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Lakhal K, Dauvergne JE, Messet-Charriere H, Nay MA, Kamel T, Muller G, Robert-Edan V, Rozec B, Ehrmann S, Jacquier S, Boulain T. Risk factors for poor performance in finger cuff non-invasive monitoring of arterial pressure: A prospective multicenter study. Anaesth Crit Care Pain Med 2024; 43:101333. [PMID: 38048986 DOI: 10.1016/j.accpm.2023.101333] [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: 10/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Compared to the invasive technique, non-invasive monitoring of arterial pressure favors easier and faster implementation while potentially sacrificing some reliability. This may be particularly true for the Clearsight™ system (Edwards Lifesciences), which enables continuous monitoring. We evaluated the risk factors for its poor performance. METHODS Patients with an arterial catheter and stable mean arterial pressure (MAP) over a 5-min period were included. Six pairs of invasive and Clearsight measurements of MAP were collected and the bias between the two techniques was calculated. Poor performance of the Clearsight™ system was defined as either a failure to measure and display MAP or displaying an erroneous MAP (individual bias > 5 mmHg). Fingertip perfusion was assessed using the plethysmographic perfusion index (PI) and the capillary refill time (CRT). RESULTS Among 152 ICU patients (MAP of 81 ± 14 mmHg, norepinephrine in 78 [51%]), 78 (51%) experienced a poor performance of the Clearsight™ system: failure to display MAP in 19 (13%) patients, and erroneous value displayed in 59 (44%). In multivariate analysis, PI ≤ 0.85% (adjusted odds ratio [aOR] = 2.94 [95% confidence interval (95%CI):1.34;6.45]), CRT > 4 s (aOR = 5.28 [95%CI 1.39;20.05]), and the presence of hand edema (aOR = 2.06 [95%CI 1.01;4.21]) were associated with a higher likelihood of poor performance. Cardiac arrhythmia (aOR = 1.39 [95%CI 0.64;3.02]) and other tested variables were not associated with poor performance. CONCLUSIONS Half of the included patients exhibited poor Clearsight™ system performance. Our results caution against using finger cuff arterial pressure monitoring in patients with low PI (≤0.85%), protracted CRT (>4 s), or hand edema. REGISTRATION ClinicalTrials.gov, NCT04269382, Dr. G. Muller, February 13, 2020. https://classic. CLINICALTRIALS gov/ct2/show/NCT04269382.
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Affiliation(s)
- Karim Lakhal
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France.
| | - Jérôme E Dauvergne
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | | | - Mai-Anh Nay
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Toufik Kamel
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
| | - Grégoire Muller
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France; CRICS-TriggerSep F-CRIN research network, Tours, France; Université de Tours, EA4245, Transplantation, Immunologie, Inflammation, Tours, France
| | - Vincent Robert-Edan
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France
| | - Bertrand Rozec
- Nantes Université, CHU Nantes, Department of Anesthesiology and Critical Care at Laënnec Hospital, University Hospital of Nantes, F-44000 Nantes, France; Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France; CRICS-TriggerSep F-CRIN research network, Tours, France; INSERM, Centre d'étude des pathologies respiratoires, U1100 Tours, France; Université de Tours, Tours, France
| | - Sophie Jacquier
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, Tours, France
| | - Thierry Boulain
- Service de médecine intensive-réanimation, Centre Hospitalier Universitaire d'Orléans, 14 avenue de l'hôpital, 45100 Orléans, France
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Liao YT, Shen HC, Huang JR, Sun CY, Ko HJ, Chang CJ, Chen YM, Feng JY, Chen WC, Yang KY. Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure. BMC Pulm Med 2024; 24:34. [PMID: 38225613 PMCID: PMC10789018 DOI: 10.1186/s12890-024-02850-z] [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: 09/18/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has affected individuals worldwide, and patients with cancer are particularly vulnerable to COVID-19-related severe illness, respiratory failure, and mortality. The relationship between COVID-19 and cancer remains a critical concern, and a comprehensive investigation of the factors affecting survival among patients with cancer who develop COVID-19-related respiratory failure is warranted. We aim to compare the characteristics and outcomes of COVID-19-related acute respiratory failure in patients with and without underlying cancer, while analyzing factors affecting in-hospital survival among cancer patients. METHODS We conducted a retrospective observational study at Taipei Veterans General Hospital in Taiwan from May to September 2022, a period during which the omicron variant of the severe acute respiratory syndrome coronavirus 2 was circulating. Eligible patients had COVID-19 and acute respiratory failure. Clinical data, demographic information, disease severity markers, treatment