Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 35
Filter
1.
Dtsch Med Wochenschr ; 139(45): 2301-7, 2014 Nov.
Article in German | MEDLINE | ID: mdl-25350245

ABSTRACT

Lung ultrasound has traditionally been limited to evaluation of pleural effusion and as guidance for thoracocentesis. However, in recent years, thoracic ultrasound became an increasingly valuable diagnostic tool in emergency and intensive care medicine. The relative easy use of bedside examination made chest ultrasonography diagnostic valuable additional tool to be used in any clinical acute context. Various pulmonary diseases like pleural effusion, pulmonary-venous congestion und edema, pneumonia and pneumothorax can be detected very fast under emergency conditions.


Subject(s)
Critical Care , Emergency Service, Hospital , Lung Diseases/diagnostic imaging , Diagnosis, Differential , Humans , Image Interpretation, Computer-Assisted , Lung Diseases, Interstitial/diagnostic imaging , Pleural Effusion/diagnostic imaging , Pneumonia/diagnostic imaging , Pneumothorax/diagnostic imaging , Predictive Value of Tests , Pulmonary Edema/diagnostic imaging , Ultrasonography
2.
Anaesthesist ; 63(10): 745-52, 2014 Oct.
Article in German | MEDLINE | ID: mdl-25300662

ABSTRACT

BACKGROUND: Current teaching methods in graduate and postgraduate training often include frontal presentations. Especially in ultrasound education not only knowledge but also sensomotory and visual skills need to be taught. This requires new learning methods. AIM: This study examined which types of teaching methods are preferred by participants in ultrasound training courses before, during and after the course by analyzing a blended learning concept. It also investigated how much time trainees are willing to spend on such activities. MATERIAL AND METHODS: A survey was conducted at the end of a certified ultrasound training course. Participants were asked to complete a questionnaire based on a visual analogue scale (VAS) in which three categories were defined: category (1) vote for acceptance with a two thirds majority (VAS 67-100%), category (2) simple acceptance (50-67%) and category (3) rejection (< 50%). RESULTS: A total of 176 trainees participated in this survey. Participants preferred an e-learning program with interactive elements, short presentations (less than 20 min), incorporating interaction with the audience, hands-on sessions in small groups, an alternation between presentations and hands-on-sessions, live demonstrations and quizzes. For post-course learning, interactive and media-assisted approaches were preferred, such as e-learning, films of the presentations and the possibility to stay in contact with instructors in order to discuss the results. Participants also voted for maintaining a logbook for documentation of results. CONCLUSION: The results of this study indicate the need for interactive learning concepts and blended learning activities. Directors of ultrasound courses may consider these aspects and are encouraged to develop sustainable learning pathways.


Subject(s)
Anesthesiology/education , Ultrasonography , Clinical Competence , Computer-Assisted Instruction , Curriculum , Educational Measurement , Humans , Learning , Surveys and Questionnaires , Teaching
3.
Unfallchirurg ; 116(7): 602-9, 2013 Jul.
Article in German | MEDLINE | ID: mdl-22367522

ABSTRACT

BACKGROUND: The implementation of ATLS® in the daily routine of trauma management in the emergency department is a challenge. This goal cannot be reached by educating ATLS® to a few team members only. In order to enforce the implementation of ATLS® in a level I trauma centre, a generic in-house training was introduced in 2009 with inter-professional integration of all specialists of the trauma team. MATERIALS AND METHODS: The TEAM® course (trauma evaluation and management concept of the American College of Surgeons) was the theoretical basis of the training. This educational program was developed for medical students and multidisciplinary team members. Prior training, a questionnaire for self-assessment was completed by n=84 team members to assess their knowledge about ATLS® principles. The hands-on training time was 90 min. N=10 members of the trauma team worked out three scenarios of multiple injured patients. These were provided as near-reality manikin simulations by a specialist trainer. After the training participants re-evaluated and analysed improvement by the training. Duration of trauma management and the number of missed injuries were analysed one year prior and one year after the training and served as a marker of the process and outcome quality of trauma care. RESULTS: Prior the training, 57% of trainees specified their knowledge related to the ATLS® can be improved. Their expectations were generally satisfied by the training. The mean time of trauma management in the ED could not be reduced one year after the training (36±16 min) compared to one year prior the training (39±18 min), however, the detection of missed injuries (5.6% vs. 3.2%, p<0.05) was significantly diminished after the training. CONCLUSION: Apart form education of ATLS® providers the inauguration of an interdisciplinary and interprofessionel team training may enhance implementation of ATLS- algorithms into daily routine.


