Publications
104 results found
Bossy M, Nyman M, Madhuri TK, et al., 2020, The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway, PERIOPERATIVE MEDICINE, Vol: 9
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- Citations: 4
Angus DC, Derde L, Al-Beidh F, et al., 2020, Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19, JAMA, Vol: 324, Pages: 1317-1329, ISSN: 0098-7484
Importance Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.Objective To determine whether hydrocortisone improves outcome for patients with severe COVID-19.Design, Setting, and Participants An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020.Interventions The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108).Main Outcomes and Measures The primary end point was organ support–free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned –1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%).Results After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137)
Hammond NE, Finfer SR, Li Q, et al., 2020, Health-related quality of life in survivors of septic shock: 6-month follow-up from the ADRENAL trial, INTENSIVE CARE MEDICINE, Vol: 46, Pages: 1696-1706, ISSN: 0342-4642
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- Citations: 16
Robba C, Hemmes SNT, Serpa Neto A, et al., 2020, Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study., BMC Anesthesiol, Vol: 20
BACKGROUND: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. METHODS: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. RESULTS: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. CONCLUSIONS: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs.
Odor PM, Bampoe S, Gilhooly D, et al., 2020, Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis., BMJ, Vol: 368
OBJECTIVE: To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA: Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS: Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS: 117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23
Blot S, Antonelli M, Arvaniti K, et al., 2019, Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project, INTENSIVE CARE MEDICINE, Vol: 45, Pages: 1703-1717, ISSN: 0342-4642
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- Citations: 73
Haller G, Bampoe S, Cook T, et al., 2019, Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: clinical indicators., Br J Anaesth, Vol: 123, Pages: 228-237
BACKGROUND: Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid clinical outcome indicators for use in perioperative clinical trials. METHODS: We identified clinical indicators via a systematic review of the anaesthesia and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 54 clinician-researchers worldwide. Indicators were first shortlisted and the most suitable definitions for evaluation of quality and safety interventions determined. Indicators were then assessed for validity, reliability, feasibility, and clarity. RESULTS: We identified 167 clinical outcome indicators. Participation in the three Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A final list of eight outcome indicators was generated: surgical site infection at 30 days, stroke within 30 days of surgery, death within 30 days of coronary artery bypass grafting, death within 30 days of surgery, admission to the intensive care unit within 14 days of surgery, readmission to hospital within 30 days of surgery, and length of hospital stay (with or without in-hospital mortality). They were rated by the majority of experts as valid, reliable, easy to use, and clearly defined. CONCLUSIONS: These clinical indicators can be confidently used as endpoints in clinical trials measuring quality, safety, and improvement in perioperative care. REGISTRATION: PROSPERO 2016 CRD42016042102 (http://www.crd.york.ac.uk/PROSPERO/display_record.php? ID=CRD42016042102).
Chhetri I, Hunt JEA, Mendis JR, et al., 2019, Repetitive vascular occlusion stimulus (RVOS) versus standard care to prevent muscle wasting in critically ill patients (ROSProx):a study protocol for a pilot randomised controlled trial., Trials, Vol: 20
BACKGROUND: Forty per cent of critically ill patients are affected by intensive care unit-acquired weakness (ICU-AW), to which skeletal muscle wasting makes a substantial contribution. This can impair outcomes in hospital, and can cause long-term physical disability after hospital discharge. No effective mitigating strategies have yet been identified. Application of a repetitive vascular occlusion stimulus (RVOS) a limb pressure cuff inducing brief repeated cycles of ischaemia and reperfusion, can limit disuse muscle atrophy in both healthy controls and bed-bound patients recovering from knee surgery. We wish to determine whether RVOS might be effective in mitigating against muscle wasting in the ICU. Given that RVOS can also improve vascular function in healthy controls, we also wish to assess such effects in the critically ill. We here describe a