, Ramy Machado Marino, Bruna Ladeira Moreno, Arthur Serapião, Roberta Momesso, Bárbara Gomes da Silva, Cintia Selles Santos, Elaine de Jesus Santos, Bruna dos Santos Sampaio, Luciana Pereira Almeida de Piano JAMA, 2024 ImportanceSodium-glucose cotransporter 2 (SGLT-2) inhibitors improve outcomes in patients with type 2 diabetes, heart failure, and chronic kidney disease, but their effect on outcomes of critically ill patients with organ failure is unknown.ObjectiveTo determine whether the addition of dapagliflozin, an SGLT-2 inhibitor, to standard intensive care unit (ICU) care improves outcomes in a critically ill population with acute organ dysfunction.Design, Setting, and ParticipantsMulticenter, randomized, open-label, clinical trial conducted at 22 ICUs in Brazil. Participants with unplanned ICU admission and presenting with at least 1 organ dysfunction (respiratory, cardiovascular, or kidney) were enrolled between November 22, 2022, and August 30, 2023, with follow-up through September 27, 2023.InterventionParticipants were randomized to 10 mg of dapagliflozin (intervention, n = 248) plus standard care or to standard care alone (control, n = 259) for up to 14 days or until ICU discharge, whichever occurred first.Main Outcomes and MeasuresThe primary outcome was a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and ICU length of stay through 28 days, analyzed using the win ratio method. Secondary outcomes included the individual components of the hierarchical outcome, duration of organ support–free days, ICU, and hospital stay, assessed using bayesian regression models.ResultsAmong 507 randomized participants (mean age, 63.9 [SD, 15] years; 46.9%, women), 39.6% had an ICU admission due to suspected infection. The median time from ICU admission to randomization was 1 day (IQR, 0-1). The win ratio for dapagliflozin for the primary outcome was 1.01 (95% CI, 0.90 to 1.13; P = .89). Among all secondary outcomes, the highest probability of benefit found was 0.90 for dapagliflozin regarding use of kidney replacement therapy among 27 patients (10.9%) in the dapagliflozin group vs 39 (15.1%) in the control group.Conclusion and RelevanceThe addition of dapagliflozin to standard care for critically ill patients and acute organ dysfunction did not improve clinical outcomes; however, confidence intervals were wide and could not exclude relevant benefits or harms for dapagliflozin.Trial RegistrationClinicalTrials.gov Identifier: NCT05558098
Exhaled air profile in the early diagnosis of ventilator-associated pneumonia Rodrigo Cruvinel Figueiredo, Jackelyne Lopes Silva, Igor Bianchini, Luana Bezerra Gonçalves Rocha, Renata Casagrande Goncalves, Cristiane Ritter, Felipe Dal-Pizzol Critical Care Science, 2024 Objective To predict exhaled air in patients undergoing mechanical ventilation during bedside diagnosis of ventilator-associated pneumonia. Methods Air samples were collected through the expiratory branch of the mechanical ventilation circuit during the hospitalization of patients at the intensive care unit of Hospital São José in Criciúma (SC), Brazil. In this study, 83 participants were divided into two groups, namely, the group with and the group without ventilator-associated pneumonia. Results The analysis of three air patterns revealed a predictive value for the diagnosis of ventilator-associated pneumonia. The analyses of samples from the first 12 hours of invasive mechanical ventilation were able to predict ventilator-associated pneumonia (p = 0.018). However, none of the other air samples collected during hospitalization were useful in identifying the severity or predicting early or late ventilator-associated pneumonia. Conclusion The use of a gas analyzer may be helpful for the early identification of patients admitted to intensive care who will develop ventilator-associated pneumonia.
