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Hanna L, Porter J, Bauer J, Nguo K. Energy Expenditure in Upper Gastrointestinal Cancers: a Scoping Review. Adv Nutr 2023; 14:1307-1325. [PMID: 37562709 PMCID: PMC10721480 DOI: 10.1016/j.advnut.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
Malnutrition is prevalent in people with upper gastrointestinal (GI) cancers and is associated with shorter survival and poor quality of life. In order to effectively prevent or treat malnutrition, nutrition interventions must ensure appropriate energy provision to meet daily metabolic demands. In practice, the energy needs of people with cancer are frequently estimated from predictive equations which are not cancer-specific and are demonstrated to be inaccurate in this population. The purpose of this scoping review was to synthesize the existing evidence regarding energy expenditure in people with upper GI cancer. Three databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus) were systematically searched to identify studies reporting on resting energy expenditure using indirect calorimetry and total energy expenditure using doubly labeled water (DLW) in adults with any stage of upper GI cancer at any point from diagnosis. A total of 57 original research studies involving 2,125 individuals with cancer of the esophagus, stomach, pancreas, biliary tract, or liver were eligible for inclusion. All studies used indirect calorimetry, and one study used DLW to measure energy expenditure, which was reported unadjusted in 42 studies, adjusted for body weight in 32 studies, and adjusted for fat-free mass in 13 studies. Energy expenditure in upper GI cancer was compared with noncancer controls in 19 studies and measured compared with predicted energy expenditure reported in 31 studies. There was heterogeneity in study design and in reporting of important clinical characteristics between studies. There was also substantial variation in energy expenditure between studies and within and between cancer types. Given this heterogeneity and known inaccuracies of predictive equations in patients with cancer, energy expenditure should be measured in practice wherever feasible. Additional research in cohorts defined by cancer type, stage, and treatment is needed to further characterize energy expenditure in upper GI cancer.
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Affiliation(s)
- Lauren Hanna
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Kay Nguo
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
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Boshier PR, Mistry V, Cushnir JR, Kon OM, Elkin SL, Curtis S, Marczin N, Hanna GB. Breath metabolite response to major upper gastrointestinal surgery. J Surg Res 2015; 193:704-12. [DOI: 10.1016/j.jss.2014.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 12/28/2022]
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Hamai Y, Hihara J, Taomoto J, Yamakita I, Ibuki Y, Okada M. Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer. Dis Esophagus 2014; 28:358-64. [PMID: 24612033 DOI: 10.1111/dote.12207] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We compared the surgical outcomes between 114 patients who did not receive neoadjuvant therapy (group 1) and 92 others who received neoadjuvant chemoradiotherapy (nCRT) (group 2), and assessed the preoperative and surgical factors that influence postoperative morbidity to determine the impact of nCRT on morbidity and mortality after esophagectomy via cervical, right transthoracic, and abdominal approaches. The overall postoperative morbidity rates were 44.7% and 55.4% in groups 1 and 2, respectively (P = 0.13). Rates of anastomotic leak (8.8% vs. 16.3%; P = 0.10), pneumonia (9.6% vs. 13.0%; P = 0.44), recurrent nerve palsy (15.8% vs. 10.9%; P = 0.31), and all other complications did not significantly differ between the groups. Multivariable analysis revealed cervical lymph node dissection (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01-3.84; P = 0.047) as the sole independent covariate for overall morbidity. Furthermore, a history of cardiovascular disease (OR, 2.90; 95% CI, 1.03-8.24; P = 0.045), the retrosternal reconstruction route (OR, 15.15; 95% CI, 3.56-62.50; P = 0.0002), and a longer surgical duration (OR, 1.01; 95% CI, 1.002-1.02; P = 0.01) were independent covariates for anastomotic leakage, and advanced age (OR, 1.08; 95% CI, 1.01-1.15; P = 0.02) and lower body mass index (OR, 1.16; 95% CI, 1.01-1.33; P = 0.04) were independent covariates for pneumonia. However, whether or not patients received nCRT was irrelevant. We found that nCRT is safe for three-incision esophagectomy and it does not increase the incidence of postoperative morbidity and mortality relative to esophagectomy alone.