pilot study to assess whether RVOS application is safe, tolerable, feasible and acceptable for ICU patients. METHODS: This is a randomised interventional feasibility trial. Thirty-two ventilated adult ICU patients with multiorgan failure will be recruited within 48 h of admission and randomised to either the intervention arm or the control arm. Intervention participants will receive RVOS twice daily (except only once on day 1) for up to 10 days or until ICU discharge. Serious adverse events and tolerability (pain score) will be recorded; feasibility of trial procedures will be assessed against pre-specified criteria and acceptability by semi-structured interview. Together with vascular function, muscle mass and quality will be assessed using ultrasound and measures of physical function at baseline, on days 6 and 11 of study enrolment, and at ICU and hospital discharge. Blood and urine biomarkers of muscle metabolism, vascular function, inflammation and DNA damage/repair mechanism will also be analysed. The Health questionnaire will be completed 3 months after hospital discharge. DISCUSSION: If this st
Potter EK, Hodgson L, Creagh-Brown B, et al., 2019, Manipulating the Microcirculation in Sepsis - the Impact of Vasoactive Medications on Microcirculatory Blood Flow: A Systematic Review., Shock, Vol: 52, Pages: 5-12
BACKGROUND: Sepsis is life-threatening organ dysfunction because of a dysregulated host response to infection. Disturbed microvascular blood flow is associated with excess mortality and is a potential future target for interventions. This review addresses the evidence for pharmacological manipulation of the microcirculation in sepsis assessed by techniques that evaluate the sublingual microvasculature. METHODS: Systematic review using a published protocol. Eligibility criteria were studies of septic patients published from January 2000 to February 2018. Interventions were drugs aimed at improving perfusion. Outcome was improvement in microvascular flow using orthogonal polarization spectral, sidestream dark field, or incident dark field imaging (Grades of Recommendation, Assessment, Development, and Evaluation criteria used). RESULTS: Two thousand six hundred and six articles were screened and 22 included. (6 randomized controlled trials, 12 interventional, 3 observational, and 1 pilot, n = 572 participants). Multiple measurement techniques were described, including: automated analyses, subjective, and composite scoring systems. Norepinephrine was not found to improve microvascular flow (low-grade evidence, n = 6 studies); except in chronic hypertension (low, n = 1 study). Addition of arginine vasopressin or terlipressin to norepinephrine maintained flow while decreasing norepinephrine requirements (high, n = 2 studies). Neither dobutamine nor glyceryl trinitrate consistently improved flow (low, n = 6 studies). A single study (n = 40 participants) demonstrated improved flow with levosimendan (high). In a risk of bias assessment 16/16 interventional, pilot and observational studies were found to be high risk. CONCLUSIONS: There is no robust evidence to date that any one agent can reproducibly lead to improved microvascular flow. Furthermore, no study demonstrated outcome benefit of one therapeutic agent over another. Updated consensus guidelines could improve compara
Rayner LH, Mcgovern A, Sherlock J, et al., 2019, The impact of therapy on the risk of asthma in type 2 diabetes., Clin Respir J, Vol: 13, Pages: 299-305
BACKGROUND AND OBJECTIVES: There are limited data about the risk of asthma in people with diabetes. We examined the incidence of asthma in subjects with type 2 diabetes (T2DM) compared to controls, and the association with metformin, sulphonylureas and insulin therapy. MATERIALS AND METHODS: We conducted a retrospective cohort study using a representative UK primary care database (N = 894 646 adults). We used 1:1 propensity score matching (age, gender, socio-economic deprivation, body mass index and smoking status) to match 29 217 pairs of T2DM cases and controls. We used Cox proportional hazard regression to compare the incidence of asthma in both groups over 8 years of follow-up. In those with T2DM, we used Cox proportional hazard regression to assess for any impact of antidiabetic medications on asthma incidence. RESULTS: Individuals with T2DM were less likely to develop asthma than matched controls (hazard ratio [HR] 0.85, 95% CI 0.77-0.93). Insulin increased the risk of incident asthma (HR 1.25, 95% CI 1.01-1.56), whilst metformin and sulphonylureas were associated with reduced risk (HR 0.80, 95% CI 0.69-0.93 and HR 0.76, 95% CI 0.60-0.97, respectively). There was no association with diabetes duration, complications or glycaemic control. CONCLUSIONS: T2DM may have a protective effect against asthma development. Insulin use was associated with an increased risk of asthma, while metformin and sulphonylureas reduced the risk in those with T2DM.
