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Ultrasound-guided vascular access in critical illness

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Abstract

Over the past two decades, ultrasound (US) has become widely accepted to guide safe and accurate insertion of vascular devices in critically ill patients. We emphasize central venous catheter insertion, given its broad application in critically ill patients, but also review the use of US for accessing peripheral veins, arteries, the medullary canal, and vessels for institution of extracorporeal life support. To ensure procedural safety and high cannulation success rates we recommend using a systematic protocolized approach for US-guided vascular access in elective clinical situations. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis. This review will address the state of US-guided vascular access, including current practice and future directions.

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References

  1. Soni NJ, Reyes LF, Keyt H et al (2016) Use of ultrasound guidance for central venous catheterization: a national survey of intensivists and hospitalists. J Crit Care 36:277–283

    Article  PubMed  Google Scholar 

  2. Parienti JJ, Mongardon N, Mégarbane B, Mira JP, Kalfon P, Gros A, Marqué S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D, 3SITES Study Group (2015) Intravascular complications of central venous catheterization by insertion site. N Engl J Med 373(13):1220–1229

    Article  CAS  PubMed  Google Scholar 

  3. Maizel J, Bastide MA, Richecoeur J, BoReal Study Group et al (2016) Practice of ultrasound-guided central venous catheter technique by the French intensivists: a survey from the BoReal study group. Ann Intensive Care. 6:76

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wong AV, Arora N, Olusanya O, First Intensive Care National Audit Project (ICNAP-1) Group et al (2018) Insertion rates and complications of central lines in the UK population: a pilot study. J Intensive Care Soc 19:19–25

    Article  PubMed  Google Scholar 

  5. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF (2015) Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization. Cochrane Database Syst Rev 1:CD006962

    PubMed  Google Scholar 

  6. Lalu MM, Fayad A, Ahmed O, Bryson GL, Fergusson DA, Barron CC, Sullivan P, Thompson C (2015) Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med 43:1498–1507

    Article  PubMed  Google Scholar 

  7. NICE Guidelines. Guidance on the use of ultrasound locating devices for placing central venous catheters. https://www.nice.org.uk/guidance/ta49/chapter/1-Guidance. ASA Task Force on Central Venous Access. Practice guidelines for central venous access. A report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2012; 116:539–573.

  8. Milling TJ Jr, Rose J, Briggs WM, Birkhahn R, Gaeta TJ, Bove JJ, Melniker LA (2005) Randomized, controlled clinical trial of point-of-care limited ultrasonography assistance of central venous cannulation: the Third Sonography Outcomes Assessment Program (SOAP-3) Trial. Crit Care Med 33:1764–1769

    Article  PubMed  Google Scholar 

  9. Maecken T, Heite L, Wolf B, Zahn PK, Litz RJ (2015) Ultrasound-guided catheterization of the subclavian vein: freehand vs needle-guided technique. Anaesthesia 70:1242–1249

    Article  CAS  PubMed  Google Scholar 

  10. Brass P, Hellmich M, Kolodziej L, Schick G, Smith AF (2015) Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev 1:CD011447

    PubMed  Google Scholar 

  11. McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348:1123–1133

    Article  PubMed  Google Scholar 

  12. Frykholm P, Pikwer A, Hammarskjöld F et al (2014) Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 58:508–524

    Article  CAS  PubMed  Google Scholar 

  13. Rupp SM, Apfelbaum JL, Blitt C et al (2012) Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 116:539–573

    Article  PubMed  Google Scholar 

  14. Lamperti M, Bodenham AR, Pittiruti M, Blaivas M, Augoustides JG, Elbarbary M, Pirotte T, Karakitsos D, Ledonne J, Doniger S, Scoppettuolo G, Feller-Kopman D, Schummer W, Biffi R, Desruennes E, Melniker LA, Verghese ST (2012) International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 38(7):1105–1117

    Article  PubMed  Google Scholar 

  15. Saugel B, Scheeren TWL, Teboul JL (2017) Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care 21:225

    Article  PubMed  PubMed Central  Google Scholar 

  16. Amaya-Zuniga WF, Raffan-Sanabria F (2018) Could ultrasound-guided internal jugular vein catheter insertion replace the use of chest x-ray? Crit Care 22:206. https://doi.org/10.1186/s13054-018-2130-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gawda R, Czarnik T, Lysenko L (2016) Infraclavicular access to the axillary vein—new possibilities for the catheterization of the central veins in the intensive care unit. Anaesthesiol Intensive Ther 48:360–366. https://doi.org/10.5603/AIT.a2016.0055

