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Zhou Q, Zhang Y, Yao W, Liang S, Feng H, Pan H. Effects of proprioceptive neuromuscular facilitation combined with threshold inspiratory muscle training on respiratory function in neurocritical patients with weaning failure: a randomized controlled trial. Int J Rehabil Res 2024:00004356-990000000-00092. [PMID: 38635479 DOI: 10.1097/mrr.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
The purpose of this study was to determine the effects of combining proprioceptive neuromuscular facilitation (PNF) with threshold inspiratory muscle training (TIMT), compared with TIMT alone, on respiratory function in neurocritical patients who experienced a weaning failure. Forty-seven participants (mostly after a stroke), were randomly divided into the experimental group (n = 24) and the control group (n = 23). The control group received usual care and TIMT, whereas the experimental group, in addition, underwent four 90-s periods of manual PNF. Both groups performed training in the ICU twice a day for 5 consecutive days. The main outcome measures included maximum inspiratory pressure, diaphragmatic excursions, diaphragm thickening fraction, oxygenation index, and forced expiratory volume in 1 s/forced vital capacity. The results showed a significant group-by-time interaction effect for maximum inspiratory pressure [F (1, 45) = 17.84, η2 = 0.328, P < 0.001] and oxygenation index [F [1, 45) = 5.58, η2 = 0.11, P = 0.023]. When compared with the control group, the experimental group showed overall significantly higher maximum inspiratory pressure [mean difference = 4.37 cm H2O, 95% confidence interval (CI) 0.25-8.50, P = 0.038]. No other significant group differences were found. Combining PNF with TIMT may improve respiratory function in neurocritical patients with weaning failure. This combination approach may increase the likelihood of survival of neurocritical patients in the ICU.
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Affiliation(s)
- Qian Zhou
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Wei Yao
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Sijie Liang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hui Feng
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
| | - Huaping Pan
- Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing
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da Silva PB, Fernandes SES, Gomes M, da Silveira CDG, Amorim FFP, de Aquino Carvalho AL, Shintaku LS, Miazato LY, Amorim FFP, Maia MDO, Neves FDAR, Amorim FF. Hyperoxemia Induced by Oxygen Therapy in Nonsurgical Critically Ill Patients. Am J Crit Care 2024; 33:82-92. [PMID: 38424024 DOI: 10.4037/ajcc2024723] [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: 03/02/2024]
Abstract
BACKGROUND Hyperoxemia, often overlooked in critically ill patients, is common and may have adverse consequences. OBJECTIVE To evaluate the incidence of hyperoxemia induced by oxygen therapy in nonsurgical critically ill patients at intensive care unit (ICU) admission and the association of hyperoxemia with hospital mortality. METHODS This prospective cohort study included all consecutive admissions of nonsurgical patients aged 18 years or older who received oxygen therapy on admission to the Hospital Santa Luzia Rede D'Or São Luiz adult ICU from July 2018 through June 2021. Patients were categorized into 3 groups according to Pao2 level at ICU admission: hypoxemia (Pao2<60 mm Hg), normoxemia (Pao2= 60-120 mm Hg), and hyperoxemia (Pao2 >120 mm Hg). RESULTS Among 3088 patients, hyperoxemia was present in 1174 (38.0%) and was independently associated with hospital mortality (odds ratio [OR], 1.32; 95% CI, 1.04-1.67; P=.02). Age (OR, 1.02; 95% CI, 1.02-1.02; P<.001) and chronic kidney disease (OR, 1.55; 95% CI, 1.02-2.36; P=.04) were associated with a higher rate of hyperoxemia. Factors associated with a lower rate of hyperoxemia were Sequential Organ Failure Assessment score (OR, 0.88; 95% CI, 0.83-0.93; P<.001); late-night admission (OR, 0.80; 95% CI, 0.67-0.96; P=.02); and renal/metabolic (OR, 0.22; 95% CI, 0.13-1.39; P<.001), neurologic (OR, 0.02; 95% CI, 0.01-0.05; P<.001), digestive (OR, 0.23; 95% CI, 0.13-0.41; P<.001), and soft tissue/skin/orthopedic (OR, 0.32; 95% CI, 0.13-0.79; P=.01) primary reasons for hospital admission. CONCLUSION Hyperoxemia induced by oxygen therapy was common in critically ill patients and was linked to increased risk of hospital mortality. Health care professionals should be aware of this condition because of its potential risks and unnecessary costs.
