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Papers by Américo Gonçalves
Canadian respiratory journal, 2018
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory ins... more Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmo...
Pediatric Research, 2011
Background and aims: Respiratory syncytial virus (RSV) lower respiratory tract infection of the n... more Background and aims: Respiratory syncytial virus (RSV) lower respiratory tract infection of the newborn can present itself as a pulmonary obstructive disease with hyperinflation, or as pneumonitis, a restrictive parenchymal disease with diffuse consolidation areas. The association between the chest radiographic pattern and the severity of the disease regarding ventilator support has been suggested before, but is not well established. Our aim is to evaluate if chest radiographic pattern (hyperinflation vs consolidation) in RSV infection can predict disease severity, need for mechanical ventilation and risk of complications. Methods: We conducted a multicenter retrospective cohort study in term and preterm neonates (≤44 weeks corrected gestational age) with confirmed lower respiratory tract RSV infection, admitted to eight level III Neonatal Intensive Care Units from 2000 to 2010. Inferential analysis was performed using the Chi-square test of independence, with a confidence interval of 95%. Results: A total of 259 neonates were enrolled. Patients with a consolidation pattern on the chest radiograph at admission (n=101) had greater need for: invasive mechanical ventilation (20.8% vs 8.2%; p=.001), noninvasive mechanical ventilation (28.7% vs. 20.9%; p=.001), supplemental oxygen (92.0% vs. 78.5%; p=.004) and higher ventilator settings. The risk of secondary bacterial pneumonia(42.0% vs. 13.3%; p< .001) was also increased. No statistically significant association was found with bronchopulmonary dysplasia, pneumothorax, subglotic stenosis or death. Conclusion: In neonates with RSV infection of the lower respiratory tract the initial radiographic pattern of pneumonitis (consolidation) was associated with increased disease severity, need for mechanical ventilation and development of complications.
Pediatrics, 2011
METHODS We conducted a prospective cohort study with 463 newborns with gestational ages of 35 wee... more METHODS We conducted a prospective cohort study with 463 newborns with gestational ages of 35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, ...
GE Jornal Português de Gastrenterologia, 2014
ABSTRACT Introduction Treatment of Crohn disease in pediatric patients must ensure not only sympt... more ABSTRACT Introduction Treatment of Crohn disease in pediatric patients must ensure not only symptom control but also remission, allowing normal growth and development. Infliximab has been shown to be effective in controlling disease in children and adolescents unresponsive to first-line treatment, although 30 to 55% of failure occurs, requiring therapeutic adjustments. Recent pediatric studies have shown that the efficacy of reducing the range from 8 to 6/7 weeks, increasing the dose to 10 mg/kg dose or shortening the interval up to 4 weeks is similar. Objective and methods Retrospective descriptive study of pediatric patients who were diagnosed with Crohn Disease and had infliximab treatment in last five years, with evaluation of treatment failure situations. Results We included 16 patients (10 males, 6 females) treated with infliximab induction regimen, followed by 5 mg/kg every 8 weeks. In most patients, treatment was initiated 10 months after diagnosis. In 50% there was clinical and/or analytical relapse, on average after 10 cycles of treatment (median 6.5), leading to an adjustment of the therapeutic regimen: 6 shortened the interval to 6/7 weeks, 1 shortened the interval to 4 weeks and 1 increased the dose to 10 mg/kg. Of the 6 patients with 5 mg/kg dose and interval of 6/7 weeks, all had initial favorable response but 4 required an increase of the dose to 10 mg/kg, 2 of them are in remission. The disease remission with infliximab was 81.2%. Discussion Treatment with infliximab was effective in controlling Crohn disease and in reducing the need of steroids, but dose adjustments were necessary, often occurring in the first year of treatment. Clinical changes determined the need of dose or interval increases or reductions. The predictable need to adjust treatment after a few months of treatment justifies that the choice of biologic therapy in Crohn disease has to be carefully considered after failure of other options.
Canadian respiratory journal, 2018
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory ins... more Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmo...
