Professor in the Postgraduate Program in Adult Intensive Care at Hospital Israelita Albert Einstein. Intensivist at the Intensive Care Center (CTIA) of Hospital Israelita Albert Einstein.
EDUCATION
Graduated in Medicine from the Federal University of Alagoas (2016). Residency in Internal Medicine at Conjunto Hospitalar do Mandaqui (2019) and in Critical Care Medicine at Hospital Israelita Albert Einstein (2021). Board-certified in Intensive Care Medicine by the Brazilian Association of Intensive Care Medicine (AMIB - 2021). Preceptor of the Adult Intensive Care Medical Residency Program at Hospital Israelita Albert Einstein (2021-2023). Master's degree in Health Sciences at the Albert Einstein Israeli Faculty of Health Sciences (FICSAE).
RESEARCH, TEACHING, or OTHER INTERESTS
Critical Care and Intensive Care Medicine
7
Scopus Publications
Scopus Publications
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.
Factors associated with the intubation of patients with acute respiratory failure and their impact on mortality: a retrospective cohort study Fabio Barlem Hohmann, Thais Dias Midega, Ricardo Esper Treml, Vinicius Barbosa Galindo, Gabriele Veiga, Isabelle Machado, Maria Regina Kraft, Sávio Custódio, Eduardo Paolinelli, Felipe Galdino, João Manoel Silva BMC Pulmonary Medicine, 2025 BACKGROUND: Severe respiratory failure often requires invasive mechanical ventilation, identifying the factors that lead to this need is crucial. This study aims to identify risk factors for invasive mechanical ventilation and clinical outcomes in patients with acute respiratory failure from the time of onset of symptoms to respiratory failure. METHODS: This retrospective cohort included adults with confirmed COVID-19 admitted to Intermediate or Intensive Care Units between May 1, 2020, and May 1, 2021. Inclusion required chest computed tomography (CT) and inflammatory markers (CRP, D-dimer, ferritin, IL-6) within 72 h of admission. The primary outcome was the need for orotracheal intubation and its association with mortality. Multivariate Cox regression and time-stratified analyses were performed. RESULTS: Of 550 patients, 346 (63%) required intubation. The overall in-hospital mortality rate was 21.6%. Intubated patients had higher BMI (p = 0.02), SAPS-3 scores (p < 0.001), and elevated CRP, IL-6, and D-dimer. CT findings showed greater lung consolidation, especially after the second week. SAPS 3 and time from symptom onset to intubation were independent predictors of mortality. Patients intubated ≥ 15 days after symptom onset had significantly higher mortality (OR = 2.13; 95% CI: 1.07-4.23), despite similar oxygenation levels at the time of intubation. These patients also had longer use of non-invasive support. CONCLUSION: Delayed intubation beyond 15 days from symptom onset is associated with increased mortality. Integrating inflammatory markers and CT findings may help identify patients at risk for clinical deterioration. Timely transition from non-invasive to invasive support may improve outcomes.
Outcomes and predictors of in-hospital mortality among patients admitted to the intensive care or step-down unit after a rapid response team activation: A retrospective cohort study Vinicius Barbosa Galindo, Thais Dias Midega, Guilherme Martins de Souza, Fábio Barlem Hohmann, Mayara Laise Assis, Ricardo Luiz Cordioli, Roseny dos Reis Rodrigues, Gustavo Faissol Janot de Matos, Andréia Pardini, Michele Jaures, Bruno de Arruda Bravim, Claudia Regina Laselva, Constantino Jose Fernandes Jr, Thiago Domingos Corrêa Plos One, 2025 Introduction It has been demonstrated that the implementation of rapid response teams (RRT) may improve clinical outcomes. Nevertheless, predictors of mortality among patients admitted to the intensive care unit (ICU) or to the step-down unit (SDU) after a RRT activation are not fully understood. Objective To describe clinical characteristics, resource use, main outcomes, and to address predictors of in-hospital mortality among patients admitted to the ICU/SDU after RRT activation. Methods Retrospective single-center cohort study conducted in a medical-surgical ICU/SDU located in a private quaternary care hospital. Adult patients admitted to the ICU or SDU between 2012 and 2020 were compared according to in-hospital mortality. A multivariate logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results Among the 3841 patients included in this analysis [3165 (82.4%) survivors and 676 (17.6%) non-survivors], 1972 (51.3%) were admitted to the ICU and 1869 (48.7%) were admitted to the SDU. Compared to survivors, non-survivors were older [76 (64–87) yrs. vs. 67 (50–81) yrs.; p < 0.001], had a higher SAPS 3 score [64 (56–72) vs. 49 (40–57); p < 0.001], and had a longer length of stay (LOS) before unit admission [8 (3–19) days vs. 2 (1–7) days; p < 0.001). Non-survivors used more non-invasive ventilation (NIV) (42.2% vs. 20.9%; p < 0.001), mechanical ventilation (MV) (36.7% vs. 9.3%; p < 0.001), vasopressors (39.2% vs. 12.3%; p < 0.001), renal replacement therapy (15.5% vs. 4.3%; p < 0.001), and blood components transfusion (34.9% vs. 14.0%; p < 0.001). Independent predictors of in-hospital mortality were the SAPS 3 score, the Charlson Comorbidity Index, LOS before unit admission, immunosuppression, respiratory rate < 8 or > 28 ipm criteria for RRT activation, RRT activation during the night shift, and the need for high-flow nasal cannula, NIV, MV, vasopressors, and blood components transfusion. Conclusion Multiple factors may affect outcomes of ICU/SDU-admitted patients after RRT activation. Therefore, efforts should be made to boost RRT effectiveness to improve patient safety.