Prospective, randomized, controlled trial assessing the effects of a driving pressure–limiting strategy for patients with acute respiratory distress syndrome due to community-acquired pneumonia (STAMINA trial): protocol and statistical analysis plan Israel Silva Maia, Fernando Azevedo Medrado Jr, Lucas Tramujas, Bruno Martins Tomazini, Júlia Souza Oliveira, Erica Regina Ribeiro Sady, Letícia Galvão Barbante, Marina Lazzari Nicola, Rodrigo Magalhães Gurgel, Lucas Petri Damiani, Karina Leal Negrelli, Tamiris Abait Miranda, Eliana Santucci, Nanci Valeis, Ligia Nasi Laranjeira, Glauco Adrieno Westphal, Ruthy Perotto Fernandes, Cássio Luis Zandonai, Mariangela Pimentel Pincelli, Rodrigo Cruvinel Figueiredo, Cíntia Loss Sartori Bustamante, Luiz Fernando Norbin, Emerson Boschi, Rafael Lessa, Marcelo Pereira Romano, Mieko Cláudia Miura, Meton Soares de Alencar Filho, Vicente Cés de Souza Dantas, Priscilla Alves Barreto, Mauro Esteves Hernandes, Cintia Magalhães Carvalho Grion, Alexandre Sanches Laranjeira, Ana Luiza Mezzaroba, Marina Bahl, Ana Carolina Starke, Rodrigo Santos Biondi, Felipe Dal-Pizzol, Eliana Bernadete Caser, Marlus Muri Thompson, Andrea Allegrini Padial, Viviane Cordeiro Veiga, Rodrigo Thot Leite, Gustavo Araújo, Mário Guimarães, Priscilla de Aquino Martins, Fábio Holanda Lacerda, Conrado Roberto Hoffmann Filho, Livia Melro, Eduardo Pacheco, Gustavo Adolfo Ospina-Táscon, Juliana Carvalho Ferreira, Fabricio Jocundo Calado Freires, Flávia Ribeiro Machado, Alexandre Biasi Cavalcanti, Fernando Godinho Zampieri Critical Care Science, 2024 Background: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. Objective: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. Methods: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. Outcomes: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. Conclusion: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.
Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study Fernando G. Zampieri, Alexandre B. Cavalcanti, Leandro U. Taniguchi, Thiago C. Lisboa, Ary Serpa-Neto, Luciano C. P. Azevedo, Antonio Paulo Nassar, Tamiris A. Miranda, Samara P. C. Gomes, Meton S. de Alencar Filho, Rodrigo T. Amancio da Silva, Fabio Holanda Lacerda, Viviane Cordeiro Veiga, Airton Leonardo de Oliveira Manoel, Rodrigo S. Biondi, Israel S. Maia, Wilson J. Lovato, Claudio Dornas de Oliveira, Felipe Dal Pizzol, Milton Caldeira Filho, Cristina P. Amendola, Glauco A. Westphal, Rodrigo C. Figueiredo, Eliana B. Caser, Lanese M. de Figueiredo, Flávio Geraldo R. de Freitas, Sergio S. Fernandes, Andre Luiz N. Gobatto, Jorge Luiz R. Paranhos, Rodrigo Morel V. de Melo, Michelle T. Sousa, Guacyra Margarita B. de Almeida, Bianca R. Ferronatto, Denise M. Ferreira, Fernando J. S. Ramos, Marlus M. Thompson, Cintia M. C. Grion, Renato Hideo Nakagawa Santos, Lucas P. Damiani, Flavia R. Machado, , Barbara Macedo, Fabio S. Coutinho, Jussara A. Arraes, Viviane S. N. Xavier, Eliana V. N. Martins, Juliana Chaves Coelho, Silvana S. Santos, Andreia Pardini, Cassio Luis Zandonai, Julia B. de Carvalho, Isabela O. B. Louredo, Renata C. Gonçalves, Micheli C. Arruda, Mariana Regina da Cunha, Mariana Bonomini F. de Almeida, Juliano Ramos, Bruna M. Binda, Priscila L. S. Almeida, Marcia Maria R. de Oliveira, Luciana S. de Mattos, Samara G. da Silva, Daniela C. Dorta, Martha Hadrich, Fernanda A. F. Gonçalves, Kaytiussia R. de Sena, Pamella M. dos Prazeres, Josiane Festti Annals of Intensive Care, 2023 Background Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Methods Matched 1:1 case–control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. Results 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068–0.084) for medical admissions; 0.043 (95% CI 0.032–0.055) for elective surgical admissions; and 0.036 (95% CI 0.017–0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. Conclusion The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.