Subject(s)
Education, Medical, Continuing/organization & administration , Leadership , Orthopedics/education , Orthopedics/organization & administration , Patient Care Team/organization & administration , Traumatology/education , Traumatology/organization & administration , Germany
4.
Praxis (Bern 1994) ; 101(18): 1153-60, 2012 Sep 05.
Article in German | MEDLINE | ID: mdl-22945815

ABSTRACT

Focused ultrasound is a key methodology of critical care medicine. By referencing few ultrasound differential diagnosis, it is possible to identifying in real-time the reason of the critical state of a patient. Therefore typical focused ultrasound protocols were developed. The well known Focused Assessment with Sonography for trauma (FAST) was incorporated into the Advanced Trauma Life Support (ATLS) for shock room. Focused echocardiographic evaluation in life support (FEEL) has been designed to be conformed with the universal Advanced Life Support (ALS) algorithm and to identify treatable conditions such as acute right ventricular pressure overload in pulmonary embolism, hypovolemia, or pericardial effusion/tamponade. Using lung ultrasound one can differentiate pulmonary edema, pleural effusion or pneumothorax.


Subject(s)
Emergency Service, Hospital , Ultrasonography/methods , Abdominal Injuries/diagnostic imaging , Algorithms , Artifacts , Cardiopulmonary Resuscitation/methods , Diagnosis, Differential , Early Diagnosis , Echocardiography/methods , Endosonography/methods , Hemoperitoneum/diagnostic imaging , Humans , Image Enhancement/methods , Image Interpretation, Computer-Assisted/methods , Life Support Care/methods , Lung/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging
5.
Anaesthesist ; 61(7): 608-17, 2012 Jul.
Article in German | MEDLINE | ID: mdl-22772347

ABSTRACT

The development of modern critical care lung ultrasound is based on the classical representation of anatomical structures and the need for the assessment of specific sonography artefacts and phenomena. The air and fluid content of the lungs is interpreted using few typical artefacts and phenomena, with which the most important differential diagnoses can be made. According to a recent international consensus conference these include lung sliding, lung pulse, B-lines, lung point, reverberation artefacts, subpleural consolidations and intrapleural fluid collections. An increased number of B-lines is an unspecific sign for an increased quantity of fluid in the lungs resembling interstitial syndromes, for example in the case of cardiogenic pulmonary edema or lung contusion. In the diagnosis of interstitial syndromes lung ultrasound provides higher diagnostic accuracy (95%) than auscultation (55%) and chest radiography (72%). Diagnosis of pneumonia and pulmonary embolism can be achieved at the bedside by evaluating subpleural lung consolidations. Detection of lung sliding can help to detect asymmetrical ventilation and allows the exclusion of a pneumothorax. Ultrasound-based diagnosis of pneumothorax is superior to supine anterior chest radiography: for ultrasound the sensitivity is 92-100% and the specificity 91-100%. For the diagnosis of pneumothorax a simple algorithm was therefore designed: in the presence of lung sliding, lung pulse or B-lines, pneumothorax can be ruled out, in contrast a positive lung point is a highly specific sign of the presence of pneumothorax. Furthermore, lung ultrasound allows not only diagnosis of pleural effusion with significantly higher sensitivity than chest x-ray but also visual control in ultrasound-guided thoracocentesis.


