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Boulton AJ, Smith E, Yasin A, Moreton J, Mendonca C. Tracheal tube introducer-associated airway trauma: a systematic review. Anaesthesia 2024. [PMID: 39073144 DOI: 10.1111/anae.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer-associated airway trauma. METHODS PubMed, EMBASE and CINAHL databases were searched using pre-determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments. RESULTS We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2-31.4 [0.5-79.2])% and with bougies was 5.4% (0.4-49.9 [0.0-68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non-robust measurement of the outcome. CONCLUSIONS Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma.
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Affiliation(s)
- Adam J Boulton
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Smith
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ambreen Yasin
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Moreton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cyprian Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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2
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Hu C, Ji H, Gong Y, Yang X, Jia Y, Liu Y, Ji G, Wang X, Wang M. Wet-adhesive γ-PGA/ε-PLL hydrogel loaded with EGF for tracheal epithelial injury repair. J Mater Chem B 2023; 11:8666-8678. [PMID: 37622289 DOI: 10.1039/d3tb01550e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Following the global COVID-19 pandemic, the incidence of tracheal epithelial injury is increasing. However, the repair of tracheal epithelial injury remains a challenge due to the slow renewal rate of tracheal epithelial cells (TECs). In traditional nebulized inhalation treatments, drugs are enriched in the lungs or absorbed into the blood, reducing drug concentration at the tracheal injury site. In this study, we prepared an epidermal growth factor (EGF)-loaded gamma-polyglutamic acid (γ-PGA)/epsilon-poly-L-lysine (ε-PLL) (PP) hydrogel (EGF@PP) to promote the repair of tracheal epithelial injury. Epidermal growth factor promotes the proliferation of TECs and enhances vascularization, thereby accelerating injury repair. The PP hydrogel exhibits outstanding wet adhesion, slow drug release, and antibacterial and anti-inflammatory properties, making it suitable for application in the airways and creating an environment conducive to epithelial repair. Here, we established a rabbit model of tracheal injury using a laser to destroy the tracheal epithelium and delivered EGF@PP powder to the injury site under fiberoptic bronchoscopy guidance. Our findings revealed that this was an effective therapeutic strategy for accelerating the repair of tracheal epithelial injury.
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Affiliation(s)
- Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Yan Gong
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Yunxuan Jia
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
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3
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Xiang M, Wu X, Jing H, Novakovic VA, Shi J. The intersection of obesity and (long) COVID-19: Hypoxia, thrombotic inflammation, and vascular endothelial injury. Front Cardiovasc Med 2023; 10:1062491. [PMID: 36824451 PMCID: PMC9941162 DOI: 10.3389/fcvm.2023.1062491] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The role of hypoxia, vascular endothelial injury, and thrombotic inflammation in worsening COVID-19 symptoms has been generally recognized. Damaged vascular endothelium plays a crucial role in forming in situ thrombosis, pulmonary dysfunction, and hypoxemia. Thrombotic inflammation can further aggravate local vascular endothelial injury and affect ventilation and blood flow ratio. According to the results of many studies, obesity is an independent risk factor for a variety of severe respiratory diseases and contributes to high mechanical ventilation rate, high mortality, and slow recovery in COVID-19 patients. This review will explore the mechanisms by which obesity may aggravate the acute phase of COVID-19 and delay long COVID recovery by affecting hypoxia, vascular endothelial injury, and thrombotic inflammation. A systematic search of PubMed database was conducted for papers published since January 2020, using the medical subject headings of "COVID-19" and "long COVID" combined with the following keywords: "obesity," "thrombosis," "endothelial injury," "inflammation," "hypoxia," "treatment," and "anticoagulation." In patients with obesity, the accumulation of central fat restricts the expansion of alveoli, exacerbating the pulmonary dysfunction caused by SARS-CoV-2 invasion, inflammatory damage, and lung edema. Abnormal fat secretion and immune impairment further aggravate the original tissue damage and inflammation diffusion. Obesity weakens baseline vascular endothelium function leading to an early injury and pre-thrombotic state after infection. Enhanced procoagulant activity and microthrombi promote early obstruction of the vascular. Obesity also prolongs the duration of symptoms and increases the risk of sequelae after hospital discharge. Persistent viral presence, long-term inflammation, microclots, and hypoxia may contribute to the development of persistent symptoms, suggesting that patients with obesity are uniquely susceptible to long COVID. Early interventions, including supplemental oxygen, comprehensive antithrombotic therapy, and anti-inflammatory drugs, show effectiveness in many studies in the prevention of serious hypoxia, thromboembolic events, and systemic inflammation, and are therefore recommended to reduce intensive care unit admission, mortality, and sequelae.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China,Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States,*Correspondence: Jialan Shi, ,
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4
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Potter T, Cronin JN, Kua J, Nurmi E, Wong DJN, Ahmad I, Cook TM, El-Boghdadly K. Aerosol precautions and airway complications: a national prospective multicentre cohort study. Anaesthesia 2023; 78:23-35. [PMID: 36070622 PMCID: PMC10087829 DOI: 10.1111/anae.15851] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/13/2022]
Abstract
The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.