Effects of balanced solution on short-term outcomes in traumatic brain injury patients: a secondary analysis of the BaSICS randomized trial Fernando Godinho Zampieri, Lucas Petri Damiani, Rodrigo Santos Biondi, Flávio Geraldo Rezende Freitas, Viviane Cordeiro Veiga, Rodrigo Cruvinel Figueiredo, Ary Serpa-Neto, Airton Leonardo de Oliveira Manoel, Tamiris Abait Miranda, Thiago Domingos Corrêa, Luciano César Pontes de Azevedo, Nilton Brandão da Silva, Flavia Ribeiro Machado, Alexandre Biasi Cavalcanti, BRICNet BRICNet Revista Brasileira De Terapia Intensiva, 2023
IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units Bruno M. Tomazini, Antonio Paulo Nassar Júnior, Thiago Costa Lisboa, Luciano César Pontes de Azevedo, Viviane Cordeiro Veiga, Daniela Ghidetti Mangas Catarino, Debora Vacaro Fogazzi, Beatriz Arns, Filipe Teixeira Piastrelli, Camila Dietrich, Karina Leal Negrelli, Isabella de Andrade Jesuíno, Luiz Fernando Lima Reis, Renata Rodrigues de Mattos, Carla Cristina Gomes Pinheiro, Mariane Nascimento Luz, Clayse Carla da Silva Spadoni, Elisângela Emilene Moro, Flávia Regina Bueno, Camila Santana Justo Cintra Sampaio, Débora Patrício Silva, Franca Pellison Baldassare, Ana Cecilia Alcantara Silva, Thabata Veiga, Leticia Barbante, Marianne Lambauer, Viviane Bezerra Campos, Elton Santos, Renato Hideo Nakawaga Santos, Ligia Nasi Laranjeiras, Nanci Valeis, Eliana Santucci, Tamiris Abait Miranda, Ana Cristina Lagoeiro do Patrocínio, Andréa de Carvalho, Eduvirgens Maria Couto de Sousa, Ancelmo Honorato Ferraz de Sousa, Daniel Tavares Malheiro, Isabella Lott Bezerra, Mirian Batista Rodrigues, Julliana Chicuta Malicia, Sabrina Souza da Silva, Bruna dos Passos Gimenes, Guilhermo Prates Sesin, Alexandre Prehn Zavascki, Daniel Sganzerla, Gregory Saraiva Medeiros, Rosa da Rosa Minho dos Santos, Fernanda Kelly Romeiro Silva, Maysa Yukari Cheno, Carolinne Ferreira Abrahão, Haliton Alves de Oliveira Junior, Leonardo Lima Rocha, Pedro Aniceto Nunes Neto, Valéria Chagas Pereira, Luis Eduardo Miranda Paciência, Elaine Silva Bueno, Eliana Bernadete Caser, Larissa Zuqui Ribeiro, Caio Cesar Ferreira Fernandes, Juliana Mazzei Garcia, Vanildes de Fátima Fernandes Silva, Alisson Junior dos Santos, Flávia Ribeiro Machado, Maria Aparecida de Souza, Bianca Ramos Ferronato, Hugo Corrêa de Andrade Urbano, Danielle Conceição Aparecida Moreira, Vicente Cés de Souza-Dantas, Diego Meireles Duarte, Juliana Coelho, Rodrigo Cruvinel Figueiredo, Fernanda Foreque, Thiago Gomes Romano, Daniel Cubos, Vladimir Miguel Spirale, Roberta Schiavon Nogueira, Israel Silva Maia, Cassio Luis Zandonai, Wilson José Lovato, Rodrigo Barbosa Cerantola, Tatiana Gozzi Pancev Toledo, Pablo Oscar Tomba, Joyce Ramos de Almeida, Luciana Coelho Sanches, Leticia Pierini, Mariana Cunha, Michelle Tereza Sousa, Bruna Azevedo, Felipe Dal-Pizzol, Danusa de Castro Damasio, Marina Peres Bainy, Dagoberta Alves Vieira Beduhn, Joana D’Arc Vila Nova Jatobá, Maria Tereza Farias de Moura, Leila Rezegue de Moraes Rego, Adria Vanessa da Silva, Luana Pontes Oliveira, Eliene