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Rilinger J, Book R, Kaier K, Giani M, Fumagalli B, Jäckel M, Bemtgen X, Zotzmann V, Biever PM, Foti G, Westermann D, Lepper PM, Supady A, Staudacher DL, Wengenmayer T. A Mortality Prediction Score for Patients With Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO): The PREDICT VV-ECMO Score. ASAIO J 2024; 70:293-298. [PMID: 37934747 PMCID: PMC10977052 DOI: 10.1097/mat.0000000000002088] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Mortality prediction for patients with the severe acute respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) is challenging. Clinical variables at baseline and on day 3 after initiation of ECMO support of all patients treated from October 2010 through April 2020 were analyzed. Multivariate logistic regression analysis was used to identify score variables. Internal and external (Monza, Italy) validation was used to evaluate the predictive value of the model. Overall, 272 patients could be included for data analysis and creation of the PREDICT VV-ECMO score. The score comprises five parameters (age, lung fibrosis, immunosuppression, cumulative fluid balance, and ECMO sweep gas flow on day 3). Higher score values are associated with a higher probability of hospital death. The score showed favorable results in derivation and external validation cohorts (area under the receiver operating curve, AUC derivation cohort 0.76 [95% confidence interval, CI, 0.71-0.82] and AUC validation cohort 0.74 [95% CI, 0.67-0.82]). Four risk classes were defined: I ≤ 30, II 31-60, III 61-90, and IV ≥ 91 with a predicted mortality of 28.2%, 56.2%, 84.8%, and 96.1%, respectively. The PREDICT VV-ECMO score suggests favorable performance in predicting hospital mortality under ongoing ECMO support providing a sound basis for further evaluation in larger cohorts.
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Affiliation(s)
- Jonathan Rilinger
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rebecca Book
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Giani
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Benedetta Fumagalli
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Markus Jäckel
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paul M. Biever
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giuseppe Foti
- Department School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Dirk Westermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp M. Lepper
- Department of Internal Medicine V – Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, Homburg, Germany
| | - Alexander Supady
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Dawid L. Staudacher
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- From the Department of Interdisciplinary Medical Intensive Care, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Giani M, Fumagalli B, Cipulli F, Rezoagli E, Pozzi M, Fumagalli D, Fumagalli L, Ferrari K, Rona R, Bellani G, Lucchini A, Foti G. The "ZEEP-PEEP test" to evaluate the response to positive end-expiratory pressure delivered by helmet: A prospective physiologic study. Heliyon 2024; 10:e28339. [PMID: 38524568 PMCID: PMC10957420 DOI: 10.1016/j.heliyon.2024.e28339] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The improvement in oxygenation after helmet application in hypoxemic patients may be explained by the alveolar recruitment obtained with positive end expiratory pressure (PEEP) or by the administration of a more accurate inspiratory fraction of oxygen (FiO2). We have designed the "ZEEP-PEEP test", capable to distinguish between the FiO2-related or PEEP-related oxygenation improvement. Our primary aim was to describe the use of this test during helmet CPAP to assess the oxygenation improvement attributable to PEEP application. Material and methods We performed a prospective physiological study including adult critically ill patients. Respiratory and hemodynamic parameters were recorded before helmet application (PRE step), after helmet application without PEEP (ZEEP step) and after the application of the PEEP valve (PEEP step), while maintaining a constant FiO2. We defined as "PEEP responders" patients showing a PaO2/FiO2 ratio improvement ≥10% after PEEP application. Results 93 patients were enrolled. Compared to the PRE step, PaO2/FiO2 ratio was significantly improved during helmet CPAP both at ZEEP and PEEP step (189 ± 55, 219 ± 74 and 241 ± 82 mmHg, respectively, p < 0.01). Both PEEP responders (41%) and non-responders showed a significant improvement of PaO2/FiO2 ratio after the application of helmet at ZEEP, PEEP responders also showed a significant improvement of oxygenation after PEEP application (208 ± 70 vs 267 ± 85, p < 0.01). Conclusions Helmet CPAP improved oxygenation. This improvement was not only due to the PEEP effect, but also to the increase of the effective inspired FiO2. Performing the ZEEP-PEEP test may help to identify patients who benefit from PEEP.
