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Furtado RHM, Barros E Silva PGM, Fonseca HAR, Serpa-Neto A, Correa TD, Guimarães HP, Pereira AJ, Olivato GB, Zampieri FG, Lisboa T, Junqueira DLM, Lapa MG, Monfardini F, Damiani LP, Echenique LS, Gebara OE, Hoffman Filho CR, Polanczyk CA, Rohde LE, Amazonas R, Machado FR, Avezum A, Azevedo LCP, Veiga VC, Rosa RG, Lopes RD, Cavalcanti AB, Berwanger O. Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials. Am J Cardiol 2024; 214:18-24. [PMID: 38104755 DOI: 10.1016/j.amjcard.2023.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
The cardiovascular safety from azithromycin in the treatment of several infectious diseases has been challenged. In this prespecified pooled analysis of 2 multicenter randomized clinical trials, we aimed to assess whether the use of azithromycin might lead to corrected QT (QTc) interval prolongation or clinically relevant ventricular arrhythmias. In the COALITION COVID Brazil I trial, 667 patients admitted with moderate COVID-19 were randomly allocated to hydroxychloroquine, hydroxychloroquine plus azithromycin, or standard of care. In the COALITION COVID Brazil II trial, 447 patients with severe COVID-19 were randomly allocated to hydroxychloroquine alone versus hydroxychloroquine plus azithromycin. The principal end point for the present analysis was the composite of death, resuscitated cardiac arrest, or ventricular arrhythmias. The addition of azithromycin to hydroxychloroquine did not result in any prolongation of the QTc interval (425.8 ± 3.6 ms vs 427.9 ± 3.9 ms, respectively, mean difference -2.1 ms, 95% confidence interval -12.5 to 8.4 ms, p = 0.70). The combination of azithromycin plus hydroxychloroquine compared with hydroxychloroquine alone did not result in increased risk of the primary end point (proportion of patients with events at 15 days 17.2% vs 16.0%, respectively, hazard ratio 1.08, 95% confidence interval 0.78 to 1.49, p = 0.65). In conclusion, in patients hospitalized with COVID-19 already receiving standard-of-care management (including hydroxychloroquine), the addition of azithromycin did not result in the prolongation of the QTc interval or increase in cardiovascular adverse events. Because azithromycin is among the most commonly prescribed antimicrobial agents, our results may inform clinical practice. Clinical Trial Registration: NCT04322123, NCT04321278.
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Affiliation(s)
- Remo H M Furtado
- Brazilian Clinical Research Institute, São Paulo, Brazil; Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Australian and New Zealand Intensive Care Research Center (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Adriano J Pereira
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil
| | | | | | - Thiago Lisboa
- HCor Research Institute, São Paulo, Brazil; Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil
| | | | - Maura G Lapa
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Lucas P Damiani
- Brazilian Clinical Research Institute, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Leandro S Echenique
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Moriah, São Paulo, Brazil
| | | | | | - Carisi A Polanczyk
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Luis E Rohde
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Flávia R Machado
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Department of Anesthesiology, Pain and Intensive Care Medicine; Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Luciano C P Azevedo
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Sírio Libanês Research and Education Institute, São Paulo, Brazil
| | - Viviane C Veiga
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; BP A Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | - Regis G Rosa
- Brazilian Intensive Care Research Network (BRICNET), São Paulo, Brazil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato D Lopes
- Brazilian Clinical Research Institute, São Paulo, Brazil; Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | | | - Otavio Berwanger
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Imperial College London, London, United Kingdom; The George Institute for Global Health, London, United Kingdom
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Nassar AP, Archanjo LV, Ranzani OT, Zampieri FG, Salluh JI, Cavalcanti GF, Moreira CE, Viana WN, Costa R, Melo UO, Roderjan CN, Correa TD, de Almeida SL, Azevedo LC, Maia MO, Cravo VS, Bozza FA, Caruso P, Soares M. Characteristics and outcomes of autologous hematopoietic stem cell transplant recipients admitted to intensive care units: A multicenter study. J Crit Care 2022; 71:154077. [DOI: 10.1016/j.jcrc.2022.154077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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Noritomi DT, Ranzani OT, Ferraz LJR, Dos Santos MC, Cordioli E, Albaladejo R, Serpa Neto A, Correa TD, Berwanger O, de Morais LC, Schettino G, Cavalcanti AB, Rosa RG, Biondi RS, Salluh JI, Azevedo LCP, Pereira AJ. TELE-critical Care verSus usual Care On ICU PErformance (TELESCOPE): protocol for a cluster-randomised clinical trial on adult general ICUs in Brazil. BMJ Open 2021; 11:e042302. [PMID: 34155070 PMCID: PMC8217943 DOI: 10.1136/bmjopen-2020-042302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Daily multidisciplinary rounds (DMRs) consist of systematic patient-centred discussions aiming to establish joint therapeutic goals for the next 24 hours of intensive care unit (ICU) care. The aim of the present study protocol is to evaluate whether an intervention consisting of guided DMRs, supported by a remote specialist and audit/feedback on care performance will reduce ICU length of stay compared with a control group. METHODS AND ANALYSIS A multicentre, controlled, cluster-randomised superiority trial including 30 ICUs in Brazil (15 intervention and 15 control), from August 2019 to June 2021. In a parallel assignment, ICUs are randomised to a complex-intervention composed by daily rounds carried out through Tele-ICU by a remote ICU physician; development of local quality indicators dashboards coupled with monthly meetings with local leadership; and dissemination of evidence-based clinical protocols versus usual care. Primary outcome is ICU length of stay. Secondary outcomes include classification of the unit according to the profiles defined by the standardised resource use and the standardised mortality rate, hospital mortality, incidence of healthcare-associated infections, ventilator-free days at 28 days, patient-days receiving oral or enteral feeding, patient-days under light sedation or alert and calm, rate of patients under normoxaemia. All adult patients admitted after the beginning of the study in each participant ICU will be enrolled. Inclusion criteria (clusters): public Brazilian ICUs with a minimum of 8 ICU beds interested/committed to participating in the study. Exclusion criteria (clusters): units with fully established DMRs by an intensivist, specialised or step-down units. ETHICS AND DISSEMINATION The study protocol was approved by the institutional review board (IRB) of the coordinator centre, and by IRBs of each enrolled hospital/ICU. Statistical analysis protocol is being prepared for submission before the end of patient's enrolment. Results will be disseminated through conferences, peer-reviewed journals and to each participating unit. TRIAL REGISTRATION NUMBER NCT03920501; Pre-results.
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Affiliation(s)
- Danilo Teixeira Noritomi
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Clinical Governance, DASA, Sao Paulo, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clinicas, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, SP, Brazil
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Catalunya, Spain
| | | | - Maura C Dos Santos
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Cordioli
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Ary Serpa Neto
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Thiago D Correa
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, São Paulo, Brazil
| | - Lubia Caus de Morais
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Guilherme Schettino
- Institute of Social Responsibility, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Alexandre Biasi Cavalcanti
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- HCor Research Institute, Sao Paulo, SP, Brazil
| | - Regis Goulart Rosa
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care, HMV, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Santos Biondi
- Instituto de Cardiologia do Distrito Federal, Brasília, Distrito Federal, Brazil
- Hospital Brasília, Brasília, DF, Brazil
| | - Jorge If Salluh
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil, Rio de Janeiro, Brazil
| | - Luciano Cesar Pontes Azevedo
- Brazilian Research in Intensive Care Network - BRICNET, São Paulo, SP, Brazil
- Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil
- Emergency Medicine Department, University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Adriano Jose Pereira
- Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Postgraduate Program of Health Sciences, Universidade Federal de Lavras, Lavras, MG, Brazil
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Zampieri FG, Lisboa TC, Correa TD, Bozza FA, Ferez M, Fernandes HS, Japiassú AM, Verdeal JCR, Carvalho ACP, Knibel MF, Mazza BF, Colombari F, Vieira JM, Viana WN, Costa R, Godoy MM, Maia MO, Caser EB, Salluh JIF, Soares M. Role of organisational factors on the 'weekend effect' in critically ill patients in Brazil: a retrospective cohort analysis. BMJ Open 2018; 8:e018541. [PMID: 29371274 PMCID: PMC5786146 DOI: 10.1136/bmjopen-2017-018541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. METHODS We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined 'weekend admission' as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patient-level (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions. RESULTS A total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95% CI 0.99 to 1.12, P=0.095). However, a 'weekend effect' was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no 'weekend effect' was observed regardless of ICU's characteristics. For scheduled surgical admissions, a 'weekend effect' was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends. CONCLUSIONS ICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends.