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Affiliation(s)
- Priscilla Barbosa da Silva
- Priscilla Barbosa da Silva is a master's student, Graduate Program in Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil, and a staff nurse, intensive care unit, Hospital Santa Luzia Rede D'Or São Luiz, Brasília
| | | | - Maura Gomes
- Maura Gomes is a staff nurse, intensive care unit, Hospital Santa Luzia Rede D'Or São Luiz
| | - Carlos Darwin Gomes da Silveira
- Carlos Darwin Gomes da Silveira is a professor, Medical School, ESCS, and a professor, Medical School, Centro Universitário do Planalto Central, Brasília
| | - Flávio Ferreira Pontes Amorim
- Flávio Ferreira Pontes Amorim is an undergraduate student, Medical School, Universidade Católica de Brasília, Brasília
| | - André Luiz de Aquino Carvalho
- André Luiz de Aquino Carvalho is a master's student, Graduate Program in Health Sciences, ESCS, and a professor, Medical School, ESCS
| | | | | | | | - Marcelo de Oliveira Maia
- Marcelo de Oliveira Maia is a master's student, Graduate Program in Health Sciences, ESCS, and an intensivist, intensive care unit, Hospital Santa Luzia Rede D'Or São Luiz
| | | | - Fábio Ferreira Amorim
- Fábio Ferreira Amorim is a professor, Graduate Program in Health Sciences, ESCS, and a professor, Graduate Program in Health Sciences, Universidade de Brasília
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Silva CA, Lopes AJ, Papathanasiou J, Reis LFF, Ferreira AS. Association of Functional Characteristics and Physiotherapy with COVID-19 Mortality in Intensive Care Unit in Inpatients with Cardiovascular Diseases. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060823. [PMID: 35744086 PMCID: PMC9229782 DOI: 10.3390/medicina58060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
Background and Objectives: To estimate the association between admission functional outcomes and exposure to physiotherapy interventions with mortality rate in intensive care unit (ICU) inpatients with cardiovascular diseases and new coronavirus disease (COVID-19). Materials and Methods: Retrospective cohort including 100 ICU inpatients (mean (standard deviation), age 75 (16) years) split into COVID-19+ or COVID-19−. The association of in-ICU death with admission functional outcomes and physiotherapy interventions was investigated using univariable and multivariable regression models. Results: In total, 42 (42%) patients tested positive for COVID-19. In-ICU mortality rate was 37%, being higher for the COVID-19+ group (odds ratio, OR (95% CI): 3.15 (1.37−7.47), p = 0.008). In-ICU death was associated with lower admission ICU Mobility Scale score (0.81 (0.71−0.91), p = 0.001). Restricted mobility (24.90 (6.77−161.94), p < 0.001) and passive kinesiotherapy (30.67 (9.49−139.52), p < 0.001) were associated with in-ICU death, whereas active kinesiotherapy (0.13 (0.05−0.32), p < 0.001), standing (0.12 (0.05−0.30), p < 0.001), or walking (0.10 (0.03−0.27), p < 0.001) were associated with in-ICU discharge. Conclusions: In-ICU mortality was higher for inpatients with cardiovascular diseases who had COVID-19+, were exposed to invasive mechanical ventilation, or presented with low admission mobility scores. Restricted mobility or passive kinesiotherapy were associated with in-ICU death, whereas active mobilizations (kinesiotherapy, standing, or walking) were associated with in-ICU discharge in this population.
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Affiliation(s)
- Chiara Andrade Silva
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Agnaldo José Lopes
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department of Kinesitherapy, Faculty of Public Health “Prof. Dr. Tzecomir Vodenicharov, DSc.”, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Luis Felipe Fonseca Reis
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
| | - Arthur Sá Ferreira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro 20080-003, Brazil; (C.A.S.); (A.J.L.); (L.F.F.R.)
- Correspondence: ; Tel.: +5521-38829797 (ext. 2012)
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[S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version]. Med Klin Intensivmed Notfmed 2021; 115:37-109. [PMID: 32356041 DOI: 10.1007/s00063-020-00685-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fiatt M, Bosio AC, Neves D, Symanski da Cunha R, Fonseca LT, Celeste RK. Accuracy of a spontaneous breathing trial for extubation of neonates. J Neonatal Perinatal Med 2020; 14:375-382. [PMID: 33337394 DOI: 10.3233/npm-200573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates' extubation and identify variables related to failures. METHODS This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1-98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5-82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.
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Affiliation(s)
- M Fiatt
- Hospital Criança Conceição, Neonatal Intensive Care Unit, Porto Alegre, Brazil
| | - A C Bosio
- Hospital Criança Conceição, Neonatal Intensive Care Unit, Porto Alegre, Brazil
| | - D Neves
- Hospital Criança Conceição, Neonatal Intensive Care Unit, Porto Alegre, Brazil
| | - R Symanski da Cunha
- Hospital Criança Conceição, Neonatal Intensive Care Unit, Porto Alegre, Brazil
| | - L T Fonseca
- Hospital Criança Conceição, Neonatal Intensive Care Unit, Porto Alegre, Brazil
| | - R K Celeste
- Departamento de Odontologia Preventiva e Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Barcellos RDA, Chatkin JM. Impact of a multidisciplinary checklist on the duration of invasive mechanical ventilation and length of ICU stay. J Bras Pneumol 2020; 46:e20180261. [PMID: 32236341 PMCID: PMC7572285 DOI: 10.36416/1806-3756/e20180261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/30/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: To assess the impact that implementing a checklist during daily multidisciplinary rounds has on the duration of invasive mechanical ventilation (IMV) and length of ICU stay. Methods: This was a non-randomized clinical trial in which the pre-intervention and post-intervention duration of IMV and length of ICU stay were evaluated in a total of 466 patients, including historical controls, treated in three ICUs of a hospital in the city of Caxias do Sul, Brazil. We evaluated 235 and 231 patients in the pre-intervention and post-intervention periods, respectively. The following variables were studied: age; gender; cause of hospitalization; diagnosis on admission; comorbidities; the Simplified Acute Physiology Score 3; the Sequential Organ Failure Assessment score; days in the ICU; days on IMV; reintubation; readmission; in-hospital mortality; and ICU mortality. Results: After the implementation of the checklist, the median (interquartile range) for days in the ICU and for days on IMV decreased from 8 (4-17) to 5 (3-11) and from 5 (1-12) to 2 (< 1-7), respectively, and the differences were significant (p ≤ 0.001 for both). Conclusions: The implementation of the checklist during daily multidisciplinary rounds was associated with a reduction in the duration of IMV and length of ICU stay among the patients in our sample.