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Affiliation(s)
- T Potter
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J N Cronin
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Kua
- Surgical Outcomes Research Centre, University College London, UK
| | - E Nurmi
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - D J N Wong
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - T M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, University of Bristol, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
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5
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Price L, Carter P, Hodzovic I, Alderman M, Hughes G, Phillips P, Varadarajan V, Wilkes A. An assessment of introducers used for airway management. Anaesthesia 2021; 77:293-300. [PMID: 34861743 DOI: 10.1111/anae.15624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
Different introducers are available to assist with tracheal intubation. Subtle differences in the design of introducers can have a marked effect on safety and performance. The Difficult Airway Society's Airway Device Evaluation Project Team proposal states that devices should only be purchased for which there is at least a case-control study on patients assessing airway devices. However, resources are not currently available to carry out a case-control study on all introducers available on the market. This study comprised a laboratory and manikin-based investigation to identify introducers that could be suitable for clinical investigation. We included six different introducers in laboratory-based assessments (design characteristics) and manikin-based assessments involving the participation of 30 anaesthetists. Each anaesthetist attempted placement in the manikin's trachea with each of the six introducers in a random order. Outcomes included first-time insertion success rate; insertion success rate; number of attempts; time to placement; and distance placed. Each anaesthetist also completed a questionnaire. First-time insertion success rate depended significantly on the introducer used (p = 0.0016) and varied from 47% (Armstrong and P3) to 77% (Intersurgical and Frova). Median time to placement (including oesophageal placement) varied from 10 s (Eschmann and Frova) to 20 s (P3) (p = 0.0025). Median time to successful placement in the trachea varied from 9 s (Frova) to 22 s (Armstrong) (p = 0.037). We found that the Armstrong and P3 devices were not as acceptable as other introducers and, without significant improvements to their design and characteristics, the use of these devices in studies on patients is questionable. The study protocol is suitable for differentiating between different introducers and could be used as a basis for assessing other types of devices.
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Affiliation(s)
- L Price
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - P Carter
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - I Hodzovic
- Department of Anaesthetics, Royal Gwent Hospital, Newport, UK
| | - M Alderman
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - G Hughes
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - P Phillips
- Surgical Materials Testing Laboratory, Princess of Wales Hospital, Bridgend, UK
| | - V Varadarajan
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
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6
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Mohd Yunus MH, Rashidbenam Z, Fauzi MB, Bt Hj Idrus R, Bin Saim A. Evaluating Feasibility of Human Tissue Engineered Respiratory Epithelium Construct as a Potential Model for Tracheal Mucosal Reconstruction. Molecules 2021; 26:molecules26216724. [PMID: 34771136 PMCID: PMC8587409 DOI: 10.3390/molecules26216724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022] Open
Abstract
The normal function of the airway epithelium is vital for the host’s well-being. Conditions that might compromise the structure and functionality of the airway epithelium include congenital tracheal anomalies, infection, trauma and post-intubation injuries. Recently, the onset of COVID-19 and its complications in managing respiratory failure further intensified the need for tracheal tissue replacement. Thus far, plenty of naturally derived, synthetic or allogeneic materials have been studied for their applicability in tracheal tissue replacement. However, a reliable tracheal replacement material is missing. Therefore, this study used a tissue engineering approach for constructing tracheal tissue. Human respiratory epithelial cells (RECs) were isolated from nasal turbinate, and the cells were incorporated into a calcium chloride-polymerized human blood plasma to form a human tissue respiratory epithelial construct (HTREC). The quality of HTREC in vitro, focusing on the cellular proliferation, differentiation and distribution of the RECs, was examined using histological, gene expression and immunocytochemical analysis. Histological analysis showed a homogenous distribution of RECs within the HTREC, with increased proliferation of the residing RECs within 4 days of investigation. Gene expression analysis revealed a significant increase (p < 0.05) in gene expression level of proliferative and respiratory epithelial-specific markers Ki67 and MUC5B, respectively, within 4 days of investigation. Immunohistochemical analysis also confirmed the expression of Ki67 and MUC5AC markers in residing RECs within the HTREC. The findings show that calcium chloride-polymerized human blood plasma is a suitable material, which supports viability, proliferation and mucin secreting phenotype of RECs, and this suggests that HTREC can be a potential candidate for respiratory epithelial tissue reconstruction.