Multicenter observational study of patients who underwent cardiac surgery and were hospitalized in an intensive care unit (BraSIS 2): study protocol and statistical analysis plan Nair Naiara Barros de Vasconcelos, Renato Carneiro de Freitas Chaves, Carolina de Moraes Pellegrino, Guilherme Martins de Souza, Veronica Neves Fialho Queiroz, Carmen Silvia Valente Barbas, Flávio Takaoka, Ricardo Luiz Cordioli, Sandrigo Mangini, Fabio de Vasconcelos Papa, Hélio Penna Guimarães, Adriano José Pereira, Ary Serpa, Andre Gulinelli, Anna Clara Legal, Caio Vinicius Gouvêa Jaoude, Eduardo Paolinelli, Eric Benedet Lineburger, Erick César de Farias Albuquerque, Evaldo Gomes Ferreira, Fabio Barlem Hohmann, Felipe Galdino, Felipe Souza Lima Vianna, Frederico Toledo Campo Dall’Orto, Lucas Tramujas, Luciano Ribeiro Pereira Silva, Maxim Goncharov, Paulo César Gottardo, Roberto Rabello, Thais Dias Midega, Vinicius Barbosa Galindo, Vinícius Caldeira Quintão, Viviane Cordeiro Veiga, Thiago Domingos Corrêa, João Manoel Silva Critical Care Science, 2025 BACKGROUND: The perioperative management of patients undergoing cardiac surgery is highly complex and involves numerous factors. There is a strong association between cardiac surgery and perioperative complications. The Brazilian Surgical Identification Study (BraSIS 2) aims to assess the incidence of death and early postoperative complications, identify potential risk factors, and examine both the demographic characteristics of patients and the epidemiology of cardiovascular procedures. METHODS AND ANALYSIS: BraSIS 2 is a multicenter observational study of patients who undergo cardiac surgery and who are admitted to the intensive care unit. The primary objective is to describe the risk factors and incidence of mortality or severe postoperative complications occurring within the first 3 postoperative days of cardiac surgery or until intensive care unit discharge (whichever event occurs first). Severe postoperative complications include acute myocardial infarction, acute respiratory distress syndrome, cardiorespiratory arrest with return of spontaneous circulation, Kidney Disease Improving Global Outcomes stage ≥ 2, a new surgical approach being conducted in an unscheduled event of urgency or emergency, renal replacement therapy, septic shock, severe bleeding, severe hemodynamic instability, stroke, unplanned reintubation, and unplanned use of a circulatory assistance device. The secondary outcomes include the evaluation of patient characteristics and descriptions of the performed surgeries and administered anesthesia. This study will also assess intraoperative and postoperative complications, as well as risk factors associated with postoperative complications and mortality. We expect to recruit 500 patients from at least 10 Brazilian intensive care units. Trial registration: NCT06154473; partial results.