Subject(s)
Critical Care/methods , Lung/diagnostic imaging , Acute Disease , Algorithms , Artifacts , Diagnosis, Differential , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/therapy , Pleura/diagnostic imaging , Pneumonia/diagnosis , Pneumonia/diagnostic imaging , Pneumothorax/diagnosis , Pneumothorax/diagnostic imaging , Pulmonary Embolism/diagnosis , Pulmonary Embolism/diagnostic imaging , Radiography, Thoracic , Ultrasonography
8.
Unfallchirurg ; 114(4): 340-4, 2011 Apr.
Article in German | MEDLINE | ID: mdl-20393830

ABSTRACT

BACKGROUND: Due to the complexity of medical emergencies undergraduate medical training in the integrative course on emergency medicine requires education combining knowledge, practical skills, algorithm-driven behavior and soft skills. New State board regulations on education and licensing of physicians demand a practical implementation of these objectives. MATERIALS AND METHODS: The medical faculty of Frankfurt medical school has implemented an obligatory prehospital elective course. A retrospective questionnaire assessed the organization, instructional competence of the paramedics and integration of students in the emergency medical teams. RESULTS: Out of a total of 486 students the majority rated the longitudinal curriculum as positive (66% very good and 28% good). The practical experience at a scene was evaluated to be reasonable by 86% and 95% of the students stated that integration into the emergency team was rendered without any difficulties. CONCLUSION: A prehospital experience supported by paramedics can serve as a valuable tool in an emergency medicine curriculum.


Subject(s)
Allied Health Personnel/statistics & numerical data , Attitude of Health Personnel , Curriculum , Education, Medical, Undergraduate/statistics & numerical data , Educational Measurement , Emergency Medicine/education , Students/statistics & numerical data , Germany , Surveys and Questionnaires
10.
Anaesthesist ; 59(1): 53-61, 2010 Jan.
Article in German | MEDLINE | ID: mdl-20012427

ABSTRACT

Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. Patients with a high risk for difficult vascular access include critical care and emergency patients as well as patients on anticoagulation medication and dialysis. Placement of central venous catheters can be difficult in ventilated patients and if there has been prior surgery in the puncture area. In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.


Subject(s)
Catheterization, Central Venous/methods , Veins/diagnostic imaging , Adult , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Catheterization, Central Venous/adverse effects , Child , Critical Care , Emergency Medical Services , Femoral Vein/diagnostic imaging , Guidelines as Topic , Humans , Jugular Veins/diagnostic imaging , Respiration, Artificial , Subclavian Vein/diagnostic imaging , Ultrasonography
11.
Minerva Anestesiol ; 75(5): 285-92, 2009 May.
Article in English | MEDLINE | ID: mdl-19412146

ABSTRACT

AIM: We describe a training programme for non-specialists in focused echocardiography in the periresuscitation setting which represents an entry level in echocardiography training (FEEL) for emergency and critical care medicine physicians. METHODS: A prospective observational study based upon the development of a periresuscitation echocardiography training programme developed for novice practitioners (N=15 courses). RESULTS: The programme enables novice echocardiographers to be able to perform a focused echocardiogram in an ALS-compliant manner, and interpret the findings in the context of the clinical scenario. It is based on the concept of blended learning, incorporating a combination of e-learning, web-based teaching and reading selected literature, and attendance at a course. The course comprises 4-hours of theory and 4-hours of hands-on training. CONCLUSIONS: Periresuscitation echocardiography, performed safely, within the competence of practitioners in an ALS-compliant manner is a potentially valuable skill to be acquired by physicians caring for the critically ill, regardless of the environment in which they work, or their level of seniority. This newly-developed blended learning periresuscitation echocardiography programme (FEEL) may serve as entry level in peri-resuscitation echocardiography for both emergency physicians and critical care practitioners.


Subject(s)
Curriculum , Echocardiography , Emergency Medicine/education , Acute Lung Injury/diagnostic imaging , Critical Care/methods , Humans , Lung Compliance , Manikins , Point-of-Care Systems , Prospective Studies , Respiratory Distress Syndrome/diagnostic imaging , Teaching Materials
12.
Anaesthesist ; 58(4): 375-8, 2009 Apr.
Article in German | MEDLINE | ID: mdl-19326055