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Affiliation(s)
- Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia;
- Correspondence: ; Tel.: +60-123-137-644
| | - Zahra Rashidbenam
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (Z.R.); (M.B.F.)
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (Z.R.); (M.B.F.)
| | - Ruszymah Bt Hj Idrus
- Department of Physiology, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia;
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (Z.R.); (M.B.F.)
| | - Aminuddin Bin Saim
- Ear, Nose & Throat Consultation Clinic, Ampang Puteri Specialist Hospital, Ampang 68000, Selangor, Malaysia;
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7
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Mohammadi A, Boroofeh B, Mohebbi A, Mirza-Aghazadeh-Attari M. Expanding spontaneous pneumothorax in COVID-19 pneumonia: Case report and review of literature. J Cardiovasc Thorac Res 2021; 13:258-262. [PMID: 34630976 PMCID: PMC8493232 DOI: 10.34172/jcvtr.2021.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/06/2020] [Indexed: 11/09/2022] Open
Abstract
Coronavirus disease 2019 has presented itself with a variety of clinical signs and symptoms. One of these has been the accordance of spontaneous pneumothorax which in instances has caused rapid deterioration of patients. Furthermore pneumothorax may happen secondary to intubation and the resulting complications. Not enough is discussed regarding cases with COVID-19 related pneumothorax and proper management of these patients. The present article reports an elderly patient with spontaneous pneumothorax secondary to COVID-19 and reviews the existing literature.
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Affiliation(s)
- Afshin Mohammadi
- Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Behdad Boroofeh
- Department of Internal Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Alisa Mohebbi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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8
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Kusumawardhani N, Dewi IP, Dharmadjati BB. Extracorporeal Membrane Oxygenation Used in Acute Respiratory Distress Syndrome with COVID-19: A Systematic Review and Meta-Analysis. J Saudi Heart Assoc 2021; 33:177-185. [PMID: 34307014 PMCID: PMC8294133 DOI: 10.37616/2212-5043.1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Protective pulmonary mechanical ventilation, higher positive end-expiratory pressure, neuromuscular blockade, prone positioning, and pulmonary recruitment procedures are all strategies in severe COVID-19 cases. Extracorporeal Membrane Oxygenation (ECMO) can be seen as an alternative to traditional treatment in certain patients when conventional therapy fails. We present a study that intends to systematically review and meta-analysis ECMO use in COVID-19 patients. Methods We search major medical databases (Cochrane Library, PubMed, EMBASE, MedRxiv) for clinical trials that were released between January 2020 until February 2021, had full-text availability, were written in English, and humans studies. We used National Heart, Lung, and Blood Institute (NHLBI) quality evaluation methods for retrospective cohort and cross-sectional studies to evaluate the quality of the articles. In addition, we used the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4. Results A total of 33 studies involving 3090 patients were included in the systematic review and six studies in the meta-analysis. There were 828 patients admitted to the ICU, of which 779 patients had ARDS (94%). Of the total study, 527 patients received ECMO therapy (17%). ARDS incidence was associated with complications during ICU care compared to non-ICU care (OR 107.98; 95% CI 55.51–210.03; p < 0.00001). Indirect comparisons, the incidence of mortality was associated with ECMO compared with non-ECMO (OR 15.79; 95% CI 4.21–59.28; p < 0.0001). Conclusion The incidence of ARDS was associated with complications during ICU stay, and the incidence of mortality was associated with ECMO. Further study about mechanisms involving illness and death of patients from COVID-19 is needed.