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Affiliation(s)
- Marco Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Francesco Cipulli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Matteo Pozzi
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Denise Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Letizia Fumagalli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Katia Ferrari
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giacomo Bellani
- Department of Medical Sciences, University of Trento, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Alberto Lucchini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Giani M, Fumagalli B, Rezoagli E, Cannizzo L, Giannini L, D’Amata D, Lucchini A, Rona R, Elli S, Foti G. Midline catheters for blood gas and acid/base monitoring in critical patients: A prospective observational study. J Vasc Access 2023:11297298231163352. [DOI: 10.1177/11297298231163352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Arterial lines and central venous catheter (CVC) allow to monitor patients’ acid-base status and gas exchange. Their placement and maintenance may however be burdened by severe complications. Midline Catheters (MC) are peripheral venous accesses that are less invasive and easier to insert compared to CVC and arterial lines. Methods: A prospective observational study was performed including stabilized critical patients with clinical indication to midline positioning before intensive care unit (ICU) discharge. The primary aim was to assess if venous sampling from MCs can be a reliable alternative to CVC for pH and CO2 monitoring. The secondary aim was to evaluate the correlation between samplings from MC, CVC and arterial line with regards to pH, carbon dioxide tension (pCO2), lactates and electrolytes. Three samples from CVC, arterial line and MC were collected simultaneously. Agreement and correlation of the studied parameters between different sampling sites were explored. Results: 40 patients were included in the analysis. A good agreement for pH and pCO2 was recorded between MC and CVC: mean differences were 0.001 (95% CI −0.006 to 0.007) and 0.7 (−0.1 to 1.5), percentage error 0.4% and 11.2%, respectively. Correlation between MC and both central venous and arterial samples for pH, pCO2, lactates and electrolytes was found to be moderate-to-strong (Pearson’s R coefficient range 0.59–0.99, p < 0.001 for all these parameters). Conclusions: In stabilized critical patients, midline catheters represent a reliable alternative to CVC and arterial lines to monitor acid-base disturbances, CO2 levels and electrolytes. The present findings add to the known advantages of MC, which might be considered a first-line vascular access for non-critical or stabilized patients who do not require infusion of vesicant or irritant drugs.
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Giani M, Forlini C, Fumagalli B, Cristina Costa M, Lucchini A, Rona R, Foti G. Carboxyhemglobin and Drainage Pressure During Venovenous Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:e114-e115. [PMID: 34033585 DOI: 10.1097/mat.0000000000001394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Marco Giani
- Scuola di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy, Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Clarissa Forlini
- Scuola di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Benedetta Fumagalli
- Scuola di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Maria Cristina Costa
- Fisiopatologia Cardiocircolatoria e Perfusione Cardiovascolare, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alberto Lucchini
- Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Roberto Rona
- Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Giuseppe Foti
- Scuola di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy, Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy
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Pozzi M, Giani M, Fumagalli B, Calabria M, Leni D, Segramora V, Bellani G, Foti G. Role of Complete Duplex Ultrasound to Diagnose Deep Vein Thrombosis in COVID-19 Critical Patients. J Vasc Ultrasound 2021; 45:11-14. [PMID: 35330906 PMCID: PMC7803790 DOI: 10.1177/1544316720985812] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
An increased risk of deep vein thrombosis (DVT) has been reported in critical COVID-19 patients, despite adequate thromboprophylaxis, and most of DVT are probably asymptomatic. As a screening approach has been advocated, the best examination protocol is unknown. The objective of this study is to assess the role of a Complete Duplex Ultrasound (CDUS) examination in detecting DVT in a large population of COVID-19 patients admitted to intensive care unit (ICU) for respiratory failure. Single-center retrospective study of 145 COVID-19 patients admitted to ICU. DVT was assessed with a CDUS performed by experienced radiologist after ICU admission. DVT was confirmed in 38 patients (26%). Most DVT were distal to the knee (66%), while only 16% were proximal. At the time of the examination, 55% of the patients received full-dose anticoagulation, while 45% received thromboprophylaxis, and there were no differences in anticoagulation regimen between positive and negative patients. Patients with DVT had higher dimers compared with those with negative CDUS (P < .002). The observed frequency of DVT is high despite adequate anticoagulation. A comprehensive and experienced ultrasound examination protocol can allow to recognize a large number of distal DVT otherwise missed, albeit their clinical significance is unknown.