Polishing the Core: Refining Venous Excess Ultrasound for Venous Congestion Assessment Rogerio da Hora Passos, Pedro Guadix Zulian Teixeira, Carolina de Moraes Pellegrino, Vinicius Barbosa Galindo, Renan Sandoval de Almeida, Thais Dias Midega, Uri Adrian Prync Flato Cardiorenal Medicine, 2024 Dear Editor,I read with great interest the recent article titled “Unlocking the Potential of VExUS in Assessing Venous Congestion: The Art of Doing it Right,” which critically examines the utility of venous excess ultrasound (VExUS) scores in assessing venous congestion. The article evaluates venous congestion across different clinical scenarios and patient populations, including those with heart failure and in critical illness [1]. While the article admirably underscores the importance of VExUS in guiding fluid management and predicting outcomes, I am particularly interested in delving deeper into certain caveats and limitations necessary to enhance its clinical applicability.The article rightly highlights the technical intricacies involved in performing VExUS assessments, particularly in interpreting inferior vena cava (IVC) and internal jugular vein ultrasound, along with Doppler evaluations. However, it is crucial to acknowledge the complexities associated with using IVC diameter alone to estimate right atrial pressure, especially in mechanically ventilated patients where such correlations may not hold uniformly. Factors such as anatomical variations, abdominal compliance, and intra-abdominal pressure dynamics can significantly influence IVC measurements, necessitating a nuanced approach that includes comprehensive visualization techniques and possibly integrating alternative modalities like internal jugular vein dynamics to mitigate potential inaccuracies [2].The article appropriately discusses how local structural changes in liver and kidney diseases can impact Doppler waveforms, thereby complicating the interpretation of VExUS findings. It is imperative to recognize that conditions such as liver cirrhosis or acute kidney injury can markedly alter venous hemodynamics, potentially confounding the reliability of traditional ultrasound parameters [3]. In such clinical scenarios, the integration of supplementary diagnostic tools and clinical judgment becomes indispensable to augment VExUS assessments and ensure judicious therapeutic decision-making [4].While acknowledging the established prognostic value of VExUS in cardiac surgery settings, the article rightly underscores the variability in its predictive accuracy across broader intensive care unit (ICU) populations. Discussions around the correlation between VExUS scores and clinical outcomes such as acute kidney injury or mortality highlight existing inconsistencies in the literature. For instance, while some studies report significant associations between higher VExUS grades and adverse outcomes, others suggest limited predictive utility in heterogeneous ICU cohorts [5]. This variability underscores the urgent need for methodologically rigorous multicenter studies with robust sample sizes to validate the prognostic efficacy of VExUS across diverse patient profiles and clinical contexts.The article’s introduction of the concept of “fluid tolerance” and emphasis on assessing hemodynamic congestion before administering fluids reflect a prudent approach aligned with contemporary patient-centered care principles. However, it is essential to underscore the complexity of fluid responsiveness assessment in critically ill patients, where individualized hemodynamic profiles and therapeutic goals necessitate a nuanced approach. Balancing the risks of fluid overload against the imperative to maintain adequate tissue perfusion underscores the critical role of integrating comprehensive clinical assessment with advanced diagnostic tools like VExUS to optimize fluid management strategies effectively [6].To enhance the clinical utility of VExUS, concerted efforts are warranted to standardize training protocols for clinicians and refine measurement techniques to mitigate interobserver variability. Moreover, expanding research initiatives should prioritize investigating the role of VExUS in specific patient cohorts, including those with complex hepatic or renal pathophysiology, to elucidate its utility beyond traditional ICU settings. Multicenter collaborations are essential to establish robust evidence supporting the broader applicability of VExUS in predicting clinical outcomes and guiding tailored therapeutic interventions.In conclusion, while recognizing the potential of VExUS as a valuable tool in assessing venous congestion and optimizing fluid management in critically ill patients, ongoing scientific rigor and methodological refinement are imperative to enhance its clinical validity and utility. As a practitioner committed to advancing nephrological care, I advocate for continued interdisciplinary collaboration and evidence-based research to maximize the impact of VExUS in improving patient outcomes.The authors have no conflicts of interest to declare.This study was not supported by any sponsor or funder.R.H.P. and P.G.Z.T. conceived and designed the study, drafted the initial manuscript, and performed critical revisions. C.M.P., V.B.G., R.S.A., T.D.M., and U.A.P.F. reviewed and edited the manuscript. All authors approved the final version.
Characteristics, risk factors, and outcomes of bloodstream Candida infections in the intensive care unit: a retrospective cohort study Fábio Barlem Hohmann, Renato Carneiro de Freitas Chaves, Guilherme Benfatti Olivato, Guilherme Martins de Souza, Vinicius Barbosa Galindo, Moacyr Silva Jr, Marines Dalla Valle Martino, Fernando Gatti de Menezes, Thiago Domingos Corrêa Journal of International Medical Research, 2023 Objective The main objective was to assess the clinical characteristics, associated factors, and outcomes of patients admitted to the ICU for candidemia. The secondary objective was to examine the relationship of candidemia with the length of stay and mortality. Methods The analysis was a retrospective single-center cohort study addressing the effect of invasive candidemia on outcomes. This study was performed in a medical-surgical ICU located in a tertiary private hospital in São Paulo, Brazil. Data was collected through the review of the hospital database. Results In total, 18,442 patients were included in our study, including 22 patients with candidemia. The median age was similar in patients with and without candidemia [67 (56–84) vs. 67 (51–80)]. Most patients were male, and the proportion of men was higher among patients with candidemia (77% vs. 55.3%). The rates of renal replacement therapy (40.9% vs. 3.3%), mechanical ventilation (63.6% vs. 29.6%), and parenteral nutrition (40.9% vs. 4.8%) were higher in patients with candidemia than in those without candidemia. The mortality rate (77.3% vs. 11.9%) and length of hospital stay [42 days (23.0–78.8) vs. 8 days (5.0–17.0)] were significantly higher in patients with candidemia. Conclusions Patients with candidemia are prone to longer hospital stay and mortality. In addition, we found associations of candidemia with the use of invasive mechanical ventilation, renal replacement therapy, and parenteral nutrition.