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Affiliation(s)
- Novia Kusumawardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ivana Purnama Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Budi Baktijasa Dharmadjati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University-Dr. Soetomo General Hospital, Surabaya, Indonesia
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9
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Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021; 25:691-698. [PMID: 34316151 PMCID: PMC8286391 DOI: 10.5005/jp-journals-10071-23870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This systematic review aims to provide insight into the outcome of extracorporeal membrane oxygenation (ECMO) and invasive mechanical ventilation use in critically ill COVID-19 patients. DATA SOURCES Electronic databases PubMed Central and PubMed were searched from January 2020 to June 2020 for published studies about ECMO and/or invasive mechanical ventilation use in COVID-19 patients. Data Extraction and Study Selection: The search strategy retrieved 766 articles, of which 19 studies consisting of 204 patients fulfilled the inclusion criteria and were included in the analysis. DATA SYNTHESIS Primary outcomes evaluated were discharge and/or clinical improvement and mortality rate. Secondary outcomes evaluated included reported complications and the mean number of days of hospitalization for survivors. Weighted averages of included studies were calculated, and data were pooled in forest plots. Nearly, 68.1% of the patients received invasive mechanical ventilation without ECMO support, and 31.9% were placed on ECMO. Also, 22.5% of the patients were discharged and/or clinically improved and 51.5% died. Twenty-six percent of the study population deteriorated but remained alive or experienced no improvement in clinical condition. And 75.2% of those who died belonged to the non-ECMO group and 24.8% to the ECMO group. The mortality rate in the non-ECMO group was 56.8% compared to 40% in the ECMO group. CONCLUSION The utility of ECMO during a pandemic is uncertain as it is a resource-intensive modality, especially when the mortality rate in severely ill patients infected with COVID-19 virus is already known to be high. HOW TO CITE THIS ARTICLE Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(6):691-698.
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Affiliation(s)
- Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, New York, United States
| | - Rutu Karia
- Department of Internal Medicine, Anna Medical College and Research Centre, Montagne Blanche, Mauritius
| | - Sahar Hassanain
- Women Medical College, Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Prithwish Ghosh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Viraj R Shah
- Department of Internal Medicine, RCSM Government Medical College, Kolhapur, Maharashtra, India
| | - Abin Thomas
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
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10
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Rahmani F, Mahmoodpoor A, Salmasi S, Ebrahimi Bakhtavar H. Safety of Healthcare Workers During the Airway Management in Adult and Pediatric Patients with COVID-19. Anesth Pain Med 2021; 11:e112508. [PMID: 34336618 PMCID: PMC8314079 DOI: 10.5812/aapm.112508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread worldwide. Although the majority of patients show mild symptoms, the disease can rapidly progress in severe cases and develop acute respiratory distress syndrome (ARDS) that may lead to therapeutic interventions, including oxygenation, tracheal intubation, and mechanical ventilation. It is suggested that the new coronavirus spreads mostly via droplets, surface contact, and natural aerosols. Hence, high-risk aerosol-producing procedures, such as endotracheal intubation, may put the healthcare workers at a high risk of infection. In the course of managing patients with COVID-19, it is essential to prioritize the safety of healthcare workers. Hence, this review study aimed to summarize new guidelines and proper airway management in adult and pediatric COVID-19 patients.
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Affiliation(s)
- Farzad Rahmani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shiva Salmasi
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran.