Sá Sodré Filho, Silvana Soares dos Santos, Itallo de Lima Neves, Vanessa Cristina de Aquino Leão, João Lucidio Lobato Paes, Marielle Cristina Mendes Silva, Cláudio Dornas de Oliveira, Raquel Caldeira Brant Santiago, Jorge Luiz da Rocha Paranhos, Iany Grinezia da Silva Wiermann, Durval Ferreira Fonseca Pedroso, Priscilla Yoshiko Sawada, Rejane Martins Prestes, Glícia Cardoso Nascimento, Cintia Magalhães Carvalho Grion, Claudia Maria Dantas de Maio Carrilho, Roberta Lacerda Almeida de Miranda Dantas, Eliane Pereira Silva, Antônio Carlos da Silva, Sheila Mara Bezerra de Oliveira, Nicole Alberti Golin, Rogerio Tregnago, Valéria Paes Lima, Kamilla Grasielle Nunes da Silva, Emerson Boschi, Viviane Buffon, André Sant’Ana Machado, Leticia Capeletti, Rafael Botelho Foernges, Andréia Schubert de Carvalho, Lúcio Couto de Oliveira Junior, Daniela Cunha de Oliveira, Everton Macêdo Silva, Julival Ribeiro, Francielle Constantino Pereira, Fernanda Borges Salgado, Caroline Deutschendorf, Cristofer Farias da Silva, Andre Luiz Nunes Gobatto, Carolaine Bomfim de Oliveira, Marianna Deway Andrade Dracoulakis, Natália Oliveira Santos Alvaia, Roberta Machado de Souza, Larissa Liz Cardoso de Araújo, Rodrigo Morel Vieira de Melo, Luiz Carlos Santana Passos, Claudia Fernanda de Lacerda Vidal, Fernanda Lopes de Albuquerque Rodrigues, Pedro Kurtz, Cássia Righy Shinotsuka, Maria Brandão Tavares, Igor das Virgens Santana, Luciana Macedo da Silva Gavinho, Alaís Brito Nascimento, Adriano J. Pereira, Alexandre Biasi Cavalcanti Revista Brasileira De Terapia Intensiva, 2023
Effect of Intravenous Fluid Treatment with a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial Fernando G. Zampieri, Flávia R. Machado, Rodrigo S. Biondi, Flávio G. R. Freitas, Viviane C. Veiga, Rodrigo C. Figueiredo, Wilson J. Lovato, Cristina P. Amêndola, Ary Serpa-Neto, Jorge L. R. Paranhos, Marco A. V. Guedes, Eraldo A. Lúcio, Lúcio C. Oliveira-Júnior, Thiago C. Lisboa, Fábio H. Lacerda, Israel S. Maia, Cintia M. C. Grion, Murillo S. C. Assunção, Airton L. O. Manoel, João M. Silva-Junior, Péricles Duarte, Rafael M. Soares, Tamiris A. Miranda, Lucas M. de Lima, Rodrigo M. Gurgel, Denise M. Paisani, Thiago D. Corrêa, Luciano C. P. Azevedo, John A. Kellum, Lucas P. Damiani, Nilton Brandão da Silva, Alexandre B. Cavalcanti, Rodrigo Biondi, Renato B. Chaves, Amanda R. Santos, Vitor S. Barzilai, Flávio G. R. de Freitas, Nathaly F. Nunes, Rodrigo C. da Cunha, Elijane F. Alves, Rodrigo C. Figueiredo, Rodrigo B. Bortolini, Cintia L. Sartori, Eduardo S. Marques, Maria A de Sousa, Danieri Y. V. Tomotani, Airton L. O. Manoel, Wilson J. Lovato, Bruno G. Dantas, Leonardo C. Palma, Fábio L. da Silva, Cristina P. Amendola, Luciana C. Sanches, Fernanda A. M. Scuoteguazza, Ligia Z. de Britto, Ary Serpa, Niklas S. Campos, Fabio B. Hohmann, Guilherme B. Olivato, Jorge L.R. Paranhos, Iany G. da Silva, Adilson de C. Meireles, Viviane C. Veiga, Juliana C. Coelho, Maiko M. Silveira, Agnes C. Lisboa, Marco A.V. Guedes, Luiz C.S. Passos, Daniela C. Dorta, Ramana