details, and outcomes were collected and analyzed. RESULTS Of the 215 enrolled critically ill patients with COVID-19, 65 had cancer. The patients with cancer were younger and had lower absolute lymphocyte counts, higher ferritin and lactate dehydrogenase (LDH) concentrations, and increased vasopressor use compared with those without cancer. The patients with cancer also received more COVID-19 specific treatments but had higher in-hospital mortality rate (61.5% vs 36%, P = 0.002) and longer viral shedding (13 vs 10 days, P = 0.007) than those without cancer did. Smoking [odds ratio (OR): 5.804, 95% confidence interval (CI): 1.847-39.746], elevated LDH (OR: 1.004, 95% CI: 1.001-1.012), vasopressor use (OR: 5.437, 95% CI: 1.202-24.593), and new renal replacement therapy (OR: 3.523, 95% CI: 1.203-61.108) were independent predictors of in-hospital mortality among patients with cancer and respiratory failure. CONCLUSION Critically ill patients with cancer experiencing COVID-19-related acute respiratory failure present unique clinical features and worse clinical outcomes compared with those without cancer. Smoking, elevated LDH, vasopressor use, and new renal replacement therapy were risk factors for in-hospital mortality in these patients.
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Affiliation(s)
- Ying-Ting Liao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Chin Shen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jhong-Ru Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chuan-Yen Sun
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hung-Jui Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Jung Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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3
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Goudarzi E, Yousefimoghaddam F, Ramandi A, Khaheshi I. 2D speckle-tracking echocardiography as a prognostic imaging modality for COVID-19 adverse outcomes. Future Cardiol 2022; 18:949-956. [PMID: 36321772 PMCID: PMC9629288 DOI: 10.2217/fca-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
2D speckle-tracking echocardiography (2D-STE) has been used to assess cardiac recovery during the COVID-19 patient follow-ups within the pandemic. The novel role of STE in predicting adverse outcomes of COVID-19 has received attention due to its high sensitivity in identifying subclinical myocardial dysfunction. We reviewed the studies on using 2D-STE to assess COVID-19 prognosis. A literature search was conducted on PubMed and Scopus for eligible articles, 24 of which discussed using prognostic 2D-STE for COVID-19 patients. 2D-STE predicts cardiovascular impairments more rapidly and precisely than conventional echocardiography. The 2D-STE technique presents an independent prognostic factor in COVID-19 infection. 2D-STE could be considered a time-efficient and accurate risk predictor of all-cause mortality in COVID-19 patients.
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Affiliation(s)
- Ehsan Goudarzi
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Yousefimoghaddam
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ramandi
- 2School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,3Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- 1Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Author for correspondence: Tel.: +98 21 2208 3106;
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Sheasby J, Krais S, Do M, Hall A, Pace H, Myers DP, George TJ. An Interprofessional Approach to Mobilizing Patients With COVID-19 Receiving Extracorporeal Membrane Oxygenation. AACN Adv Crit Care 2022; 33:262-273. [PMID: 36067264 DOI: 10.4037/aacnacc2022293] [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: 11/01/2022]
Abstract
OBJECTIVE To assess survival outcomes with the intervention of an interprofessional mobilization program for patients with COVID-19 who were receiving venovenous extracorporeal membrane oxygenation (VV-ECMO). DESIGN Preintervention and postintervention retrospective cohort study. METHODS Survival outcomes of nonmobilized, adult patients (n = 16) with COVID-19 who were receiving VV-ECMO (May 2020 through December 2020) were compared with those of 26 patients who received a mobility care plan (January 2021 through November 2021). In the preintervention group, full sedation and paralysis were used. In the postintervention group, an early mobilization strategy involving interprofessional collaboration was introduced. RESULTS The postintervention group had improved survival (73.1% vs 43.8%; P < .04); fewer days of receiving paralytics, fentanyl, and midazolam (P < .01 for all); but more days of dexmedetomidine, morphine, and ketamine administration (P < .01 for all). Concomitantly, more patients in the postintervention cohort received oral or transdermal analgesics, oral anxiolytics, and oral antipsychotics (P < .01 for all), and also required more VV-ECMO cannula adjustments (P = .03). CONCLUSION Early mobilization of patients with COVID-19 who were receiving VV-ECMO improved survival rates but led to more cannula adjustments.
