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Zhu Q, Tan D, Wang H, Zhao R, Ling B. High-flow nasal cannula oxygen therapy for mild-moderate acute respiratory failure in patients with blunt chest trauma: An exploratory descriptive study. Am J Emerg Med 2024; 83:76-81. [PMID: 38981159 DOI: 10.1016/j.ajem.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/04/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE The use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT). METHODS This retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa). RESULTS A total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, -5.94-16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40-16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure. CONCLUSION In BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.
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Affiliation(s)
- Qingcheng Zhu
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Dingyu Tan
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Huihui Wang
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Runmin Zhao
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Bingyu Ling
- Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China.
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Kourouche S, Wiseman T, Lam MK, Mitchell R, Sarrami P, Dinh M, Singh H, Curtis K. Impact of comorbidities in severely injured patients with blunt chest injury: A population-based retrospective cohort study. Injury 2024; 55:111538. [PMID: 38599952 DOI: 10.1016/j.injury.2024.111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Blunt chest injuries result in up to 10 % of major trauma admissions. Comorbidities can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, such as older adults. AIMS i) compare the characteristics of severely injured patients with blunt chest injury with and without comorbidities and ii) examine the relationship between comorbidities and key patient outcomes: prolonged length of stay, re-admission within 28 days, and mortality within 30 days in a cohort of patients with blunt chest injury admitted after severe trauma. METHODS A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019. RESULTS After adjusting for potential confounding factors, patients with severe injuries, chest injuries, and comorbidities were found to have a 34 % increased likelihood of having a prolonged length of stay (OR = 1.34, 95 %I = 1.17-1.53) compared to patients with no comorbidities. There was no difference in 30-day mortality for patients with a severe chest injury who did or did not have comorbidities (OR = 1.05, 95 %CI = 0.80-1.39). No significant association was found between comorbidities and re-admission within 28 days. CONCLUSION Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay.
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Affiliation(s)
- S Kourouche
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia.
| | - T Wiseman
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia
| | - M K Lam
- School of Health and Biomedical Sciences, RMIT University, Australia
| | - R Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - P Sarrami
- New South Wales Institute of Trauma and Injury Management, South Western Sydney Clinical School, University of New South Wales, Australia
| | - M Dinh
- Sydney Local Health District, New South Wales Institute of Trauma and Injury Management, Australia; Sydney Medical School, the University of Sydney, Australia
| | - H Singh
- New South Wales Institute of Trauma and Injury Management, Australia
| | - K Curtis
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; Emergency Services, Illawarra Shoalhaven LHD, NSW, Australia
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Mutar MF, Ben Hamada H, Askar TRM, Hassini L, Naija W, Kahloul M. Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study. Cureus 2024; 16:e55846. [PMID: 38590487 PMCID: PMC11001159 DOI: 10.7759/cureus.55846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The procedure of hip fracture repair poses a risk for postoperative pulmonary complications (PPCs) in elderly patients, accompanied by anesthesia and operations. Various noninvasive methods of respiratory support are used as prophylactic and therapeutic, mainly in the postoperative period. Objective: This study aims to determine whether intraoperative use of a high-flow nasal cannula (HFNC) impacts elderly patient outcomes after hip fracture surgery. METHOD Seventy patients aged 65 and older undergoing traumatic hip surgery under spinal anesthesia for isolated hip fractures were randomly assigned to either an interventional group (I) utilizing a high-flow nasal cannula or a control group (C) without respiratory intervention in a six-month single-blind controlled study at Sahloul Teaching Hospital. RESULTS The two groups had identical socio-demographic traits and baseline data. Respiratory postoperative complications occurred in two patients in group (I) and in nine patients in group (C), with a significant difference (p = 0.023). The main respiratory postoperative complications in group (I) were atelectasis (one case) and pulmonary edema (one case). The main respiratory postoperative complications in group (C) were atelectasis (four cases), pneumonia (two cases), COPD decompensation (two cases), and pulmonary edema (one case). No intensive care unit admissions or intraoperative complications were associated with using HFNC. The mean length of stay (LOS) in the hospital was 8.83 ± 2.91 for group I and 10.46 ± 3.4 for group (C), which differed significantly (p = 0.03) with no in-hospital mortality for the two groups. CONCLUSION The intraoperative administration of HFNC may lower the incidence of postoperative respiratory complications and the duration of hospital stays.