A. Rangel, Péricles Duarte, Eraldo de A. Lúcio, Eduardo B. Tondo, Pablo A.A. Vaz, Paula K. de Oliveira, Lúcio C. de Oliveira, Paulo H.P. Ferreira, Patrick H.S. Sampaio, Maurício G.S. Serra, Thiago C. Lisboa, Caroline Fachini, André P. Torelly, Alldren Souza, Fábio H. Lacerda, Eliana V. N. Martins, Bruno A.M.P. Besen, Carlos E. Brandão, João M. Silva, Flávio W.F. Melo, Flávio A. dos Santos, Israel S. Maia, Cássio L. Zandonai, Eduardo Berbigier, Cíntia M.C. Grion, Josiane Festti, Ana Luiza Mezzaroba, José Andrade, Marianne S. Camargo, Adriano F. Teixeira, José de S. Andrade, Michele M.G. de Godoy, Andréia de F. T. de Mendonça, Mara L.F.S. Mendes, Renata C.I.C. Beltrão, Edson Romano, Marcelo L.P. Romano, Andre F. Costa, Jorge Farran, Felipe Dal-Pizzol, Danusa Damásio, Renata Gonçalves, Émerson B. da Silva, Luiz de F. Ferreira, Rafael L. da Costa, Kellen Lopes, Miquéias M.L. Silva, Douglas L.A.B. de Matos, Renata de A. Marques, Glauco A. Westphal, Miriam C. Machado, Juliano Ramos, Luiz M.S. Malbouisson, Bruno N. Lucena, Marlus M. Thompson, Lanese M. Figueiredo, Luana F. Mourão, Thiago S. Garces, Israel da S. Maia, Jaqueline F. Rohr, Fernanda Fontanela, Cassia P. B. Martins, Álvaro Rea, Fernanda Reese, Mirella Oliveira, André L. N. Gobatto, Luciana S. de Mattos, Carolaine B. de Oliveira, Meton S. de Alencar, Jussara A. Arraes, João G.T. Alves, Thiago C. De Morais, Antônio A. P. Fagundes, Roberta T. Tallarico, Thais Coutinho, Ronald Torres, Fernando J.S. Ramos, Fernanda C. Athalla, Mauricio H.C. dos Santos, Paulo M.G. Nose, Cássia R. Shinotsuka, Pedro Kurtz, Bruno Guimarães, Luciana G. Pereira, Raquel B. Jupato, Bruno de A. Bravim, Marcos F. Knibel, Allan S. da Silva, Vinícius G. de Luca, Niklas Soderberg, Roseny dos R. Rodrigues, Luis E.P. Pfingsten, Cassiano Teixeira, José H.D. Barth, Giselle C. Pratini, Luiz Dalfior, Márcio H. Kai, Sérgio Blecher, Hugo C. A. Urbano, Lucas L. Carvalho, Danielle C. A. Moreira, Ana L. S. Bernardes, Vandack A. Nobre, Paula F. Vassallo, Cecília G. Ravetti, Ho Y. Li, Vivian V. T. Sales, Renata Guazzelli, Rafael D. de Oliveira, Leandro Pozzo, Leandro U. Taniguchi, Pedro V. Mendes, Suzana M. A. Lobo, Miriam Machado, Ana B. B. Camacho, Pablo O. Tomba, Fred C. T. Lizidatti, Walter C. G. Baptista, Aline R. Moreira, Manoela M. de Sousa, Marcelo O. Santos, Karla Moretto, Priscilla A. de Martins, Liz M. L. de Souza, Thiago R. Sequeira, Manoel M. S. Pedrinha, Marcone L. S. da Rocha, Francisco R. V. Saleiro, Tatiana M. Clementino, Hélio P. Guimarães, Marcos C. R. Mello, Mirella C. de Oliveira, Fernanda B. Reese, Denise M. Ferreira, Fernanda A. F. Gonçalves, Roberta M. L. Roepke, Bruno M. Tomazini, Sidiner M. Vaz, Miria Bonjour Laviola, Thiago D. Correa, Roger M. Alencar, Denise N. Freitas, Heitor P. Póvoas, Liliane B. S. Passos, Juliane de M. Silva, and JAMA Journal of the American Medical Association, 2021
Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial Fernando G. Zampieri, Flávia R. Machado, Rodrigo S. Biondi, Flávio G. R. Freitas, Viviane C. Veiga, Rodrigo C. Figueiredo, Wilson J. Lovato, Cristina P. Amêndola, Murillo S. C. Assunção, Ary Serpa-Neto, Jorge L. R. Paranhos, José Andrade, Michele M. G. Godoy, Edson Romano, Felipe Dal Pizzol, Emerson B. Silva, Miqueias M. L. Silva, Miriam C. V. Machado, Luiz Marcelo S. Malbouisson, Airton L. O. Manoel, Marlus M. Thompson, Lanese M. Figueiredo, Rafael M. Soares, Tamiris A. Miranda, Lucas M. de Lima, Eliana V. Santucci,, Thiago D. Corrêa, Luciano C. P. Azevedo, John A. Kellum, Lucas P. Damiani, Nilton B. Silva, Alexandre B. Cavalcanti, Rodrigo Biondi, Bruno C. R. Amaral, Edvar Ferreira R., Andrea Z. Abdalla, Flávio G. R. de Freitas, Nathaly F. Nunes, Rodrigo C. da Cunha, Elijane F. Alves, Rodrigo C. Figueiredo, Rodrigo B. Bortolini, Cintia L. Sartori, Eduardo S. Marques, Maria A de Sousa, Danieri Y. V. Tomotani, Airton L. O. Manoel, Wilson J. Lovato, Bruno G. Dantas, Leonardo C. Palma, Fábio L. da Silva, Cristina P. Amendola, Luciana C. Sanches, Fernanda A. M. Scuoteguazza, Ligia Z. de Britto, Ary Serpa, Niklas S. Campos, Fabio B. Hohmann, Guilherme B. Olivato, Jorge L.R. Paranhos, Iany G. da Silva, Adilson de C. Meireles, Viviane C. Veiga, Juliana C. Coelho, Maiko M. Silveira, Agnes C. Lisboa, Marco A.V. Guedes, Luiz C.S. Passos, Daniela C. Dorta, Ramana A. Rangel, Péricles Duarte, Eraldo de A. Lúcio, Eduardo B. Tondo, Pablo A.A. Vaz, Paula K. de Oliveira, Lúcio C. de Oliveira, Paulo H.P. Ferreira, Patrick H.S. Sampaio, Maurício G.S. Serra, Thiago C. Lisboa, Caroline Fachini, André P. Torelly, Alldren Souza, Fábio H. Lacerda, Eliana V. N. Martins, Bruno A.M.P. Besen, Carlos E. Brandão, João M. Silva, Flávio W.F. Melo, Flávio A. dos Santos, Israel S. Maia, Cássio L. Zandonai, Eduardo Berbigier, Cíntia M.C. Grion, Josiane Festti, Ana Luiza Mezzaroba, José Andrade, Marianne S. Camargo, Adriano F. Teixeira, José de S. Andrade, Michele M.G. de Godoy, Andréia de F. T. de Mendonça, Mara L.F.S. Mendes, Renata C.I.C. Beltrão, Edson Romano, Marcelo L.P. Romano, Andre F. Costa, Jorge Farran, Felipe Dal-Pizzol, Danusa Damásio, Renata Gonçalves, Émerson B. da Silva, Luiz de F. Ferreira, Rafael L. da Costa, Kellen Lopes, Miquéias M.L. Silva, Douglas L.A.B. de Matos, Renata de A. Marques, Glauco A. Westphal, Miriam C. Machado, Juliano Ramos, Luiz M.S. Malbouisson, Bruno N. Lucena, Marlus M. Thompson, Lanese M. Figueiredo, Luana F. Mourão, Thiago S. Garces, Israel da S. Maia, Jaqueline F. Rohr, Fernanda Fontanela, Cassia P. B. Martins, Álvaro Rea, Fernanda Reese, Mirella Oliveira, André L. N. Gobatto, Luciana S. de Mattos, Carolaine B. de Oliveira, Meton S. de Alencar, Jussara A. Arraes, João G.T. Alves, Thiago C. De Morais, Antônio A. P. Fagundes, Roberta T. Tallarico, Thais Coutinho, Ronald Torres, Fernando J.S. Ramos, Fernanda C. Athalla, Mauricio H.C. dos Santos, Paulo M.G. Nose, Cássia R. Shinotsuka, Pedro Kurtz, Bruno Guimarães, Luciana G. Pereira, Raquel B. Jupato, Bruno de A. Bravim, Marcos F. Knibel, Allan S. da Silva, Vinícius G. de Luca, Niklas Soderberg, Roseny dos R. Rodrigues, Luis E.P. Pfingsten, Cassiano Teixeira, José