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Affiliation(s)
- Y Hamai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Weekes CE. Nutritional Requirements of Patients with Cancer. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg 2012; 254:894-906. [PMID: 21785341 DOI: 10.1097/sla.0b013e3182263781] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study the differences in short and long-term outcomes of transthoracic and transhiatal esophagectomy for cancer. BACKGROUND Studies have compared transthoracic with transhiatal esophagectomy with varying results. Previous systematic reviews (1999, 2001) do not include the latest randomized controlled trials. METHODS Systematic review of English-language studies comparing transthoracic with transhiatal esophagectomy up to January 31, 2010. Meta-analysis was used to summate the study outcomes. Methodological and surgical quality of included studies was assessed. RESULTS Fifty-two studies, comprising 5905 patients (3389 transthoracic and 2516 transhiatal) were included in the analysis. No study met all minimum surgical quality standards. Transthoracic operations took longer and were associated with a significantly longer length of stay. There was no difference in blood loss. The transthoracic group had significantly more respiratory complications, wound infections, and early postoperative mortality, whereas anastomotic leak, anastomotic stricture, and recurrent laryngeal nerve palsy rate was significantly higher in the transhiatal group. Lymph node retrieval was reported in 4 studies and was significantly greater in the transthoracic group by on average 8 lymph nodes. Analysis of 5-year survival showed no significant difference between the groups and was subject to significant heterogeneity. CONCLUSIONS This meta-analysis of studies comparing transthoracic with transhiatal esophagectomy for cancer demonstrates no difference in 5-year survival, however lymphadenectomy and reported surgical quality was suboptimal in both groups and the transthoracic group had significantly more advanced cancer. The finding of equivalent survival should therefore be viewed with caution.
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Okamoto H, Sasaki M, Johtatsu T, Kurihara M, Iwakawa H, Akabane M, Hoshino N, Yamamoto H, Murata S, Yamaguchi T, Tani T, Yamamoto A. Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer. J Clin Biochem Nutr 2011; 49:169-73. [PMID: 22128215 PMCID: PMC3208012 DOI: 10.3164/jcbn.11-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/20/2011] [Indexed: 12/26/2022] Open
Abstract
This study was to assess the resting energy expenditure of patients with esophageal cancer using indirect calorimetry. Eight male patients with esophageal cancer and eight male healthy controls were enrolled in this study. All patients underwent transthoracic esophagectomy with lymph nodes dissections. The resting energy expenditure was measured preoperatively, and on postoperative day 7 and 14 using indirect calorimetry. Preoperatively, the measured resting energy expenditure/body weight in these patients was significantly higher than that of the controls (23.3 ± 2.1 kcal/kg/day vs 20.4 ± 1.6 kcal/kg/day), whereas the measured/predicted energy expenditure from the Harris-Benedict equation ratio was 1.01 ± 0.09, which did not differ significantly from the control values. The measured resting energy expenditure/body weight was 27.3 ± 3.5 kcal/kg/day on postoperative day 7, and 23.7 ± 5.07 kcal/kg/day on postoperative day 14. Significant increases in the measured resting energy expenditure were observed on postoperative day 7, and the measured/predicted energy expenditure ratio was 1.17 ± 0.15. In conclusion, patients with operable esophageal cancers were almost normometabolic before surgery. On the other hand, the patients showed a hyper-metabolic status after esophagectomy. We recommended that nutritional management based on 33 kcal/body weight/day (calculated by the measured resting energy expenditure × active factor 1.2-1.3) may be optimal for patients undergoing esophagectomy.
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Affiliation(s)
- Haruka Okamoto
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-tsukinowa, Otsu, Shiga 520-2192, Japan
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Sasaki M, Okamoto H, Johtatsu T, Kurihara M, Iwakawa H, Tanaka T, Shiomi H, Naka S, Kurumi Y, Tani T. Resting energy expenditure in patients undergoing pylorus preserving pancreatoduodenectomies for bile duct cancer or pancreatic tumors. J Clin Biochem Nutr 2011. [PMID: 21562636 DOI: 10.3164/jcbn.10.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We measured the energy expenditure weekly in patients undergoing a pylorus preserving pancreatoduodenectomy for bile duct cancer or pancreatic tumors. Twelve patients (5 women and 7 men; mean age 70.1 years) were enrolled in this study, and their resting energy expenditure levels were determined by indirect calorimetry. In these patients, a significant correlation was observed between the measured resting energy expenditures and the predicted resting energy expenditures calculated by the Harris-Benedict equation. The resting energy expenditures measured before surgery were almost the same as the predicted resting energy expenditures (measured resting energy expenditure: 22.4 ± 3.9 kcal/kg/day vs predicted resting energy expenditure: 21.7 ± 2.0 kcal/kg/day). The measured resting energy expenditure/predicted resting energy expenditure ratio, which reflects the stress factor, was 1.02 ± 0.10. After the pylorus preserving pancreatoduodenectomy, a significant increase in energy expenditure was observed, and the measured resting energy expenditure was 25.7 ± 3.5 kcal/kg/day on postoperative day 7 and 25.4 ± 4.9 kcal/kg/day on postoperative day 14. The measured resting energy expenditure/predicted resting energy expenditure ratio was 1.16 ± 0.14 on postoperative day 7, and 1.16 ± 0.18 on postoperative day 14 respectively. In conclusion, patients undergoing a pylorus preserving pancreatoduodenectomy showed a hyper-metabolic status as evaluated by their measured resting energy expenditure/predicted resting energy expenditure ratio. From our observations, we recommend that nutritional management based on 30 kcal/body weight/day (calculated by the measured resting energy expenditure×activity factor 1.2-1.3) may be optimal for patients undergoing a pylorus preserving pancreatoduodenectomy.