Barnes J, Hunter J, Harris S, et al., 2019, Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis., Br J Anaesth, Vol: 122, Pages: 500-508
BACKGROUND: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of infection and sepsis used in the perioperative literature. A multi-round Delphi consensus process that included more than 60 clinician researchers was then used to refine a recommended list of outcome measures. RESULTS: A literature search yielded 1857 titles of which 255 met inclusion criteria for endpoint extraction. A long list of endpoints, with definitions and timescales, was generated and those potentially relevant to infection and sepsis circulated to the theme subgroup and then the wider StEP-COMPAC working group, undergoing a three-stage Delphi process. The response rates for Delphi rounds 1, 3, and 3 were 89% (n=8), 67% (n=62), and 80% (n=8), respectively. A set of 13 endpoints including fever, surgical site, and organ-specific infections as defined by the US Centres for Disease Control and Sepsis-3 are proposed for future use. CONCLUSIONS: We defined a consensus list of standardised endpoints related to infection and sepsis for perioperative trials using an established and rigorous approach. Each endpoint was evaluated with respect to validity, reliability, feasibility, and patient centredness. One or more of these should be considered for inclusion in future perioperative clinical trials assessing infection, sepsis, or both, thereby permitting synthesis and comparison of future results.
Nikolakopoulou Z, Hector LR, Creagh-Brown BC, et al., 2019, Plasma S100A8/A9 heterodimer is an early prognostic marker of acute kidney injury associated with cardiac surgery, Biomarkers in Medicine, Vol: 13, Pages: 205-218, ISSN: 1752-0363
We investigated whether plasma levels of the inflammation marker S100A8/A9, could predict acutekidney injury (AKI) onset in patients undergoing cardiac surgery necessitating cardiopulmonary bypass(CPB). Patients & methods: Plasma levels of S100A8/A9 and other neutrophil cytosolic proteins were measured in 39 patients pre- and immediately post-CPB. Results: All markers increased significantly post-CPBwith S100A8/A9, S100A12 and myeloperoxidase levels significantly higher in patients who developed AKIwithin 7 days. S100A8/A9 had good prognostic utility for AKI, with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.676–0.949) and a cut-off value of 10.6 μg/ml (85.7% sensitivityand 75% specificity) irrespective of age. Conclusion: Plasma S100A8/A9 levels immediately after cardiacsurgery, can predict onset of AKI, irrespective of age.
Rayner L, McGovern A, Creagh-Brown B, et al., 2019, Type 2 Diabetes and Asthma: Systematic Review of the Bidirectional Relationship., Curr Diabetes Rev, Vol: 15, Pages: 118-126
BACKGROUND AND OBJECTIVE: Obesity is an important contributor to the risk of both asthma and Type 2 Diabetes (T2DM). However, it has been suggested that T2DM and asthma are also independently associated. The aim of this systematic review was to synthesize the evidence for an independent relationship between T2DM and asthma. METHODS: MEDLINE and EMBASE were searched for studies reporting the relationship between asthma and T2DM in adults. Given a potential bidirectional relationship, articles relating to T2DM as a risk factor for asthma, and asthma as a risk factor for T2DM were examined separately. RESULTS: Eight studies were identified for inclusion in the review (n=2,934,399 participants). Four studies examined incident diabetes in those with asthma. The pooled (random effects model) adjusted hazard ratio for incident T2DM in asthma was 1.37 (95%CI 1.12-1.69; p <0.001) after controlling for BMI. Four studies reported prevalence or incidence rates of asthma in people with T2DM; higher rates of asthma in those with T2DM were reported in all four studies. Meta-analysis of results was not possible due to methodological heterogeneity. The quality of included studies was good, but due to small numbers, publication bias cannot be excluded. CONCLUSION: The published literature suggests a bidirectional independent relationship between T2DM and asthma, although we cannot exclude publication bias.
Tyson E, Creagh-Brown B, 2018, Postoperative care, Medicine (United Kingdom), Vol: 46, Pages: 750-753, ISSN: 1357-3039
Optimal postoperative care involves a multidisciplinary team of healthcare professionals and a patient-centred approach to avoid postoperative complications and enable a rapid return to normal function. During the last decade, enhanced recovery after surgery programmes have been implemented worldwide to reduce complications and length of stay – challenging traditional models of perioperative care. Some aspects of perioperative care have consensus guidelines without significant controversy, whereas others, such as perioperative fluid therapy, remain contentious.