H.D. Barth, Giselle C. Pratini, Luiz Dalfior, Márcio H. Kai, Sérgio Blecher, Hugo C. A. Urbano, Lucas L. Carvalho, Danielle C. A. Moreira, Ana L. S. Bernardes, Vandack A. Nobre, Paula F. Vassallo, Cecília G. Ravetti, Ho Y. Li, Vivian V. T. Sales, Renata Guazzelli, Rafael D. de Oliveira, Leandro Pozzo, Leandro U. Taniguchi, Pedro V. Mendes, Suzana M. A. Lobo, Miriam Machado, Ana B. B. Camacho, Pablo O. Tomba, Fred C. T. Lizidatti, Walter C. G. Baptista, Aline R. Moreira, Manoela M. de Sousa, Marcelo O. Santos, Karla Moretto, Priscilla A. de Martins, Liz M. L. de Souza, Thiago R. Sequeira, Manoel M. S. Pedrinha, Marcone L. S. da Rocha, Francisco R. V. Saleiro, Tatiana M. Clementino, Hélio P. Guimarães, Marcos C. R. Mello, Mirella C. de Oliveira, Fernanda B. Reese, Denise M. Ferreira, Fernanda A. F. Gonçalves, Roberta M. L. Roepke, Bruno M. Tomazini, Sidiner M. Vaz, Miria Bonjour Laviola, Thiago D. Correa, Roger M. Alencar, Denise N. Freitas, Heitor P. Póvoas, Liliane B. S. Passos, Juliane de M. Silva, , , and JAMA Journal of the American Medical Association, 2021
Resuscitation fluid practices in Brazilian intensive care units: A secondary analysis of Fluid-TRIPS Flavio Geraldo Rezende de Freitas, Naomi Hammond, Yang Li, Luciano Cesar Pontes de Azevedo, Alexandre Biasi Cavalcanti, Leandro Taniguchi, André Gobatto, André Miguel Japiassú, Antonio Tonete Bafi, Bruno Franco Mazza, Danilo Teixeira Noritomi, Felipe Dal-Pizzol, Fernando Bozza, Jorge Ibrahin Figueira Salluh, Glauco Adrieno Westphal, Márcio Soares, Murillo Santucci César de Assunção, Thiago Lisboa, Suzana Margarete Ajeje Lobo, Achilles Rohlfs Barbosa, Adriana Fonseca Ventura, Ailson Faria de Souza, Alexandre Francisco Silva, Alexandre Toledo, Aline Reis, Allan Cembrane, Alvaro Rea Neto, Ana Lúcia Gut, Ana Patricia Pierre Justo, Ana Paula Santos, André Campos D. de Albuquerque, André Scazufka, Antonio Babo Rodrigues, Bruno Bonaccorsi Fernandino, Bruno Goncalves Silva, Bruno Sarno Vida, Bruno Valle Pinheiro, Bruno Vilela Costa Pinto, Carlos Augusto Ramos Feijo, Carlos de Abreu Filho, Carlos Eduardo da Costa Nunes Bosso, Carlos Eduardo Nassif Moreira, Carlos Henrique Ferreira Ramos, Carmen Tavares, Cidamaiá Arantes, Cintia Grion, Ciro Leite Mendes, Claudio Kmohan, Claudio Piras, Cristine Pilati Pileggi Castro, Cyntia Lins, Daniel Beraldo, Daniel Fontes, Daniela Boni, Débora Castiglioni, Denise de Moraes Paisani, Durval Ferreira Fonseca Pedroso, Ederson Roberto Mattos, Edgar de Brito Sobrinho, Edgar M. V. Troncoso, Edison Moraes Rodrigues Filho, Eduardo Enrico Ferrari Nogueira, Eduardo Leme Ferreira, Eduardo Souza Pacheco, Euzebio Jodar, Evandro L. A. Ferreira, Fabiana Fernandes de Araujo, Fabiana Schuelter Treviso, Fábio Ferreira Amorim, Fabio Poianas Giannini, Fabrício Primitivo Matos Santos, Fátima Buarque, Felipe Gallego Lima, Fernando Antonio Alvares da Costa, Fernando Cesar dos Anjos Sad, Fernando G. Aranha, Fernando Ganem, Flavio Callil, Francisco Flávio Costa Filho, Frederico Toledo Campo Dall´Arto, Geovani Moreno, Gilberto Friedman, Giulliana