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Affiliation(s)
- Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
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Sasaki M, Okamoto H, Johtatsu T, Kurihara M, Iwakawa H, Tanaka T, Shiomi H, Naka S, Kurumi Y, Tani T. Resting energy expenditure in patients undergoing pylorus preserving pancreatoduodenectomies for bile duct cancer or pancreatic tumors. J Clin Biochem Nutr 2011; 48:183-6. [PMID: 21562636 PMCID: PMC3082071 DOI: 10.3164/jcbn.10-83] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/07/2010] [Indexed: 02/06/2023] Open
Abstract
We measured the energy expenditure weekly in patients undergoing a pylorus preserving pancreatoduodenectomy for bile duct cancer or pancreatic tumors. Twelve patients (5 women and 7 men; mean age 70.1 years) were enrolled in this study, and their resting energy expenditure levels were determined by indirect calorimetry. In these patients, a significant correlation was observed between the measured resting energy expenditures and the predicted resting energy expenditures calculated by the Harris-Benedict equation. The resting energy expenditures measured before surgery were almost the same as the predicted resting energy expenditures (measured resting energy expenditure: 22.4 ± 3.9 kcal/kg/day vs predicted resting energy expenditure: 21.7 ± 2.0 kcal/kg/day). The measured resting energy expenditure/predicted resting energy expenditure ratio, which reflects the stress factor, was 1.02 ± 0.10. After the pylorus preserving pancreatoduodenectomy, a significant increase in energy expenditure was observed, and the measured resting energy expenditure was 25.7 ± 3.5 kcal/kg/day on postoperative day 7 and 25.4 ± 4.9 kcal/kg/day on postoperative day 14. The measured resting energy expenditure/predicted resting energy expenditure ratio was 1.16 ± 0.14 on postoperative day 7, and 1.16 ± 0.18 on postoperative day 14 respectively. In conclusion, patients undergoing a pylorus preserving pancreatoduodenectomy showed a hyper-metabolic status as evaluated by their measured resting energy expenditure/predicted resting energy expenditure ratio. From our observations, we recommend that nutritional management based on 30 kcal/body weight/day (calculated by the measured resting energy expenditure×activity factor 1.2–1.3) may be optimal for patients undergoing a pylorus preserving pancreatoduodenectomy.
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Affiliation(s)
- Masaya Sasaki
- Division of Clinical Nutrition, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, Shiga 520-2192, Japan
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Ma Y, Liu W, Peng J, Huang L, Zhang P, Zhao X, Cheng Y, Qin H. A pilot study of gas chromatograph/mass spectrometry-based serum metabolic profiling of colorectal cancer after operation. Mol Biol Rep 2009; 37:1403-11. [DOI: 10.1007/s11033-009-9524-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 03/20/2009] [Indexed: 01/09/2023]
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García-Peris P, Lozano MA, Velasco C, de La Cuerda C, Iriondo T, Bretón I, Camblor M, Navarro C. Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry. Nutrition 2005; 21:1107-12. [PMID: 16308133 DOI: 10.1016/j.nut.2005.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 03/30/2005] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The prevalence of malnutrition is high in patients with head and neck cancer due to tumor location and coadjuvant treatment. We studied changes in resting energy expenditure (REE) during treatment with chemoradiotherapy and compared the measured REE by indirect calorimetry (IC) with the value estimated by the Harris-Benedict (HB) formula. METHODS Eighteen patients with head and neck cancer (15 men and 3 women, mean age 57 +/- 10.7 y, age range 30-71 y) entered the study. All patients were treated with radiotherapy (70.8 +/- 1 Gy, range 70-72) and received 37.4 +/- 3.5 fractions (range 32-42) and concurrent chemotherapy with cisplatinum (absolute doses of 400 to 1000 mg). Nutrition assessment included anthropometry (body mass index, triceps skinfold thickness, subscapular skinfold thickness, midarm circumference, and midarm muscle circumference) and tetrapolar bioimpedance (Holtain BC). The IC (kcal/24 h; Deltatrac II MBM-200) was performed after an overnight fast. Measurements were done before treatment, at weeks 2, 4, and 6 of treatment, at the end of treatment, and 2 wk after treatment. RESULTS Body mass index decreased during treatment from 24.7 +/- 4.4 kg/m(2) (range 16.9-31.4) to 22.3 +/- 4.2 kg/m(2) (range 15.1-29.6). REE (kcal/24 h) changed significantly during treatment (IC P < 0.05, HB formula P < 0.001). REE measured by IC appeared as a U-shaped curve, but REE estimated by the HB formula decreased during treatment. The HB underestimated REE measurements compared with IC. These differences were statistically significant before treatment, at the end of treatment, and 2 wk after treatment (P < 0.05) and showed a limited clinical agreement with the Bland-Altman method. CONCLUSIONS REE measured by IC significantly changed during chemoradiotherapy. It was higher before treatment, at the end of treatment, and 2 wk after treatment. The HB formula underestimated REE in these patients. IC is a suitable method for measuring REE in this cohort of patients.