    Article  PubMed  Google Scholar 

  18. Spencer TR, Pittiruti M (2018) Rapid Central Vein Assessment (RaCeVA): a systematic, standardized approach for ultrasound assessment before central venous catheterization. J Vasc Access. https://doi.org/10.1177/1129729818804718

    Article  PubMed  Google Scholar 

  19. Nifong TP, McDevitt TJ (2011) The effect of catheter to vein ratio on blood flow rates in a simulated model of peripherally inserted central venous catheters. Chest 140(1):48–53

    Article  PubMed  Google Scholar 

  20. Hoffman T, Du Plessis M, Prekupec MP, Gielecki J, Zurada A, Shane Tubbs R, Loukas M (2017) Ultrasound-guided central venous catheterization: a review of the relevant anatomy, technique, complications, and anatomical variations. Clin Anat 30:237–250. https://doi.org/10.1002/ca.22768

    Article  PubMed  Google Scholar 

  21. Lamperti M, Subert M, Cortellazzi P, Vailati D, Borrelli P, Montomoli C, D’Onofrio G, Caldiroli D (2012) Is a neutral head position safer than 45-degree neck rotation during ultrasound-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial. Anesth Analg 114(4):777–784

    Article  PubMed  Google Scholar 

  22. Bodenham AR (2011) Ultrasound-guided subclavian vein catheterization: beyond just the jugular vein. Crit Care Med 39(7):1819–1820

    Article  PubMed  Google Scholar 

  23. Bodenham A, Lamperti M (2016) Ultrasound guided infraclavicular axillary vein cannulation, coming of age. Br J Anaesth 116:325–327

    Article  CAS  PubMed  Google Scholar 

  24. Aslamy Z, Dewald CL, Heffner JE (1998) MRI of central venous anatomy: implications for central venous catheterization. Chest 114:820–826

    Article  CAS  PubMed  Google Scholar 

  25. Wirsing M, Schummer C, Neumann R, Steenbeck J, Schmidt P, Schummer W (2000) Is traditional reading of the bedside chest radiograph appropriate to detect intraatrial central venous catheter position? Chest 134:527–533

    Article  Google Scholar 

  26. Frankel HL, Kirkpatrick AW, Elbarbary M, Blaivas M, Desai H, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, Marik PE, Talmor D, Levitov A (2015) Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part I: general ultrasonography. Crit Care Med 43:2479–2502

    Article  PubMed  Google Scholar 

  27. Ablordeppey EA, Drewry AM, Beyer AB, Theodoro DL, Fowler SA, Fuller BM, Carpenter CR (2017) Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: a systematic review and meta-analysis. Crit Care Med 45:715–724. https://doi.org/10.1097/ccm.0000000000002188

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bou Chebl R, Kiblawi S, El Khuri C, El Hajj N, Bachir R, Aoun R, Abou Dagher G (2017) Use of contrast-enhanced ultrasound for confirmation of central venous catheter placement: systematic review and meta-analysis. J Ultrasound Med 36:2503–2510

    Article  PubMed  Google Scholar 

  29. Jauss M, Zanette E (2000) Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis 10:490–496

    Article  CAS  PubMed  Google Scholar 

  30. Jeon DS, Luo H, Iwami T, Miyamoto T, Brasch AV, Mirocha J, Naqvi TZ, Siegel RJ (2002) The usefulness of a 10% air–10% blood–80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure. J Am Coll Cardiol 39:124–129

    Article  PubMed  Google Scholar 

  31. Fan S, Nagai T, Luo H, Atar S, Naqvi T, Birnbaum Y, Lee S, Siegel RJ (1999) Superiority of the combination of blood and agitated saline for routine contrast enhancement. J Am Soc Echocardiogr 12:94–98

    Article  CAS  PubMed  Google Scholar 

  32. Ablordeppey EA, Drewry AM, Theodoro DL, Tian L, Fuller BM, Griffey RT (2018) Current practices in central venous catheter position confirmation by point of care ultrasound: a survey of early adopters. Shock. https://doi.org/10.1097/shk.0000000000001218

    Article  PubMed  PubMed Central  Google Scholar 

  33. Liu C, Mao Z, Kang H, Hu X, Jiang S, Hu P, Hu J, Zhou F (2018) Comparison between the long-axis/in-plane and short-axis/out-of-plane approaches for ultrasound-guided vascular catheterization: an updated meta-analysis and trial sequential analysis. Ther Clin Risk Manag 14:331–340