ABSTRACT

In the last decade prehospital focused abdominal sonography for trauma (P-FAST) could be established as a valid on-site diagnostic tool for both air and ground rescue medical services in Germany. An appropriate use of P-FAST demands a standardized training concept. Therefore a 1-day training program was developed by the working group "emergency ultrasound" in Frankfurt/Main and was introduced in 2003. The training consists of lectures on general and specific aspects of emergency ultrasound techniques with demonstrations of numerous pathological findings, intensive hands-on training with patients and volunteers, as well as simulated on-site training. After completing the P-FAST course the participants gained competency to perform prehospital emergency ultrasound with high accuracy. Strict application of the exact technique as well as appropriate integration of the adjunct into the algorithm of prehospital care are the most important prerequisites for successful use of P-FAST. From February 2003 to March 2008 540 participants were trained in P-FAST in the 1-day course.


Subject(s)
Emergency Medicine/education , Ultrasonography , Wounds and Injuries/diagnostic imaging , Curriculum , Emergency Medical Services , Germany , Humans , Rescue Work
14.
Br J Surg ; 93(2): 238-42, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16329081

ABSTRACT

BACKGROUND: Blunt abdominal trauma with intra-abdominal bleeding is often underdiagnosed or even overlooked at trauma scenes. The purpose of this prospective, multicentre study was to compare the accuracy of physical examination and prehospital focused abdominal sonography for trauma (PFAST) to detect abdominal bleeding. METHODS: Six rescue centres took part in the study from December 2002 to December 2003, including 230 patients with suspected abdominal injury. The accuracy of physical examination at the scene and PFAST were compared. Later examinations in the emergency department (ultrasonography and/or computed tomography) were used as the reference standard. RESULTS: The complete protocol and follow-up was obtained in 202 patients. The sensitivity, specificity and accuracy of PFAST were 93 per cent, 99 per cent and 99 per cent, respectively, compared with 93 per cent, 52 per cent and 57 per cent for physical examination at the scene. Scanning with PFAST occurred a mean(s.d.) 35(13) min earlier than ultrasound in the emergency department. Abdominal bleeding was detected in 14 per cent of patients. Using PFAST led to a change in either prehospital therapy or management in 30 per cent of patients, and a change to admitting hospital in 22 per cent. CONCLUSION: In this study, PFAST was a useful and reliable diagnostic tool when used as part of surgical triage at the trauma scene.


Subject(s)
Abdominal Injuries/diagnostic imaging , Emergency Medical Services/methods , Hemorrhage/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Abdominal Injuries/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Emergency Medical Services/standards , Feasibility Studies , Female , Humans , Infant , Male , Middle Aged , Physical Examination/standards , Prospective Studies , Ultrasonography
15.
Ann N Y Acad Sci ; 945: 195-206, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11708479

ABSTRACT

Circulating nucleic acids in serum and plasma are common in a variety of disease conditions. Here, we focus (i) on our approach for the detection of various hepatitis B virus (HBV)-related nucleic acids in liver tissue and in serum, (ii) on the progression of the chronic HBV infection, (iii) on the relation of HBV-specific nucleic acids circulating in the blood of patients with hepatocellular carcinoma, and in general (iv) on the diagnostic potential of circulating HBV nucleic acids.


Subject(s)
Carcinoma, Hepatocellular/blood , Carrier State , Hepatitis B Surface Antigens/genetics , Hepatitis B virus/genetics , Liver Neoplasms/blood , Amino Acid Sequence , Disease Progression , Humans , Molecular Sequence Data , Sequence Homology, Amino Acid , Trans-Activators/chemistry , Trans-Activators/genetics , Viral Regulatory and Accessory Proteins
16.
Transpl Int ; 14(5): 329-33, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11692217

ABSTRACT

Experimental treatment with the antioxidant and glutathione precursor N-acetylcysteine (NAC) has been performed in orthotopic liver transplantation (OLT) to reduce reperfusion injury. To investigate the effect of NAC on the hepatic and intestinal amino acid metabolism, intraoperative amino acid exchange rates were studied in liver transplant recipients with high dose NAC treatment (n = 10) and in control patients (n = 9). Treatment with NAC was found to cause a loss of amino acids and increased urea nitrogen release from the liver graft. The net balance of most amino acids was shifted to increased hepatic release or decreased hepatic uptake. The initial cumulative splanchnic release of all proteinogenic amino acids in the NAC treated group was significantly higher than in the control group. These findings are tentatively explained by an increased net protein catabolism in the liver. The increased hepatic urea and glutamine production rate of the NAC treated patients is expected to increase the energy and oxygen demand of the liver in this critical situation. Thus, NAC may have caused marked metabolic disturbances in the freshly implanted graft. The dosage of NAC should therefore be modified to avoid these disadvantages.