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Affiliation(s)
- Jenelle Sheasby
- Jenelle Sheasby is ECMO Coordinator, Baylor Scott & White The Heart Hospital, 1100 Allied Drive, Plano, TX 75093
| | - Suzanne Krais
- Suzanne Krais is Chief Nursing Officer, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Monica Do
- Monica Do is Clinical Pharmacist, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Amy Hall
- Amy Hall is Senior Physical Therapist, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Holland Pace
- Holland Pace is Senior Occupational Therapist, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - David P Myers
- David P. Myers is Staff Pulmonologist, Pulmonary Critical Care Medicine, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Timothy J George
- Timothy J. George is Surgical Director of Mechanical Circulatory Support, Baylor Scott & White The Heart Hospital, Plano, Texas
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Transthoracic echocardiography of patients in prone position ventilation during the COVID-19 pandemic: an observational and retrospective study. Int J Cardiovasc Imaging 2022; 38:2303-2309. [PMID: 36434340 PMCID: PMC9244514 DOI: 10.1007/s10554-022-02659-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 12/15/2022]
Abstract
Mechanical ventilation in prone position is a strategy that increases oxygenation and reduces mortality in severe ARDS. The hemodynamic and cardiovascular assessment of these patients is essential. Transthoracic echocardiography (TTE) is a widely used tool to assess hemodynamics in critical care, but the prone position is thought to limit adequate TTE views and goal-oriented measurements. The aim of this study is to show the feasibility of the hemodynamic assessment by transthoracic echocardiography during prone position ventilation (PPV). This is a retrospective, observational study, carried out in the intensive care unit (ICU) of a tertiary-care center in Buenos Aires, Argentina. We included all the adult patients admitted to the ICU between March 2020 and August 2021 who had a TTE examination in PPV due to ARDS. During the study period, we evaluated by TTE a total of 35 patients requiring PPV. The vast majority of the patients had COVID-19 pneumonia (91.4%). In 33 out of 35 (94.3%) cases, it was able to achieve an adequate apical four chamber view. We assessed qualitatively the systolic function of left ventricle (LV) and right ventricle (RV) in all of the successfully evaluated patients. We measured the RV basal diameter (94.3%), RV/LV ratio (77.1%), tricuspid annular plane systolic excursion (TAPSE) (91.4%), and septal mitral annular plane systolic excursion (MAPSE) (88.5%) in most of them. Also, we quantified the left ventricle outflow tract velocity time integral (LVOT VTI) in a large part (68.5%) of the examinations. Transthoracic echocardiography is a useful tool for the hemodynamic assessment of patients in prone position under mechanical ventilation.
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6
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Affiliation(s)
| | - Filipe Gonzalez
- Department of Intensive Care, Hospital Garcia de Orta, Almada, Portugal
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7
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Menezes HFD, Moura JL, Oliveira SSD, Fonseca MC, Sousa PAFD, Silva RARD. Nursing diagnoses, results, and interventions in the care for Covid-19 patients in critical condition. Rev Esc Enferm USP 2021; 55:e20200499. [PMID: 34423806 DOI: 10.1590/1980-220x-reeusp-2020-0499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop and validate a terminological subset of the International Classification for Nursing Practice for COVID-19 patients in critical care. METHOD This is a methodological study, which followed the guidelines of the Brazilian method, using the Basic Human Needs as a theoretical model. Content validation was performed by 25 specialist nurses using the Delphi technique. RESULTS A total of 73 diagnoses and their respective nursing results were prepared. Of these, 62 statements had a Content Validity Index ≥ 0.80, with the need for oxygenation having the highest number of statements. Of the 210 nursing interventions developed, and after suggestions from experts, 150 interventions reached an index ≥ 0.80 and comprised the terminological subset. CONCLUSION The terminological subset developed showed statements that were validated by specialist nurses and, therefore, are relevant to the nurse's clinic in the critical care scenario associated with Covid-19.