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Affiliation(s)
- Pilar García-Peris
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Sato N, Oyamatsu M, Tsukada K, Suzuki T, Hatakeyama K, Muto T. Serial changes in contribution of substrates to energy expenditure after transthoracic esophagectomy for cancer. Nutrition 1997; 13:100-3. [PMID: 9106786 DOI: 10.1016/s0899-9007(96)00382-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was designed to examine the metabolic response of patients following transthoracic esophagectomy for carcinoma of the esophagus during the administration of total parenteral nutrition. Thirty-five patients underwent a right thoracotomy and transthoracic esophagectomy with nodal dissection in the neck, mediastinum, and abdomen. The resting energy expenditure (REE) was measured preoperatively, and on the 1st, 3rd, 5th, and 7th postoperative days (PODs) using indirect calorimetry. The REE was significantly higher following transthoracic esophagectomy on PODs 1, 3, 5, and 7 than preoperatively. The caloric contribution of fat was significantly less on 3rd, 5th, and 7th PODs than on the 1st POD. In contrast, carbohydrate oxidation increased significantly on the 3rd, 5th, and 7th PODs compared to that of the 1st POD. These results may help optimize the nutritional support regimen for post-esophagectomy patients.
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Affiliation(s)
- N Sato
- Department of Surgery, Niigata University School of Medicine, Japan
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Brandi LS, Bertolini R, Janni A, Gioia A, Angeletti CA. Energy metabolism of thoracic surgical patients in the early postoperative period. Effect of posture. Chest 1996; 109:630-7. [PMID: 8617069 DOI: 10.1378/chest.109.3.630] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE To determine the effect of elective thoracic surgery on energy metabolism and gas exchange and to evaluate whether the 30-degree sitting position would affect these variables. DESIGN Prospective, unblinded, controlled study. SETTING Surgical ICU in a university hospital. PATIENTS Twenty-two adult patients undergoing elective pulmonary resection. INTERVENTIONS Posture change from supine to 30-degree sitting position. MEASUREMENTS AND RESULTS Oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient (RQ), and energy expenditure (EE) were measured by means of computerized indirect calorimetry before and after surgery. Heart rate and respiratory frequency were measured continuously during gas exchange measurement. Blood gases were analyzed with an automated blood gas analyzer. Preoperatively, altering position did not affect energy metabolism, gas exchange, and cardiopulmonary variables. Postoperatively, the measured EE was 116% of the expected value. Mean EE and VO2 values for each position were higher than the preoperative values for the corresponding postures (p<0.05 for each position), while VCO2 increased only in the supine position (p<0.05). Mean percent increases in EE, VO2, and VCO2 were significantly lower in the 30-degree sitting position than in the supine position (EE: 7.9+/-2.7% vs 14.4+/-2.3%; p<0.001; VO2: 9.0+/-3.0% vs 16.4+/- 2.6%; p<0.001; VCO2: 3.2+/-2.1% vs 6.5+/-1.4%: p<0.05). Arterial oxygen tension and all the physiologic indexes of gas exchange for each position were worse than the preoperative values for the corresponding postures (p<0.05 for each position). Mean arterial pressure, heart rate, and respiratory frequency for each position were higher than the preoperative values for the corresponding postures (p<0.05 for each position). No changes in mean values of these variables occurred between the two positions postoperatively. CONCLUSIONS The early postoperative period of patients undergoing elective thoracic surgery is characterized by a condition of impaired gas exchange and by a hypermetabolic state. Hypermetabolism can be partly mitigated by assuming the 30-degree sitting position.
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Affiliation(s)
- L S Brandi
- Department of Surgery, Intensive Care Unit at School of Anesthesiology and Intensive Care, University of Pisa, Italy
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