Subject(s)
Acetylcysteine/pharmacology , Amino Acids/metabolism , Free Radical Scavengers/pharmacology , Liver Transplantation/physiology , Liver/metabolism , Amino Acids, Aromatic/metabolism , Amino Acids, Branched-Chain/metabolism , Biological Transport , Glutathione/metabolism , Humans , Liver/drug effects , Middle Aged , Reperfusion Injury/prevention & control , Splanchnic Circulation/drug effects , Urea/metabolism
17.
J Mol Med (Berl) ; 79(11): 671-8, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11715071

ABSTRACT

Increased whole-body proteolysis with muscle protein net degradation has been suggested as one of the causes of weight loss in patients infected with human immunodeficiency virus (HIV). We studied the exchange rates of amino acids and energy substrates across the lower extremity in 16 HIV patients and 16 age-matched controls with similar body cell mass. The patients had either opportunistic infections or chronic diarrhea but no signs of clinical malnutrition. The following findings were obtained in the HIV patients: an augmented peripheral net release of arginine and lysine; an increase in both the negative arterial-venous difference and the efflux of the nitrogen contained in nonmetabolized amino acids; diminished export of 3-methylhistidine; lowered plasma and erythrocyte amino acid concentrations; reduced output of glycerol and furthermore; and neither a net release nor a net uptake of free fatty acids. The findings concerning nitrogen metabolism support the hypothesis that, in the presence of a reduction in protein breakdown, peripheral protein synthesis is severely depressed, making a slow protein wasting process likely to occur. The balances of glycerol and free fatty acids are due not only to the leg tissues but perhaps also in part to increased net retention of these substrates by skeletal muscle.


Subject(s)
AIDS-Related Opportunistic Infections/metabolism , Amino Acids/metabolism , HIV Seropositivity/metabolism , HIV Wasting Syndrome/metabolism , Leg/physiology , Adult , Amino Acids/blood , Arginine/metabolism , Blood Glucose/metabolism , Case-Control Studies , Dose-Response Relationship, Drug , Erythrocytes/metabolism , Fatty Acids/blood , Fatty Acids/metabolism , Female , Glycerol/metabolism , Humans , Insulin/blood , Interleukin-6/blood , Ketones/blood , Ketones/metabolism , Lactic Acid/blood , Lysine/metabolism , Male , Middle Aged , Muscle, Skeletal/metabolism , Nitrogen/metabolism , Pyruvic Acid/blood
19.
Clin Cancer Res ; 7(7): 2005-15, 2001 Jul.
Article in English | MEDLINE | ID: mdl-11448918

ABSTRACT

PURPOSE: Beside the established maturation of hepatitis B virus (HBV) transcripts at a polyadenylation signal downstream of the HBV x protein open reading frame, maturation at an internal polyadenylation signal has been observed in the chronically infected liver. In the present study, it was the aim to identify the respective circulating full-length and truncated transcripts in plasma/serum of carriers. EXPERIMENTAL DESIGN: Nucleic acids extracted from sera were analyzed using established PCR and reverse transcription-PCR procedures targeted to HBV x protein gene regions. Amplification products were cloned and sequenced. RESULTS: Base substitution patterns were determined, which indicated infection stages advanced to different degrees regardless of the transcript type analyzed. HBV full-length RNA (fRNA) showed a high correlation with hepatitis B e antigen and viral DNA, indicative for a replicative infection. In contrast, truncated RNA (trRNA) appeared to be independent of hepatitis B e antigen and showed only a weak association with circulating viral DNA. No correlation was observed between the levels of trRNA and the apparent liver damage as reflected by alanine transaminase levels. An age-dependent representation of fRNA and trRNA was observed: fRNA decreased progressively to low levels, whereas trRNA remained at comparably high values. trRNA and RNA not polyadenylated at either of the two polyadenylation signals were detected even in the absence of any other conventional HBV seromarker, including viral DNA. This was shown for patients with cryptogenic cirrhosis and hepatitis C virus carriers. CONCLUSIONS: The identification of HBV RNA in human serum has a diagnostic potential for apparent and for inapparent infection stages.