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Affiliation(s)
- Harlon França de Menezes
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói,, RJ, Brazil
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Hollenberg SM, Safi L, Parrillo JE, Fata M, Klinkhammer B, Gayed N, Glotzer T, Go RC, Gourna-Paleoudis E, Landers D, Jamal S, Shah N, Shah R, Tancredi J, Turi ZG. Hemodynamic Profiles of Shock in Patients With COVID-19. Am J Cardiol 2021; 153:135-139. [PMID: 34167784 PMCID: PMC8149198 DOI: 10.1016/j.amjcard.2021.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023]
Abstract
Patients with serious COVID infections develop shock frequently. To characterize the hemodynamic profile of this cohort, 156 patients with COVID pneumonia and shock requiring vasopressors had interpretable echocardiography with measurement of ejection fraction (EF) by Simpson's rule and stroke volume (SV) by Doppler. RV systolic pressure (RVSP) was estimated from the tricuspid regurgitation peak velocity. Patients were divided into groups with low or preserved EF (EFL or EFP, cutoff ≤45%), and low or normal cardiac index (CIL or CIN, cutoff ≤2.2 L/min/m2). Mean age was 67 ± 12.0, EF 59.5 ± 12.9, and CI 2.40 ± 0.86. A minority of patients had depressed EF (EFLCIL, n = 15, EFLCIN, n = 8); of those with preserved EF, less than half had low CI (EFPCIL, n = 55, EFPCIN, n = 73). Overall hospital mortality was 73%. Mortality was highest in the EFLCIL group (87%), but the difference between groups was not significant (p = 0.68 by ANOVA). High PEEP correlated with low CI in the EFPCIL group (r = 0.44, p = 0.04). In conclusion, this study reports the prevalence of shock characterized by EF and CI in patients with COVID-19. COVID-induced shock had a cardiogenic profile (EFLCIL) in 9.6% of patients, reflecting the impact of COVID-19 on myocardial function. Low CI despite preservation of EF and the correlation with PEEP suggests underfilling of the LV in this subset; these patients might benefit from additional volume. Hemodynamic assessment of COVID patients with shock with definition of subgroups may allow therapy to be tailored to the underlying causes of the hemodynamic abnormalities.
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Hamzaoui O, Shi R, Carelli S, Sztrymf B, Prat D, Jacobs F, Monnet X, Gouëzel C, Teboul JL. Changes in pulse pressure variation to assess preload responsiveness in mechanically ventilated patients with spontaneous breathing activity: an observational study. Br J Anaesth 2021; 127:532-538. [PMID: 34246460 DOI: 10.1016/j.bja.2021.05.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pulse pressure variation (PPV) is not reliable in predicting preload responsiveness in patients receiving mechanical with spontaneous breathing (SB) activity. We hypothesised that an increase in PPV after a tidal volume (VT) challenge (TVC) or a decrease in PPV during passive leg raising (PLR) can predict preload responsiveness in such cases. METHODS This prospective observational study was performed in two ICUs and included patients receiving mechanical ventilation with SB, for whom the treating physician decided to test preload responsiveness. Transthoracic echocardiography was used to measure the velocity-time integral (VTI) of the left ventricular outflow tract. Patients exhibiting an increase in VTI ≥12% during PLR were defined as PLR+ patients (or preload responders). Then, a TVC was performed by increasing VT by 2 ml kg-1 predicted body weight (PBW) for 1 min. PPV was recorded at each step. RESULTS Fifty-four patients (Simplified Acute Physiology Score II: 60 (25) ventilated with a VT of 6.5 (0.8) ml kg-1 PBW, were included. Twenty-two patients were PLR+. The absolute decrease in PPV during PLR and the absolute increase in PPV during TVC discriminated between PLR+ and PLR- patients with area under the receiver operating characteristic (AUROC) curve of 0.78 and 0.73, respectively, and cut-off values of -1% and +2%, respectively. Those AUROC curve values were similar but were significantly different from that of baseline PPV (0.61). CONCLUSION In patients undergoing mechanical ventilation with SB activity, PPV does not predict preload responsiveness. However, the decrease in PPV during PLR and the increase in PPV during a TVC help discriminate preload responders from non-responders with moderate accuracy. CLINICAL TRIAL REGISTRATION NCT04369027 (ClinicalTrials.gov).