    Article  PubMed  PubMed Central  Google Scholar 

  34. McCarthy ML, Shokoohi H, Boniface KS et al (2016) Ultrasonography versus landmark for peripheral intravenous cannulation: a randomized controlled trial. Ann Emerg Med 68:10–18

    Article  PubMed  Google Scholar 

  35. Bauman M, Braude D, Crandall C (2009) Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med 27:135–140

    Article  PubMed  Google Scholar 

  36. El-Shafey E, Tammam T (2012) Ultrasonography-guided peripheral intravenous access: regular technique versus seldinger technique in patients with difficult vascular access. Eur J Gen Med 9:216–222

    Article  Google Scholar 

  37. Vinograd AM, Zorc JJ, Dean AJ, Abbadessa MKF, Chen AE (2018) First-attempt success, longevity, and complication rates of ultrasound-guided peripheral intravenous catheters in children. Ped Emerg Care 34:376–380

    Article  Google Scholar 

  38. Elia F, Ferrari G, Molino P, Converso M, De Filippi G, Milan A, Aprà F (2012) Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation. Am J Emerg Med 30:712–716

    Article  PubMed  Google Scholar 

  39. Bahl A, Hang B, Brackney A, Joseph S, Karabon P, Mohammad A, Nnanabu I, Shotkin P (2018) Standard long IV catheters versus extended dwell catheters: a randomized comparison of ultrasound-guided catheter survival. Am J Emerg Med. https://doi.org/10.1016/j.ajem.2018.07.031

    Article  PubMed  Google Scholar 

  40. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH (2015) Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med 10:581–585

    Article  PubMed  Google Scholar 

  41. White L, Halpin A, Turner M, Wallace L (2016) Ultrasound-guided radial artery cannulation in adult and paediatric populations: a systematic review and meta-analysis. Br J Anaesth 116(5):610–617

    Article  PubMed  Google Scholar 

  42. Sobolev M, Slovut DP, Lee Chang A, Shiloh AL, Eisen LA (2015) Ultrasound-guided catheterization of the femoral artery: a systematic review and meta-analysis of randomized controlled trials. J Invasive Cardiol 27(7):318–323

    PubMed  Google Scholar 

  43. Gu WJ, Wu XD, Wang F, Ma ZL, Gu XP (2016) Ultrasound guidance facilitates radial artery catheterization: a meta-analysis with trial sequential analysis of randomized controlled trials. Chest 149:166–179

    Article  PubMed  Google Scholar 

  44. Sobolev M, Slovut DP, Lee Chang A, Shiloh AL, Eisen LA (2015) Ultrasound-guided catheterization of the femoral artery: a systematic review and meta-analysis of randomized controlled trials. J Invasive Cardiol 27:318–323

    PubMed  Google Scholar 

  45. Htet N, Vaughn J, Adigopula A, Hennessey E, Mihm F (2017) Needle-guided ultrasound technique for axillary artery catheter placement in critically ill patients: a case series and technique description. J Crit Care 41:194–197

    Article  PubMed  Google Scholar 

  46. Tsung JW, Blaivas M, Stone MB (2009) Feasibility of point-of-care colour Doppler ultrasound confirmation of intraosseous needle placement during resuscitation. Resuscitation 80(6):665–668

    Article  PubMed  Google Scholar 

  47. Saul T, Siadecki SD, Berkowitz R, Rose G, Matilsky D (2015) The accuracy of sonographic confirmation of intraosseous line placement vs physical examination and syringe aspiration. Am J Emerg Med 33:586–588

    Article  PubMed  Google Scholar 

  48. Bustamante S, Cheruku S (2016) Ultrasound to improve target site identification for proximal humerus intraosseous vascular access. Anesth Analg 123:1335–1337

    Article  PubMed  Google Scholar 

  49. Conrad SA, Grier LR, Scott LK, Green R, Jordan M (2015) Percutaneous cannulation for extracorporeal membrane oxygenation by intensivists: a retrospective single-institution case series. Crit Care Med 43(5):1010–1015

    Article  CAS  PubMed  Google Scholar 

  50. Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY (1997) Improvement of internal jugular vein cannulation using an ultrasound-guided technique. Intensive Care Med 23(8):916–919