Subject(s)
Hepatitis B virus/genetics , Hepatitis B, Chronic/virology , RNA, Viral/blood , Adolescent , Adult , Age Factors , Alanine Transaminase/blood , Child , DNA Primers , DNA, Complementary/chemistry , DNA, Complementary/genetics , DNA, Viral/blood , DNA, Viral/chemistry , Genetic Variation , Hepatitis B Surface Antigens/blood , Hepatitis B Surface Antigens/genetics , Hepatitis B e Antigens/blood , Hepatitis B e Antigens/genetics , Hepatitis B, Chronic/blood , Humans , Middle Aged , Oligodeoxyribonucleotides/genetics , Poly A/genetics , Reverse Transcriptase Polymerase Chain Reaction , Sequence Analysis, DNA , Trans-Activators/blood , Trans-Activators/genetics , Transcription, Genetic , Viral Regulatory and Accessory Proteins , Virus Replication/genetics
20.
Crit Care Med ; 29(2): 272-6, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11246305

ABSTRACT

OBJECTIVE: The antioxidant N-acetylcysteine (NAC) has been shown to attenuate septic tissue injury. To evaluate whether NAC affects host defense mechanisms in critically ill patients, thus predisposing to increased risk of infection, the current study focuses on neutrophil phagocytotic and burst activity after treatment with NAC. DESIGN: Prospective, randomized, clinical trial. SETTING: Twelve-bed operative intensive care unit in a university hospital. PATIENTS: Thirty patients diagnosed with sepsis/systemic inflammatory response syndrome, or multiple trauma. INTERVENTIONS: Patients were randomly assigned to receive either NAC (n = 15) for 4 days in increasing dosages (day 1: 6 g; day 2: 12 g; days 3 and 4: 18 g) or a mucolytic basis dosage of NAC (3 x 300 mg/day [control]; n = 15), respectively. MEASUREMENTS AND MAIN RESULTS: Blood samples were taken before NAC high-dose infusion (day 1), after increasing doses of NAC (days 3 and 5) and 4 days after the last high-dose treatment (day 8). Neutrophil oxidative burst activity after stimulation with Escherichia coli and polymorphonuclear phagocytosis were determined in a flow cytometric assay. Baseline values of polymorphonuclear functions were comparable in both groups. NAC high-dose treatment resulted in a significantly improved phagocytosis activity compared with control patients. In contrast to this, polymorphonuclear burst activity was significantly reduced in the NAC high-dose treated group on day 3. CONCLUSION: These findings suggest that infusion of NAC in high doses affects granulocyte functions in critically ill patients. Antimicrobial host defense requires the effective sequence of cell adhesion, phagocytosis, and bactericidal respiratory burst. The enhanced phagocytotic activity might be a compensatory mechanism in states of impaired respiratory burst to maintain tissue sterility. For certain mechanisms of disease, the effects observed might be favorable (e.g., ischemia/reperfusion, endothelial cell activation), for others (infection) this might be detrimental.


Subject(s)
Acetylcysteine/pharmacology , Acetylcysteine/therapeutic use , Free Radical Scavengers/pharmacology , Free Radical Scavengers/therapeutic use , Neutrophils/drug effects , Phagocytosis/drug effects , Respiratory Burst/drug effects , Shock, Septic/drug therapy , APACHE , Adult , Analysis of Variance , Female , Flow Cytometry , Hospital Mortality , Humans , Infusions, Intravenous , Length of Stay/statistics & numerical data , Male , Middle Aged , Neutrophils/immunology , Phagocytosis/immunology , Prospective Studies , Respiratory Burst/immunology , Shock, Septic/blood , Shock, Septic/immunology , Shock, Septic/mortality , Survival Analysis , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...