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Affiliation(s)
- Olfa Hamzaoui
- Service de réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, Clamart, France.
| | - Rui Shi
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Le Kremlin-Bicêtre, France; INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Simone Carelli
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Le Kremlin-Bicêtre, France
| | - Benjamin Sztrymf
- Service de réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, Clamart, France; INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Dominique Prat
- Service de réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, Clamart, France
| | - Frederic Jacobs
- Service de réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, Clamart, France
| | - Xavier Monnet
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Le Kremlin-Bicêtre, France; INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Corentin Gouëzel
- Service de réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP Université Paris-Saclay, Clamart, France
| | - Jean-Louis Teboul
- Université Paris-Saclay, AP-HP, Service de Médecine Intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Le Kremlin-Bicêtre, France; INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
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Guven G, Ince C, Topeli A, Caliskan K. Cardio-Pulmonary-Renal Consequences of Severe COVID-19. Cardiorenal Med 2021; 11:133-139. [PMID: 34082420 PMCID: PMC8247817 DOI: 10.1159/000516740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/16/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the coronavirus disease 2019 (COVID-19) pandemic. The disease raised an unprecedented demand for intensive care support due to severe pulmonary dysfunction and multiorgan failure. Although the pulmonary system is the potential target of the COVID-19, recent reports have demonstrated that COVID-19 profoundly influences the cardiovascular system and the kidneys. Research studies on cadavers have shown that direct heart and kidney injury can be frequently seen in patients deceased due to COVID-19 infection. On the other hand, functional or structural dysfunction of the heart may deteriorate the renal function and vice versa. This concept is already known as the cardiorenal syndrome and may play a role in COVID-19. Proactive monitoring of micro- and macrohemodynamics could allow prompt correction of circulatory dysfunction and can be of pivotal importance in the prevention of acute kidney injury. Moreover, type and amount of fluid therapy and vasoactive drug support could help manage these patients either with or without mechanical ventilator support. This brief review outlines the current evidence regarding the COVID-19-related renal and cardiorenal complications and discusses potential hemodynamic management strategies.
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Affiliation(s)
- Goksel Guven
- Department of Intensive Care Adults, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands, .,Department of Intensive Care Adults, Tokat State Hospital, Tokat, Turkey, .,Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey,
| | - Can Ince
- Department of Intensive Care Adults, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure, Heart Transplantation & Mechanical Circulatory Support, Thorax Center, Rotterdam, The Netherlands
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Could strain echocardiography help to assess systolic function in critically ill COVID-19 patients? J Clin Monit Comput 2021; 35:1229-1234. [PMID: 33638061 PMCID: PMC7910195 DOI: 10.1007/s10877-021-00677-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/15/2021] [Indexed: 01/07/2023]
Abstract
Strain echocardiography enables the automatic quantification of the global longitudinal strain (GLS), which is a direct measure of ventricular shortening during systole. In the current context of overwhelmed ICUs and clinician shortage, GLS has the advantage to be quick and easy to measure by non-experts. However, little is known regarding its value to assess bi-ventricular systolic function in critically ill COVID-19 patients. Therefore, we designed a study to compare right and left ventricular GLS with classic echo-Doppler indices of systolic function, namely the ejection fraction for the left ventricle (LVEF) and the fractional area change (FAC), the tricuspid annular plane systolic excursion (TAPSE), and the tissue Doppler velocity of the basal free lateral wall (S’) for the right ventricle. Eighty transthoracic echocardiographic evaluations done in 30 ICU patients with COVID-19 were analyzed. We observed a fair relationship (r = 0.73, p < 0.01) between LVEF and left ventricular GLS. The GLS cut-off value of − 22% identified a LVEF < 50% with a sensitivity of 63% and a specificity of 80%. All patients with a GLS > − 17% had a LVEF < 50%. Although statistically significant, relationships between FAC (r = 0.41, p < 0.01), TAPSE (r = 0.26, p < 0.05) and right ventricular GLS were weak. S’ was not correlated with right ventricular GLS. In conclusion, left ventricular GLS was useful to assess left ventricular systolic function. However, right ventricular GLS was poorly correlated with FAC, TAPSE and S’. Further studies are needed to clarify what is the best method to assess right ventricular systolic function in ICU patients with COVID-19.