Rayner LH, McGovern AP, Sherlock J, et al., 2018, Type 2 diabetes: A protective factor for COPD?, PRIMARY CARE DIABETES, Vol: 12, Pages: 438-444, ISSN: 1751-9918
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- Citations: 10
Lambden S, Creagh-Brown BC, Hunt J, et al., 2018, Definitions and pathophysiology of vasoplegic shock, Critical Care, Vol: 22, ISSN: 1364-8535
Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition.
Buggy DJ, Freeman J, Johnson MZ, et al., 2018, Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes, BRITISH JOURNAL OF ANAESTHESIA, Vol: 121, Pages: 38-44, ISSN: 0007-0912
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- Citations: 40
Abbott TEF, Fowler AJ, Pelosi P, et al., 2018, A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications, BRITISH JOURNAL OF ANAESTHESIA, Vol: 120, Pages: 1066-1079, ISSN: 0007-0912
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- Citations: 146
Davies M, Allen M, Bentley A, et al., 2018, British Thoracic Society Quality Standards for acute non-invasive ventilation in adults, BMJ OPEN RESPIRATORY RESEARCH, Vol: 5, ISSN: 2052-4439
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- Citations: 26
Seaton A, Hodgson LE, Creagh-Brown B, et al., 2017, The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism., J Intensive Care Soc, Vol: 18, Pages: 342-347, ISSN: 1751-1437
A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.
Rayner L, Sherlock J, Creagh-Brown B, et al., 2017, The prevalence of COPD in England: An ontological approach to case detection in primary care, RESPIRATORY MEDICINE, Vol: 132, Pages: 217-225, ISSN: 0954-6111
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- Citations: 6
Hemmes SNT, Neto AS, Binnekade JM, et al., 2017, Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries, EUROPEAN JOURNAL OF ANAESTHESIOLOGY, Vol: 34, Pages: 492-507, ISSN: 0265-0215
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- Citations: 129
Vandevala T, Pavey L, Chelidoni O, et al., 2017, Psychological rumination and recovery from work in intensive care professionals: associations with stress, burnout, depression and health, JOURNAL OF INTENSIVE CARE, Vol: 5, ISSN: 2052-0492
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- Citations: 66
Salciccioli JD, Marshall DC, Komorowsk M, et al., 2016, ESICM LIVES 2016: part one : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Sivakumar S, Taccone FS, Desai KA, et al., 2016, ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016, Intensive Care Medicine Experimental, Vol: 4, ISSN: 2197-425X
Velasquez T, Mackey G, Lusk J, et al., 2016, ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016., Intensive Care Med Exp, Vol: 4, Pages: 28-28
Creagh-Brown B, 2016, Respiratory failure, Medicine (United Kingdom), Vol: 44, Pages: 342-345, ISSN: 1357-3039
Respiratory failure is a common complication of acute cardiorespiratory disease and exacerbations of chronic respiratory disease. It can be a feature of advanced chronic cardiac, respiratory and neurological diseases. Respiratory failure can manifest as hypoxaemia, hypercapnia or both. This article reviews the pathophysiology of these perturbations in respiratory homeostasis, the clinical features of acute and chronic respiratory failure and a brief discussion of the management.
Creagh-Brown BC, De Silva AP, Ferrando-Vivas P, et al., 2016, Relationship Between Peak Lactate and Patient Outcome Following High-Risk Gastrointestinal Surgery: Influence of the Nature of Their Surgery: Elective Versus Emergency, CRITICAL CARE MEDICINE, Vol: 44, Pages: 918-925, ISSN: 0090-3493
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- Citations: 13
Creagh-Brown BC, Evans TW, 2016, Pathogenesis of acute lung injury: Clinical studies, Acute Respiratory Distress Syndrome, Second Edition, Pages: 72-92, ISBN: 9781138115415
Davidson AC, Banham S, Elliott M, et al., 2016, BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults, THORAX, Vol: 71, Pages: 1-35, ISSN: 0040-6376
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- Citations: 155
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