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Affiliation(s)
- Ruy de Almeida Barcellos
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - José Miguel Chatkin
- . Programa de Pós-Graduação em Medicina e Ciências da Saúde, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
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Ferreira JC, Diniz-Silva F, Moriya HT, Alencar AM, Amato MBP, Carvalho CRR. Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial. BMC Pulm Med 2017; 17:139. [PMID: 29115949 PMCID: PMC5678780 DOI: 10.1186/s12890-017-0484-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022] Open
Abstract
Background Neurally Adjusted Ventilatory Assist (NAVA) is a proportional ventilatory mode that uses the electrical activity of the diaphragm (EAdi) to offer ventilatory assistance in proportion to patient effort. NAVA has been increasingly used for critically ill patients, but it has not been evaluated during spontaneous breathing trials (SBT). We designed a pilot trial to assess the feasibility of using NAVA during SBTs, and to compare the breathing pattern and patient-ventilator asynchrony of NAVA with Pressure Support (PSV) during SBTs. Methods We conducted a crossover trial in the ICU of a university hospital in Brazil and included mechanically ventilated patients considered ready to undergo an SBT on the day of the study. Patients underwent two SBTs in randomized order: 30 min in PSV of 5 cmH2O or NAVA titrated to generate equivalent peak airway pressure (Paw), with a positive end-expiratory pressure of 5 cmH2O. The ICU team, blinded to ventilatory mode, evaluated whether patients passed each SBT. We captured flow, Paw and electrical activity of the diaphragm (EAdi) from the ventilator and used it to calculate respiratory rate (RR), tidal volume (VT), and EAdi. Detection of asynchrony events used waveform analysis and we calculated the asynchrony index as the number of asynchrony events divided by the number of neural cycles. Results We included 20 patients in the study. All patients passed the SBT in PSV, and three failed the SBT in NAVA. Five patients were reintubated and the extubation failure rate was 25% (95% CI 9–49%). Respiratory parameters were similar in the two modes: VT = 6.1 (5.5–6.5) mL/Kg in NAVA vs. 5.5 (4.8–6.1) mL/Kg in PSV (p = 0.076) and RR = 27 (17–30) rpm in NAVA vs. 26 (20–30) rpm in PSV, p = 0.55. NAVA reduced AI, with a median of 11.5% (4.2–19.7) compared to 24.3% (6.3–34.3) in PSV (p = 0.033). Conclusions NAVA reduces patient-ventilator asynchrony index and generates a respiratory pattern similar to PSV during SBTs. Patients considered ready for mechanical ventilation liberation may be submitted to an SBT in NAVA using the same objective criteria used for SBTs in PSV. Trial registration ClinicalTrials.gov (NCT01337271), registered April 12, 2011. Electronic supplementary material The online version of this article (10.1186/s12890-017-0484-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juliana C Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Fabia Diniz-Silva
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Henrique T Moriya
- Biomedical Engineering Laboratory, Escola Politécnica da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Adriano M Alencar
- Instituto de Física, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo B P Amato
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Carlos R R Carvalho
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Medeiros GCD, Sassi FC, Zambom LS, Andrade CRFD. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration. J Bras Pneumol 2017; 42:114-20. [PMID: 27167432 PMCID: PMC4853064 DOI: 10.1590/s1806-37562015000000192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/27/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.
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Kutchak FM, Debesaitys AM, Rieder MDM, Meneguzzi C, Skueresky AS, Forgiarini Junior LA, Bianchin MM. Reflex cough PEF as a predictor of successful extubation in neurological patients. J Bras Pneumol 2016; 41:358-64. [PMID: 26398756 PMCID: PMC4635956 DOI: 10.1590/s1806-37132015000004453] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation. Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters. Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure. Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.
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Affiliation(s)
| | | | | | | | | | | | - Marino Muxfeldt Bianchin
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
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Affiliation(s)
- Rogério Souza
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Souza R. Bringing the JBP and its readers closer together. J Bras Pneumol 2015. [PMCID: PMC4541754 DOI: 10.1590/s1806-37132015000300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Schettino G. Adding value to mechanical ventilation. J Bras Pneumol 2015; 40:455-7. [PMID: 25410834 PMCID: PMC4263327 DOI: 10.1590/s1806-37132014000500002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Guilherme Schettino
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
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