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Asar S, Acicbe Ö, Sabaz MS, Tontu F, Canan E, Cukurova Z, Cakar N. Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients. Indian J Crit Care Med 2021; 25:704-708. [PMID: 34316153 PMCID: PMC8286393 DOI: 10.5005/jp-journals-10071-23856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. Patients and methods Data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PiCCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. Results No difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. Conclusions The results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology. How to cite this article Asar S, Acicbe Ö, Sabaz MS, Tontu F, Canan E, Cukurova Z, et al. Comparison of Respiratory and Hemodynamic Parameters of COVID-19 and Non-COVID-19 ARDS Patients. Indian J Crit Care Med 2021;25(6):704-708.
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Affiliation(s)
- Sinan Asar
- Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Özlem Acicbe
- Department of Anesthesiology and Reanimation, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet S Sabaz
- Department of Anesthesiology and Reanimation-Intensive Care Unit, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Furkan Tontu
- Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Emral Canan
- Department of IMDSoft - QlinICU, Istanbul, Turkey
| | - Zafer Cukurova
- Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Nahit Cakar
- General Intensive Care Unit, Koç University School of Medicine, Istanbul, Turkey
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14
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Enev R, Krastev P, Abedinov F. Prediction of fluid responsiveness: a review. BIOTECHNOL BIOTEC EQ 2021. [DOI: 10.1080/13102818.2021.1960190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rostislav Enev
- Department of Anesthesiology and Intensive Care, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
| | - Plamen Krastev
- Department of Cardiology, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
| | - Filip Abedinov
- Department of Anesthesiology and Intensive Care, University Hospital “Sveta Ekaterina”, Medical University of Sofia, Sofia, Bulgaria
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15
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Jasiński T, Stefaniak J. COVID-19 and haemodynamic failure: a point of view on mechanisms and treatment. Anaesthesiol Intensive Ther 2020; 52:409-417. [PMID: 33327700 PMCID: PMC10183984 DOI: 10.5114/ait.2020.101813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022] Open
Abstract
The SARS-CoV-2-related disease has an undoubted impact on the healthcare system. In the treatment of severe COVID-19 cases, the main focus is on respiratory failure. However, available data suggest an important contribution of haemodynamic impairment in the course of this disease. SARS-CoV-2 may affect the circulatory system in various ways that are universal for septic conditions. Nonetheless, unique features of this pathogen, e.g. direct insult leading to myocarditis and renin-angiotensin-aldosterone axis dysregulation, must be taken into account. Although current recommendations on COVID-19 resemble previous septic shock guidelines, special attention to haemodynamic monitoring and treatment is necessary. Regarding treatment, one must take into account the potential profound hypovolaemia of severe COVID-19 patients. Pharmacological cardiovascular support should follow existing guidelines and practice. Interesting concepts of decatecholaminisation and the effect of vasopressors on pulmonary circulation are also presented in this review on COVID-19-related haemodynamic failure.
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Affiliation(s)
- Tomasz Jasiński
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Poland
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16
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Hussain A, Via G, Melniker L, Goffi A, Tavazzi G, Neri L, Villen T, Hoppmann R, Mojoli F, Noble V, Zieleskiewicz L, Blanco P, Ma IWY, Wahab MA, Alsaawi A, Al Salamah M, Balik M, Barca D, Bendjelid K, Bouhemad B, Bravo-Figueroa P, Breitkreutz R, Calderon J, Connolly J, Copetti R, Corradi F, Dean AJ, Denault A, Govil D, Graci C, Ha YR, Hurtado L, Kameda T, Lanspa M, Laursen CB, Lee F, Liu R, Meineri M, Montorfano M, Nazerian P, Nelson BP, Neskovic AN, Nogue R, Osman A, Pazeli J, Pereira-Junior E, Petrovic T, Pivetta E, Poelaert J, Price S, Prosen G, Rodriguez S, Rola P, Royse C, Chen YT, Wells M, Wong A, Xiaoting W, Zhen W, Arabi Y. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit Care 2020; 24:702. [PMID: 33357240 PMCID: PMC7759024 DOI: 10.1186/s13054-020-03369-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.