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Affiliation(s)
- Fernando G Zampieri
- Research Institute, Hospital do Coração (IEP- HCor), São Paulo, Brazil
- ICU, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Thiago C Lisboa
- Intensive Care Unit, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Fernando A Bozza
- Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil
| | - Marcus Ferez
- ICU, Hospital São Francisco, Ribeirão Preto, Brazil
| | | | - André M Japiassú
- Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brazil
- Intensive Care Unit, Rede Amil de Hospitais, Rio de Janeiro, Brazil
| | | | | | | | - Bruno F Mazza
- ICU, Hospital São Luiz Morumbi, São Paulo, Brazil
- ICU, Hospital Samaritano, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Jorge I F Salluh
- Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
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Filho RR, Cavalheiro AM, Cazati DC, Lomar F, de Matos GFJ, de Assunção MSC, Filho RR, Mohovic T, Correa TD. Appraisal of the daily clinical rounds performed in an open and general ICU. Crit Care 2015. [PMCID: PMC4601817 DOI: 10.1186/cc14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Palomba H, Correa TD, Assunção MSC, Pardini A, de Melo DR, Silva E. Comparative analysis of survival between older and nonolder severe sepsis and septic shock resuscitated patients. Crit Care 2013. [PMCID: PMC3892562 DOI: 10.1186/cc12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cavalcanti AB, Silva E, Pereira AJ, Caldeira-Filho M, Almeida FP, Westphal GA, Beims R, Fernandes CC, Correa TD, Gouvea MR, Eluf-Neto J. A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. J Crit Care 2009; 24:371-8. [PMID: 19592202 DOI: 10.1016/j.jcrc.2009.05.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 04/29/2009] [Accepted: 05/06/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE The objective of this study is to evaluate blood glucose (BG) control efficacy and safety of 3 insulin protocols in medical intensive care unit (MICU) patients. METHODS This was a multicenter randomized controlled trial involving 167 MICU patients with at least one BG measurement >or=150 mg/dL and one or more of the following: mechanical ventilation, systemic inflammatory response syndrome, trauma, or burns. The interventions were computer-assisted insulin protocol (CAIP), with insulin infusion maintaining BG between 100 and 130 mg/dL; Leuven protocol, with insulin maintaining BG between 80 and 110 mg/dL; or conventional treatment-subcutaneous insulin if glucose >150 mg/dL. The main efficacy outcome was the mean of patients' median BG, and the safety outcome was the incidence of hypoglycemia (<or=40 mg/dL). RESULTS The mean of patients' median BG was 125.0, 127.1, and 158.5 mg/dL for CAIP, Leuven, and conventional treatment, respectively (P = .34, CAIP vs Leuven; P < .001, CAIP vs conventional). In CAIP, 12 patients (21.4%) had at least one episode of hypoglycemia vs 24 (41.4%) in Leuven and 2 (3.8%) in conventional treatment (P = .02, CAIP vs Leuven; P = .006, CAIP vs conventional). CONCLUSIONS The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols.
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Correa TD, Pereira AJ, Campos F, Cavalcanti AB, Passos RDH, Ferri MB, Rosa CA, Neto AC. Central venous catheterization: a randomized comparison between external and internal jugular access. Crit Care 2009. [PMCID: PMC4085462 DOI: 10.1186/cc7864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Correa TD, Passos RH, Kanda S, Taniguchi C, Hoelz C, Bastos J, Matos GFJ, Meyer EC, Barbas CSV. Does the cycling-off criteria of pressure support change the respiratory parameters in intensive care unit patients? Crit Care 2007. [PMCID: PMC3301190 DOI: 10.1186/cc5850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Cavalcanti AB, Eluf-Neto J, Pereira AJ, Caldeira M, Almeida FP, Westphal G, Beims R, Fernandes CC, Correa TD, Gouvea MR, Silva E. A computer-guided insulin protocol causes less hypoglycemia than a strict glycemic control protocol: a randomized controlled trial. Crit Care 2007. [PMCID: PMC3301211 DOI: 10.1186/cc5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pereira AJ, Cavalcanti AB, Correa TD, Almeida FP, Figueiredo EJA, Silva E. Reliability of arterial, capillary and venous point-of-care glucose measurements in the intensive care unit setting: evaluation of two glucometers. Crit Care 2007. [PMCID: PMC3301212 DOI: 10.1186/cc5872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Correa TD, Passos RH, Kanda S, Taniguchi C, Hoelz C, Bastos J, Matos GFJ, Meyer EC, Barbas CSV. Influence of the pressure support slope on the respiratory parameters of intensive care unit patients. Crit Care 2007. [PMCID: PMC3301191 DOI: 10.1186/cc5851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Correa TD, Passos RH, Kanda S, Taniguchi C, Hoelz C, Bastos J, Matos GFJ, Meyer EC, Barbas CSV. Flow or pressure triggering during pressure support ventilation? Crit Care 2007. [PMCID: PMC3301192 DOI: 10.1186/cc5852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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