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Affiliation(s)
| | - Marco Giani
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
| | | | | | | | | | - Giacomo Bellani
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
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Grasselli G, Giani M, Scaravilli V, Fumagalli B, Mariani C, Redaelli S, Lucchini A, Zanella A, Patroniti N, Pesenti A, Foti G. Volatile Sedation for Acute Respiratory Distress Syndrome Patients on Venovenous Extracorporeal Membrane Oxygenation and Ultraprotective Ventilation. Crit Care Explor 2021; 3:e0310. [PMID: 33458679 PMCID: PMC7803679 DOI: 10.1097/cce.0000000000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available in the text. Patients on extracorporeal support for severe acute respiratory distress syndrome may require a prolonged period of deep sedation. In these patients, volatile sedation may represent a valid alternative to IV drugs. The aim of our study was to describe the feasibility of volatile sedation in a large cohort of acute respiratory distress syndrome patients undergoing venovenous extracorporeal membrane oxygenation and ultraprotective ventilation.
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Affiliation(s)
- Giacomo Grasselli
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Giani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy.,Dipartimento di Emergenza-Urgenza, ASST Monza, Monza, Italy
| | - Vittorio Scaravilli
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Fumagalli
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Carminia Mariani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Sara Redaelli
- Dipartimento di Emergenza-Urgenza, ASST Monza, Monza, Italy
| | | | - Alberto Zanella
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicolò Patroniti
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università di Genova, Genova, Italy.,Dipartimento di Anestesia e Terapia Intensiva, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Pesenti
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.,Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Foti
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy.,Dipartimento di Emergenza-Urgenza, ASST Monza, Monza, Italy
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Jaber S, Langlais N, Fumagalli B, Cornec S, Beydon L, Harf A, Brochard L. [Performance studies of 6 new anesthesia ventilators: bench tests]. Ann Fr Anesth Reanim 2000; 19:16-22. [PMID: 10751951 DOI: 10.1016/s0750-7658(00)00128-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the pneumatic performances of six new anaesthesia ventilators. STUDY DESIGN Bench test study. MATERIAL The study included one ventilator operated by an electric motor: ABT 5300 (Kontron); four ventilators of "bellows-in-bottle" category: ADU version 97 (Datex-Ohmeda); Aestiva 3000 (Datex-Ohmeda), Kion (Siemens), the two versions of Julian (Dräger); and an original ventilator devised for quantitative, or self-regulating target controlled inhalation anaesthesia, with a totally closed circuit, made of four ventilating chambers: PhysioFlex (Dräger). METHODS The bench test included a passive lung model with adjustable compliance and resistances, and flow and pressure gauges. The accuracy of volume and pressure measurements was tested in various conditions of resistance and compliance. RESULTS Pneumatic performance and accuracy were satisfactory, even in severe ventilatory conditions. All the ventilators, except ABT 5300 and Julian 1, have a compliance compensation system permitting to deliver and to maintain a constant tidal volume under various conditions of downstream load, particularly under maximal load condition. Variations of tidal volume with the increase of the fresh gas flow are negligible. CONCLUSION Recent technological progress has improved pneumatic performance of anaesthesia ventilators and the marketed models are more homogeneous at present. Ergonomics and training for the use of the machine are becoming major criteria for the global assessment and the choice of a ventilator.
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Affiliation(s)
- S Jaber
- Réanimation médicale et Inserm U492, CHU Henri-Mondor, Créteil, France
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Fumagalli B. [Materials monitoring]. Soins Chir 1997:5-6. [PMID: 9479224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Ventura M, Allegrini T, Bois F, Noirot L, Longval MT, Vanpevenage E, Fumagalli B, Meunier D. [The role of the nurse in the recovery room]. Soins Chir 1993:28-33. [PMID: 8265894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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10
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Fumagalli B. [Pulse oximetry or monitoring of SpO2]. Soins Chir 1992:43-4. [PMID: 1492189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Fumagalli B, Ang A, Chambord F, Chéru F, Colleu C, Moulia N. [Pediatric surgery. Experiences of children in day hospitals]. Soins Chir 1991:43-59. [PMID: 1801132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Castanié JB, Cohanier F, Eccher E, Espy MM, Fortias J, Fumagalli B. [The Swan-Ganz floating catheter (3). Catheterization of the right heart]. Soins Chir 1991:III-IV. [PMID: 1957076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Castanié JB, Cohanier F, Eccher E, Espy MM, Fortias J, Fumagalli B. [The floating Swan-Ganz catheter. Catheterizing the right heart]. Soins Chir 1991:III-IV. [PMID: 1853022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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14
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Fumagalli B. Rational arrangement of limb leads. J Electrocardiol 1980; 13:204. [PMID: 7365363 DOI: 10.1016/s0022-0736(80)80056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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