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Affiliation(s)
- Arif Hussain
- Department of Cardiac Sciences, King Abdulaziz Medical City and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Lawrence Melniker
- New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Alberto Goffi
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy
- Anaesthesia and Intensive Care, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico, Policlinico San Matteo Foundation, Pavia, Italy
| | - Luca Neri
- Emergency Medicine and Critical Care Consultant, King Fahad Specialist Hospital - Dammam, Dammam, Saudi Arabia
| | - Tomas Villen
- School of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - Richard Hoppmann
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Francesco Mojoli
- Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Università Degli Studi Di Pavia, Pavia, Italy
| | - Vicki Noble
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Laurent Zieleskiewicz
- Service D'Anesthésie Réanimation Hôpital Nord, APHM, Chemin des Bourrely, 13015, Marseille, France
| | - Pablo Blanco
- Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", Necochea, Argentina
| | - Irene W Y Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Mahathar Abd Wahab
- Emergency and Trauma Department, Hospital Kuala Lumpur, 50586, Kuala Lumpur, Malaysia
| | - Abdulmohsen Alsaawi
- King Abdulaziz Medical City, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Majid Al Salamah
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Martin Balik
- Dept of Anaesthesiology and Intensive Care, First Medical Faculty, Charles University, Prague, Czechia
| | - Diego Barca
- Médico Ecografista IADT, Buenos Aires, Argentina
| | - Karim Bendjelid
- Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, C.H.U. Dijon and Université Bourgogne Franche-Comté, LNC UMR866, 21000, Dijon, France
| | | | - Raoul Breitkreutz
- FOM University of Economy & Management, Frankfurt Campus, Frankfurt, Germany
| | - Juan Calderon
- Hospital General, Instituto Mexicano del Seguro Social, De Zona 4 Monterrey, Nuevo Leon, Mexico
| | - Jim Connolly
- Great North Trauma and Emergency Care Newcastle, Newcastle upon Tyne, UK
| | - Roberto Copetti
- Emergency Department, Latisana General Hospital, Latisana, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | | | | | - Young-Rock Ha
- Dept. of Emergency Medicine, Bundang Jesaeng Hospital, Seoul, Korea
| | | | - Toru Kameda
- Department of Clinical Laboratory Medicine and Department of Emergency Medicine, Jichi Medical University, Tokyo, Japan
| | | | - Christian B Laursen
- Department of Respiratory Medicine, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Francis Lee
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Rachel Liu
- Dept. of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Miguel Montorfano
- Department of Ultrasound & Doppler Hospital de Emergencias "Dr. Clemente Alvarez", Rosario, Santa Fe, Argentina
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italia
| | - Bret P Nelson
- Department of Emergency Medicine, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Aleksandar N Neskovic
- Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ramon Nogue
- Faculty of Medecine, University of Lleida, Lleida, Spain
| | - Adi Osman
- Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - José Pazeli
- FAME - Medicine School of Barbacena - MG-Brasil, Barbacena, Brazil
| | | | | | - Emanuele Pivetta
- Città Della Salute E Della Scienza Di Torino Hospital, University of Turin, Turin, Italy
| | - Jan Poelaert
- Faculty of Medicine and Pharmacy VUB, Univ Hospital Brussels, Brussels, Belgium
| | | | - Gregor Prosen
- Emergency Department, University Clinical Centre Maribor, Maribor, Slovenia
| | | | | | - Colin Royse
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Yale Tung Chen
- Department of Emergency Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Mike Wells
- Division of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Wang Xiaoting
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wang Zhen
- The Fourth Military Medical University, Xi'an, 710032, China
| | - Yaseen Arabi
- King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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17
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Critically ill patients with COVID-19: are they hemodynamically unstable and do we know why? Intensive Care Med 2020; 47:254-255. [PMID: 32910203 PMCID: PMC7482382 DOI: 10.1007/s00134-020-06238-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
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18
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Bendjelid K, Muller L. Haemodynamic monitoring of COVID-19 patients: Classical methods and new paradigms. Anaesth Crit Care Pain Med 2020; 39:551-552. [PMID: 32896671 PMCID: PMC7473332 DOI: 10.1016/j.accpm.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Karim Bendjelid
- Intensive Care Division, University Hospitals, Geneva, Switzerland; Geneva Haemodynamic Research Group, Geneva, Switzerland; Faculty of Medicine, Geneva, Switzerland.
| | - Laurent Muller
- Department of Anaesthesia, Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, France; University of Montpellier, France.
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