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11
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COVID-19 survivorship: How otolaryngologist-head and neck surgeons can restore quality of life after critical illness. Am J Otolaryngol 2021; 42:102917. [PMID: 33545448 PMCID: PMC7833311 DOI: 10.1016/j.amjoto.2021.102917] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/05/2023]
Abstract
Mortality from COVID-19 has obscured a subtler crisis – the swelling ranks of COVID-19 survivors. After critical illness, patients often suffer post-intensive care syndrome (PICS), which encompasses physical, cognitive, and/or mental health impairments that are often long-lasting barriers to resuming a meaningful life. Some deficits after COVID-19 critical illness will require otolaryngologic expertise for years after hospital discharge. There are roles for all subspecialties in preventing, diagnosing, or treating sequelae of COVID-19. Otolaryngologist leadership in multidisciplinary efforts ensures coordinated care. Timely tracheostomy, when indicated, may shorten the course of intensive care unit stay and thereby potentially reduce the impairments associated with PICS. Otolaryngologists can provide expertise in olfactory disorders; thrombotic sequelae of hearing loss and vertigo; and laryngotracheal injuries that impair speech, voice, swallowing, communication, and breathing. In the aftermath of severe COVID-19, otolaryngologists are poised to lead efforts in early identification and intervention for impairments affecting patients' quality of life.
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12
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Ho JSY, Fernando DI, Chan MY, Sia CH. Obesity in COVID-19: A Systematic Review and Meta-analysis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020; 49:996-1008. [DOI: 10.47102/annals-acadmedsg.2020299] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract
Objective: Obesity has been shown to be associated with adverse outcomes in viral
infections such as influenza, but previous studies on coronavirus disease 2019
(COVID-19) had mixed results. The aim of this systematic review is to investigate the
relationship between COVID-19 and obesity.
Methods: We performed a systematic review and meta-analysis. A literature search of
MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL, OpenGrey and preprint
servers medRxiv and bioRxiv was performed, with no restriction on language or date of
publication. Primary outcomes of this study were intensive care unit (ICU) admission
or critical disease, severe disease and mortality. Secondary outcome was a positive
COVID-19 test. Meta-analysis was performed using OpenMeta-Analyst software, and
heterogeneity was tested using Cochran’s Q test and I2 statistic. The study protocol was
registered on PROSPERO (CRD42020184953).
Results: A total of 1,493 articles were identified and 61 studies on 270,241 patients
were included. The pooled prevalence of obesity was 27.6% (95% confidence interval
[CI] 22.0–33.2) in hospitalised patients. Obesity was not significantly associated with
increased ICU admission or critical illness (odds ratio [OR] 1.25, 95% CI 0.99–1.58,
P=0.062, I2=31.0) but was significantly associated with more severe disease (OR 3.13,
95% CI 1.41–6.92, P=0.005, I2=82.6), mortality (OR 1.36, 95% CI 1.09–1.69, P=0.006,
I2=88.5) and a positive COVID-19 test (OR 1.50, 95% CI 1.25–1.81, P<0.001).
Conclusion: Obesity increased the risk of severe disease, mortality and infection with
COVID-19. Higher body mass index was associated with ICU admission and critical
disease. Patients who are obese may be more susceptible to severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection, and infected patients should be
monitored closely for adverse outcomes.
Keywords: Body mass index, coronavirus, intensive care, mortality, prognosis
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Zheng H, Li S, Sun R, Yang H, Chi X, Chen M, Xu L, Deng Q, Li X, Yu J, Wan L, Luo A. Clinical experience with emergency endotracheal intubation in COVID-19 patients in the intensive care units: a single-centered, retrospective, descriptive study. Am J Transl Res 2020; 12:6655-6664. [PMID: 33194062 PMCID: PMC7653591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
Few studies have reported the implications of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units (ICUs). Therefore, this study aimed to summarize the outcomes of COVID-19 patients in the ICU following endotracheal intubation and provide a clinical reference for the high-risk procedure. From February 1 to February 18, 2020, we enrolled 59 critically ill COVID-19 patients who received emergency endotracheal intubation in the ICUs of Tongji Hospital. We recorded demographic information, laboratory parameters, comorbidities, changes in vital signs pre- and post-intubation, the airway grade, intubation success rate using three types of laryngoscopes, and the experience of intubators. Follow-up evaluations were performed for all proceduralists to monitor nosocomial infections. The majority of the patients requiring intubation were elderly and had at least one comorbidity. Of the patients, 86.4% developed hypoxia before intubation. The first and second attempts of successful endotracheal intubation with the Macintosh laryngoscope (70.0% and 83.3%), Airtraq videolaryngoscope (93.5% and 80%), and UE videolaryngoscope (88.9% and 100%) were performed. Notably, SpO2 <93% and hypotension were observed 3 min after intubation in 32.2% and 39% patients, respectively. With the proper use of personal protective equipment (PPE), no nosocomial infections were observed among proceduralists. Full PPE increased the occurrence of fogging on goggles and myopia glasses. Overall, a higher success rate of intubation was achieved by senior intubators using a videolaryngoscope. Although inconvenient, appropriate ensembles of PPE could prevent nosocomial infections.
