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Monti G, Konkayev A, Carta S, Bradic N, Bruni A, Kotani Y, Guarracino F, Redkin I, Biondi-Zoccai G, Benedetto U, D'Ascenzo F, Garofalo E, Baiardo Redaelli M, Brizzi G, Forfori F, Borghi G, Scapol S, Momesso E, Cuffaro R, Boffa N, Rauch S, D'Amico F, Montrucchio G, Pace MC, Galbiati C, Bosso S, Savelli F, Giardina G, Silvetti S, Tripodi VF, Labanca R, Lembo R, Marmiere M, Marzaroli M, Nakhnoukh C, Valsecchi D, Finco G, Agrò FE, Bove T, Corradi F, Longhini F, Landoni G, Bellomo R, Zangrillo A. High dose esomeprazole as an anti-inflammatory agent in sepsis: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 133:107319. [PMID: 37625587 DOI: 10.1016/j.cct.2023.107319] [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: 03/31/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sepsis is caused by dysregulated immune responses due to infection and still presents high mortality rate and limited efficacious therapies, apart from antibiotics. Recent evidence suggests that very high dose proton pump inhibitors might regulate major sepsis mediators' secretion by monocytes, which might attenuate excessive host reactions and improve clinical outcomes. This effect is obtained with doses which are approximately 50 times higher than prophylactic esomeprazole single daily administration and 17 times higher than the cumulative dose of a three day prophylaxis. We aim to perform a randomized trial to investigate if high dose esomeprazole reduces organ dysfunction in patients with sepsis or septic shock. METHODS This study, called PPI-SEPSIS, is a multicenter, randomized, double blind, placebo-controlled clinical trial on critically ill septic patients admitted to the emergency department or intensive care unit. A total of 300 patients will be randomized to receive high dose esomeprazole (80 mg bolus followed by 12 mg/h for 72 h and a second 80 mg bolus 12 h after the first one) or equivolume placebo (sodium chloride 0.9%), with 1:1 allocation. The primary endpoint of the study will be mean daily Sequential Organ Failure Assessment (SOFA) score over 10 days. Secondary outcomes will include antibiotic-free days, single organ failure severity, intensive care unit-free days at day 28, and mortality. DISCUSSION This trial aims to test the efficacy of high dose esomeprazole to reduce acute organ dysfunction in patients with septic shock. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov with the trial identification NCT03452865 in March 2018.
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Affiliation(s)
- Giacomo Monti
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Aidos Konkayev
- Astana Medical University, National Scientific Center of Traumatology and Orthopedia, Astana, Kazakhstan
| | - Sonia Carta
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nikola Bradic
- University Hospital Dubrava, Zagreb, Croatia; University North, Varazdin, Croatia
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Yuki Kotani
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Kameda Medical Center, Kamogawa, Japan
| | | | - Ivan Redkin
- Federal Research and Clinical Center of Reanimatology and Rehabilitology, Moscow, Russia
| | | | | | - Fabrizio D'Ascenzo
- University of Turin, Turin, Italy; Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Giulia Brizzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Scapol
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elena Momesso
- Ospedale San Donà di Piave, San Donà di Piave (VE), Italy
| | | | | | | | | | - Giorgia Montrucchio
- University of Turin, Turin, Italy; Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | | | | | | | | | | | | | - Rosa Labanca
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalba Lembo
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy; University of Udine, Udine, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Rinaldo Bellomo
- The University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Gordon AC, Perkins GD, Singer M, McAuley DF, Orme RML, Santhakumaran S, Mason AJ, Cross M, Al-Beidh F, Best-Lane J, Brealey D, Nutt CL, McNamee JJ, Reschreiter H, Breen A, Liu KD, Ashby D. Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis. N Engl J Med 2016; 375:1638-1648. [PMID: 27705084 DOI: 10.1056/nejmoa1609409] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. METHODS We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. RESULTS The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], -0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, -4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). CONCLUSIONS The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039 .).
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Affiliation(s)
- Anthony C Gordon
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Gavin D Perkins
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Mervyn Singer
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Daniel F McAuley
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Robert M L Orme
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Shalini Santhakumaran
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Alexina J Mason
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Mary Cross
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Farah Al-Beidh
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Janis Best-Lane
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - David Brealey
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Christopher L Nutt
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - James J McNamee
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Henrik Reschreiter
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Andrew Breen
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Kathleen D Liu
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
| | - Deborah Ashby
- From the Section of Anaesthetics, Pain Medicine and Intensive Care Medicine, the Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust (A.C.G., F.A.-B., J.B.-L.), Bloomsbury Institute of Intensive Care Medicine, the Division of Medicine, University College London (M.S.), Imperial Clinical Trials Unit Imperial College London (S.S., M.C., F.A.-B., J.B.-L., D.A.), the Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine (A.J.M.), and the Division of Critical Care, University College London Hospitals (D.B.), London, Warwick Clinical Trials Unit, University of Warwick and Heart of England NHS Foundation Trust, Coventry (G.D.P.), the Centre for Experimental Medicine, Queen's University of Belfast (D.F.M., J.J.M.), and the Regional Intensive Care Unit, the Royal Hospitals (D.F.M., J.J.M.), Belfast, the Department of Critical Care, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham (R.M.L.O.), Intensive Care Unit, Antrim Area Hospital, Antrim (C.L.N.), Intensive Care Unit, Poole Hospital NHS Foundation Trust, Poole (H.R.), and Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds (A.B.) - all in the United Kingdom; and the Department of Medicine, University of California at San Francisco, San Francisco (K.D.L.)
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