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Affiliation(s)
- Majid F Mutar
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
- Anesthesia Department, College of Medical Technology, Al-Ayen Iraqi University, Thi-Qar, Thi-Qar, IRQ
| | - Habiba Ben Hamada
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Souse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Talib Razaq M Askar
- Anesthesia Department, Faculty of Medicine, University of Thi-Qar, Thi-Qar, IRQ
| | - Lassaad Hassini
- Department of Orthopedic Surgery, Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Walid Naija
- Department of Anesthesia and Intensive Care, Faculty of Medicine of Sousse, Sahloul Hospital/University of Sousse, Sousse, TUN
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care/Faculty of Medicine of Souse, Sahloul Hospital/University of Sousse, Sousse, TUN
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Elkins MR. Physiotherapy management of rib fractures. J Physiother 2023; 69:211-219. [PMID: 37714770 DOI: 10.1016/j.jphys.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Mark R Elkins
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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Carrié C, Rieu B, Benard A, Trin K, Petit L, Massri A, Jurcison I, Rousseau G, Tran Van D, Reynaud Salard M, Bourenne J, Levrat A, Muller L, Marie D, Dahyot-Fizelier C, Pottecher J, David JS, Godet T, Biais M. Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial. Crit Care 2023; 27:163. [PMID: 37101272 PMCID: PMC10131545 DOI: 10.1186/s13054-023-04429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The benefit-risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O2) during the early stage of blunt chest trauma remains controversial because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients. METHODS The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO2/FiO2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O2 and "early" NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and "late" NIV, indicated in patients with respiratory deterioration and/or PaO2/FiO2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS). RESULTS Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20-2.43), p = 0.60. The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73-5.89], p = 0.18, 0.85 [95%IC: 0.33-2.20], p = 0.74 and 2.14 [95%IC: 0.36-20.77], p = 0.41, respectively). CONCLUSION A prompt association of HFNC-O2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure. CLINICAL TRIAL REGISTRATION NCT03943914, Registered 7 May 2019.
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Affiliation(s)
- Cédric Carrié
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France.
| | - Benjamin Rieu
- Anesthesiology and Critical Care Department, Clermont - Ferrand University Hospital, Clermont - Ferrand, France
| | - Antoine Benard
- Pôle de Santé Publique, Service d'information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux, Bordeaux, France
| | - Kilian Trin
- Pôle de Santé Publique, Service d'information Médicale, Clinical Epidemiology Unit (USMR), CHU Bordeaux, Bordeaux, France
| | - Laurent Petit
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
| | - Alexandre Massri
- Anesthesiology and Critical Care Department, Pau Hospital, Pau, France
| | - Igor Jurcison
- Anesthesiology and Critical Care Department, Beaujon University Hospital, Paris, France
| | - Guillaume Rousseau
- Anesthesiology and Critical Care Department, Beaujon University Hospital, Paris, France
| | - David Tran Van
- Anesthesiology and Critical Care Department, Robert Picqué Hospital, Bordeaux, France
| | - Marie Reynaud Salard
- Anesthesiology and Critical Care Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Jeremy Bourenne
- Emergency and Critical Care Department, Hôpital de La Timone, Marseille University Hospital, Marseille, France
| | - Albrice Levrat
- Anesthesiology and Critical Care Department, Annecy Hospital, Annecy, France
| | - Laurent Muller
- Anesthesiology and Critical Care Department, Nimes University Hospital, Nimes, France
| | - Damien Marie
- Anesthesiology and Critical Care Department, Poitiers University Hospital, Poitiers, France
| | - Claire Dahyot-Fizelier
- Anesthesiology and Critical Care Department, Poitiers University Hospital, Poitiers, France
| | - Julien Pottecher
- Anesthesiology and Critical Care Department, Strasbourg University Hospital, Strasbourg, France
| | - Jean-Stéphane David
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Lyon, France
- Research On Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Thomas Godet
- Anesthesiology and Critical Care Department, Clermont - Ferrand University Hospital, Clermont - Ferrand, France
| | - Matthieu Biais
- Surgical and Trauma Intensive Care Unit, Anesthesiology and Critical Care Department, Hôpital Pellegrin, CHU Bordeaux, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France
- INSERM U1034, Biology of Cardiovascular Diseases, Bordeaux University, Pessac, France
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High flow nasal cannula outside the ICU in thoracic trauma patients - who, when, where, why and how? Injury 2023; 54:795-796. [PMID: 36503840 DOI: 10.1016/j.injury.2022.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 11/29/2022]
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Bhattacharya D, Mukherjee P, Esquinas AM, Mandal M. Managing patients with multiple rib fractures outside the ICU: Can high flow nasal cannula be a game changer? Injury 2023; 54:800. [PMID: 36424217 DOI: 10.1016/j.injury.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Dipasri Bhattacharya
- Professor and Head, Department of Anaesthesiology, Pain Medicine, and Critical Care, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Prosenjit Mukherjee
- Associate Professor, Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Antonio M Esquinas
- Critical Care Specialist and Staff Physician, Intensive Care Unit, Hospital Morales, Meseguer, Murcia, Spain
| | - Mohanchandra Mandal
- Professor, Department of Anaesthesiology and Critical Care, Institute of Post Graduate Medical Education and Research / S.S.K.M. Hospital, Kolkata, West Bengal, India.