Pediatric Research, 2011
Background and aims: Respiratory syncytial virus (RSV) lower respiratory tract infection of the n... more Background and aims: Respiratory syncytial virus (RSV) lower respiratory tract infection of the newborn can present itself as a pulmonary obstructive disease with hyperinflation, or as pneumonitis, a restrictive parenchymal disease with diffuse consolidation areas. The association between the chest radiographic pattern and the severity of the disease regarding ventilator support has been suggested before, but is not well established. Our aim is to evaluate if chest radiographic pattern (hyperinflation vs consolidation) in RSV infection can predict disease severity, need for mechanical ventilation and risk of complications. Methods: We conducted a multicenter retrospective cohort study in term and preterm neonates (≤44 weeks corrected gestational age) with confirmed lower respiratory tract RSV infection, admitted to eight level III Neonatal Intensive Care Units from 2000 to 2010. Inferential analysis was performed using the Chi-square test of independence, with a confidence interval of 95%. Results: A total of 259 neonates were enrolled. Patients with a consolidation pattern on the chest radiograph at admission (n=101) had greater need for: invasive mechanical ventilation (20.8% vs 8.2%; p=.001), noninvasive mechanical ventilation (28.7% vs. 20.9%; p=.001), supplemental oxygen (92.0% vs. 78.5%; p=.004) and higher ventilator settings. The risk of secondary bacterial pneumonia(42.0% vs. 13.3%; p< .001) was also increased. No statistically significant association was found with bronchopulmonary dysplasia, pneumothorax, subglotic stenosis or death. Conclusion: In neonates with RSV infection of the lower respiratory tract the initial radiographic pattern of pneumonitis (consolidation) was associated with increased disease severity, need for mechanical ventilation and development of complications.
Pediatrics, 2011
METHODS We conducted a prospective cohort study with 463 newborns with gestational ages of 35 wee... more METHODS We conducted a prospective cohort study with 463 newborns with gestational ages of 35 weeks who were admitted to the well-infant nursery. Total bilirubin levels were measured daily until discharge and once after discharge, between the third and eighth days of life, ...
GE Jornal Português de Gastrenterologia, 2014
ABSTRACT Introduction Treatment of Crohn disease in pediatric patients must ensure not only sympt... more ABSTRACT Introduction Treatment of Crohn disease in pediatric patients must ensure not only symptom control but also remission, allowing normal growth and development. Infliximab has been shown to be effective in controlling disease in children and adolescents unresponsive to first-line treatment, although 30 to 55% of failure occurs, requiring therapeutic adjustments. Recent pediatric studies have shown that the efficacy of reducing the range from 8 to 6/7 weeks, increasing the dose to 10 mg/kg dose or shortening the interval up to 4 weeks is similar. Objective and methods Retrospective descriptive study of pediatric patients who were diagnosed with Crohn Disease and had infliximab treatment in last five years, with evaluation of treatment failure situations. Results We included 16 patients (10 males, 6 females) treated with infliximab induction regimen, followed by 5 mg/kg every 8 weeks. In most patients, treatment was initiated 10 months after diagnosis. In 50% there was clinical and/or analytical relapse, on average after 10 cycles of treatment (median 6.5), leading to an adjustment of the therapeutic regimen: 6 shortened the interval to 6/7 weeks, 1 shortened the interval to 4 weeks and 1 increased the dose to 10 mg/kg. Of the 6 patients with 5 mg/kg dose and interval of 6/7 weeks, all had initial favorable response but 4 required an increase of the dose to 10 mg/kg, 2 of them are in remission. The disease remission with infliximab was 81.2%. Discussion Treatment with infliximab was effective in controlling Crohn disease and in reducing the need of steroids, but dose adjustments were necessary, often occurring in the first year of treatment. Clinical changes determined the need of dose or interval increases or reductions. The predictable need to adjust treatment after a few months of treatment justifies that the choice of biologic therapy in Crohn disease has to be carefully considered after failure of other options.