Martines Moralez, Guilherme Abdalla da Silva, Guilherme Costa, Guilherme Silva Cavalcanti, Guilherme Silva Cavalcanti, Gustavo Navarro Betônico, Gustavo Navarro Betônico, Hélder Reis, Helia Beatriz N. Araujo, Helio Anjos Hortiz Júnior, Helio Penna Guimaraes, Hugo Urbano, Israel Maia, Ivan Lopes Santiago Filho, Jamil Farhat Júnior, Janu Rangel Alvarez, Joel Tavares Passos, Jorge Eduardo da Rocha Paranhos, José Aurelio Marques, José Gonçalves Moreira Filho, Jose Neto Andrade, José Onofre de C Sobrinho, Jose Terceiro de Paiva Bezerra, Juliana Apolônio Alves, Juliana Ferreira, Jussara Gomes, Karina Midori Sato, Karine Gerent, Kathia Margarida Costa Teixeira, Katia Aparecida Pessoa Conde, Laércia Ferreira Martins, Lanese Figueirêdo, Leila Rezegue, Leonardo Tcherniacovsk, Leone Oliveira Ferraz, Liane Cavalcante, Ligia Rabelo, Lilian Miilher, Lisiane Garcia, Luana Tannous, Ludhmila Abrahão Hajjar, Luís Eduardo Miranda Paciência, Luiz Monteiro da Cruz Neto, Macia Valeria Bley, Marcelo Ferreira Sousa, Marcelo Lourencini Puga, Marcelo Luz Pereira Romano, Marciano Nobrega, Marcio Arbex, Márcio Leite Rodrigues, Márcio Osório Guerreiro, Marcone Rocha, Maria Angela Pangoni Alves, Maria Angela Pangoni Alves, Maria Doroti Rosa, Mariza D’Agostino Dias, Miquéias Martins, Mirella de Oliveira, Miriane Melo Silveira Moretti, Mirna Matsui, Octavio Messender, Orlando Luís de Andrade Santarém, Patricio Júnior Henrique da Silveira, Paula Frizera Vassallo, Paulo Antoniazzi, Paulo César Gottardo, Paulo Correia, Paulo Ferreira, Paulo Torres, Pedro Gabrile M. de Barros e Silva, Rafael Foernges, Rafael Gomes, Rafael Moraes, Raimundo Nonato filho, Renato Luis Borba, Renato V Gomes, Ricardo Cordioli, Ricardo Lima, Ricardo Pérez López, Ricardo Rath de Oliveira Gargioni, Richard Rosenblat, Roberta Machado de Souza, Roberto Almeida, Roberto Camargo Narciso, Roberto Marco, Roberto waltrick, Rodrigo Biondi, Rodrigo Figueiredo, Rodrigo Santana Dutra, Roseane Batista, Rouge Felipe, Rubens Sergio da Silva Franco, Sandra Houly, Sara Socorro Faria, Sergio Felix Pinto, Sergio Luzzi, Sergio Sant’ana, Sergio Sonego Fernandes, Sérgio Yamada, Sérgio Zajac, Sidiner Mesquita Vaz, Silvia Aparecida Bezerra Bezerra, Tatiana Bueno Tardivo Farhat, Thiago Martins Santos, Tiago Smith, Ulysses V. A. Silva, Valnei Bento Damasceno, Vandack Nobre, Vicente Cés de Souza Dantas, Vivian Menezes Irineu, Viviane Bogado, Wagner Nedel, Walther Campos Filho, Weidson Dantas, William Viana, Wilson de Oliveira Filho, Wilson Martins Delgadinho, Simon Finfer, Flavia Ribeiro Machado Revista Brasileira De Terapia Intensiva, 2021
Statistical analysis plan for the Balanced Solution versus Saline in Intensive Care Study (BaSICS) L. Damiani, A. Cavalcanti, R. Biondi, F. Freitas, Rodrigo Cruvinel Figueiredo, W. J. Lovato, C. Amêndola, A. Serpa Neto, Jorge L Paranhos, V. Veiga, M. Guedes, Eraldo de Azevedo Lúcio, Lúcio Couto Oliveira Júnior, T. Lisboa, F. Lacerda, T. A. Miranda, I. Maia, C. Grion, F. Machado, F. Zampieri Revista Brasileira De Terapia Intensiva, 2020