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In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study. J Clin Med 2023; 12:jcm12020714. [PMID: 36675639 PMCID: PMC9863024 DOI: 10.3390/jcm12020714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
Chest trauma management often requires the use of invasive and non-invasive ventilation. To date, only a few studies investigated the predictors of the need for ventilatory support. Data on 1080 patients with chest trauma managed in two different centers were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the predictors of tracheal intubation (TI), non-invasive mechanical ventilation (NIMV), and mortality. Rib fractures (p = 0.0001) fracture of the scapula, clavicle, or sternum (p = 0.045), hemothorax (p = 0.0035) pulmonary contusion (p = 0.0241), and a high Injury Severity Score (ISS) (p ≤ 0001) emerged as independent predictors of the need of TI. Rib fractures (p = 0.0009) hemothorax (p = 0.0027), pulmonary contusion (p = 0.0160) and a high ISS (p = 0.0001) were independent predictors of NIMV. The center of trauma care (p = 0.0279), age (p < 0.0001) peripheral oxygen saturation in the emergency department (p = 0.0010), ISS (p < 0.0001), and Revised Trauma Score (RTS) (p < 0.0001) were independent predictors of outcome. In conclusion, patients who do not require TI, while mandating ventilatory support with selected types of injuries and severity scores, are more likely to be subjected to NIMV. Trauma team expertise and the level of the trauma center could influence patient outcomes.
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Pelaez CA, Jackson JA, Hamilton MY, Omerza CR, Capella JM, Trump MW. High flow nasal cannula outside the ICU provides optimal care and maximizes hospital resources for patients with multiple rib fractures. Injury 2022; 53:2967-2973. [PMID: 35667887 DOI: 10.1016/j.injury.2022.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND High flow nasal cannula (HFNC) use reduces work of breathing and improves oxygenation for patients with hypoxemic respiratory failure. Limited prior work has explored protocolized use of HFNC for trauma patients outside the Intensive Care Unit (ICU). The purpose of this study is to describe and evaluate use of HFNC for patients with rib fractures when therapy was standard of care on all floors of the hospital. METHODS In 2018, the study hospital expanded use of HFNC (AIRVO; Fisher Paykel, Auckland, NZ) to all floors of the hospital, making it available in the ICU, Emergency Department (ED), and on general inpatient floors. The study group included adult patients with three or more rib fractures who received HFNC at any location in the hospital (Phase 2: January 2018-December 2019). The study group was compared to a historical control group when HFNC was available only in the ICU (Phase 1: March 2013-July 2015). Patients were excluded from the study if they received invasive mechanical ventilation prior to HFNC. Primary outcomes were mechanical ventilation rates, ICU days, length of hospitalization, and mortality. RESULTS During the study period, 63 patients received HFNC, with 35% of patients (n = 22) receiving the duration of therapy outside the ICU. When compared to the control group (N = 63), there were no significant differences in total hospital days (9 vs. 9, p=.64), mechanical ventilation (19% vs. 13%, p=.47), or mortality (3% vs. 5%, p = 1.00). Twenty-seven percent of patients (n = 17) in the study group avoided the ICU during hospitalization. CONCLUSIONS Findings suggest that HFNC therapy can be safely initiated and managed on all hospital floors for patients with multiple rib fractures. Making the therapy available outside the ICU may reduce healthcare resource use without adversely affecting patient outcomes.
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Affiliation(s)
- Carlos A Pelaez
- Trauma Surgery, The Iowa Clinic, 1200 Pleasant St, Des Moines, IA, United States of America; Trauma Services, UnityPoint Health, Des Moines, IA, United States of America.
| | - Julie A Jackson
- Respiratory Therapy, UnityPoint Health, 1200 Pleasant St, Des Moines, IA, United States of America
| | - Mikayla Y Hamilton
- Doctor of Osteopathic Medicine Program, Des Moines University, 3200 Grand Ave, Des Moines, IA, United States of America
| | - Christopher R Omerza
- General Surgery Residency Program, 1415 Woodland Ave, UnityPoint Health, Des Moines, IA, United States of America
| | - Jeannette M Capella
- Trauma Surgery, The Iowa Clinic, 1200 Pleasant St, Des Moines, IA, United States of America; Trauma Services, UnityPoint Health, Des Moines, IA, United States of America
| | - Matthew W Trump
- Pulmonary and Critical Care Medicine, The Iowa Clinic, 1200 Pleasant St, Des Moines, IA, United States of America
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