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Affiliation(s)
- Hongbo Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Shiyong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Rao Sun
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Hui Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Xiaohui Chi
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Mingbing Chen
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Li Xu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Qingzhu Deng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Xinhua Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Jie Yu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
| | - Ailin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology 1095 Jiefang Avenue, Wuhan 430030, Hubei, China
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Rodríguez-Fuster A, Espases RA, Ventura JF, Bartolomé RA, Navas SS, Belda-Sanchis J. Tracheal trauma in the context of the current infection by COVID-19. About 2 cases. ARCHIVOS DE BRONCONEUMOLOGÍA (ENGLISH EDITION) 2020. [PMCID: PMC7474846 DOI: 10.1016/j.arbr.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Rychter AM, Zawada A, Ratajczak AE, Dobrowolska A, Krela‐Kaźmierczak I. Should patients with obesity be more afraid of COVID-19? Obes Rev 2020; 21:e13083. [PMID: 32583537 PMCID: PMC7362042 DOI: 10.1111/obr.13083] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 crisis has lasted since the late 2019 to the present day. The severity of the disease is positively correlated with several factors, such as age and coexisting diseases. Furthermore, obesity is increasingly considered as a yet another risk factor, particularly, because it has been observed that people suffering from excessive body weight may experience a more severe course of COVID-19 infection. On the basis of current research, in our nonsystematic review, we have investigated the extent to which obesity can affect the SARS-CoV-2 course and identify the potential mechanisms of the disease. We have also described the role of proper nutrition, physical activity and other aspects relevant to the management of obesity.
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Affiliation(s)
- Anna Maria Rychter
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Agnieszka Zawada
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal DiseasesUniversity of Medical Sciences PoznanPoznanPoland
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16
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Heidegger T. Airway management lessons from case reports of negative outcomes. Comment on Br J Anaesth; 125: e168-70. Br J Anaesth 2020; 125:e307-e309. [PMID: 32680606 PMCID: PMC7328571 DOI: 10.1016/j.bja.2020.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
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17
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Underner M, Peiffer G, Perriot J, Jaafari N. [Spontaneous pneumomediastinum: A rare complication of COVID-19?]. Rev Mal Respir 2020; 37:680-683. [PMID: 32675006 PMCID: PMC7358751 DOI: 10.1016/j.rmr.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 02/08/2023]
Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France.
| | - G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 57038 Metz, France
| | - J Perriot
- Dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
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18
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Rodríguez-Fuster A, Aguiló Espases R, Fontané Ventura J, Adália Bartolomé R, Sánchez Navas S, Belda-Sanchis J. Tracheal Trauma in the Context of the Current Infection by COVID-19. About 2 Cases. Arch Bronconeumol 2020; 56:670-671. [PMID: 32586703 PMCID: PMC7261453 DOI: 10.1016/j.arbres.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Alberto Rodríguez-Fuster
- Servicio de Cirugía Torácica, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España.
| | | | | | - Ramón Adália Bartolomé
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital del Mar, Barcelona, España
| | - Saida Sánchez Navas
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital del Mar, Barcelona, España
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19
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Sorbello M, Hodzovic I, Cusumano G, Frova G. Tracheal introducers and airway trauma COVID-19. Comment on Br J Anaesth 2020; 125: e168-e170. Br J Anaesth 2020; 125:e305-e307. [PMID: 32507333 PMCID: PMC7236728 DOI: 10.1016/j.bja.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
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20
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Asai T, O'Sullivan EP, Hemmings HC. A special issue on respiration and the airway: critical topics at a challenging time. Br J Anaesth 2020; 125:1-4. [PMID: 32416990 PMCID: PMC7186195 DOI: 10.1016/j.bja.2020.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Centre, Koshigaya, Japan.
| | | | - Hugh C Hemmings
- Departments of Anesthesiology and Pharmacology, Weill Cornell Medicine, New York, NY, USA
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