    Article  CAS  PubMed  Google Scholar 

  51. Airapetian N, Maizel J, Langelle F, Modeliar SS, Karakitsos D, Dupont H, Slama M (2013) Ultrasound-guided central venous cannulation is superior to quick-look ultrasound and landmark methods among inexperienced operators: a prospective randomized study. Intensive Care Med 39(11):1938–1944

    Article  PubMed  Google Scholar 

  52. Schmidt GA, Maizel J, Slama M (2015) Ultrasound-guided central venous access: what’s new? Intensive Care Med 41(4):705–707. https://doi.org/10.1007/s00134-014-3628-6

    Article  PubMed  Google Scholar 

  53. Barsuk JH, McGaghie WC, Cohen ER, O’Leary KJ, Wayne DB (2009) Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med 37(10):2697–2701

    PubMed  Google Scholar 

  54. Bayci AW, Mangla J, Jenkins CS, Ivascu FA, Robbins JM (2015) Novel educational module for subclavian central venous catheter insertion using real-time ultrasound guidance. J Surg Educ 72(6):1217–1223. https://doi.org/10.1016/j.jsurg.2015.07.010

    Article  PubMed  Google Scholar 

  55. McGraw R, Chaplin T, McKaigney C, Rang L, Jaeger M, Redfearn D, Davison C, Ungi T, Holden M, Yeo C, Keri Z, Fichtinger G (2016) Development and evaluation of a simulation-based curriculum for ultrasound-guided central venous catheterization. CJEM 18(6):405–413

    Article  PubMed  Google Scholar 

  56. Latif RK, Bautista AF, Memon SB, Smith EA, Wang C, Wadhwa A, Carter MB, Akca O (2012) Teaching aseptic technique for central venous access under ultrasound guidance: a randomized trial comparing didactic training alone to didactic plus simulation-based training. Anesth Analg 114(3):626–633

    Article  PubMed  Google Scholar 

  57. Woo MY, Frank J, Lee AC, Thompson C, Cardinal P, Yeung M, Beecker J (2009) Effectiveness of a novel training program for emergency medicine residents in ultrasound-guided insertion of central venous catheters. CJEM 11(4):343–348

    Article  PubMed  Google Scholar 

  58. Tokumine J, Matsushima H, Lefor AK, Igarashi H, Ono K (2015) Ultrasound-guided subclavian venipuncture is more rapidly learned than the anatomic landmark technique in simulation training. J Vasc Access 16(2):144–147. https://doi.org/10.5301/jva.5000318

    Article  PubMed  Google Scholar 

  59. Moureau N, Lamperti M, Kelly LJ, Dawson R, Elbarbary M, van Boxtel AJ, Pittiruti M (2013) Evidence-based consensus on the insertion of central venous access devices: definition of minimal requirements for training. Br J Anaesth 110(3):347–356

    Article  CAS  PubMed  Google Scholar 

  60. Nguyen BV, Prat G, Vincent JL, Nowak E, Bizien N, Tonnelier JM, Renault A, Ould-Ahmed M, Boles JM, L’Her E (2014) Determination of the learning curve for ultrasound-guided jugular central venous catheter placement. Intensive Care Med 40(1):66–73. https://doi.org/10.1007/s00134-013-3069-7

    Article  PubMed  Google Scholar 

  61. Maizel J, Guyomarc’h L, Henon P, Modeliar SS, de Cagny B, Choukroun G, Slama M (2014) Residents learning ultrasound-guided catheterization are not sufficiently skilled to use landmarks. Crit Care 18(1):R36. https://doi.org/10.1186/cc13741

    Article  PubMed  PubMed Central  Google Scholar 

  62. Stolz LA, Cappa AR, Minckler MR, Stolz U, Wyatt RG, Binger CW, Amini R, Adhikari S (2016) Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement. J Vasc Access 17:366–370

    Article  PubMed  Google Scholar 

  63. Duran-Gehring P, Bryant L, Reynolds JA, Aldridge P, Kalynych CJ, Guirgis FW (2016) Ultrasound-guided peripheral intravenous catheter training results in physician-level success for emergency department technicians. J Ultrasound Med 35:2343–2352

    Article  PubMed  Google Scholar 

  64. Smit JM, Raadsen R, Blans MJ, Petjak M, Van de Ven PM, Tuinman PR (2018) Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis. Crit Care 22:65. https://doi.org/10.1186/s13054-018-1989-x

    Article  PubMed  PubMed Central  Google Scholar 

  65. Chui J, Saeed R, Jakobowski L, Wang W, Eldeyasty B, Zhu F, Fochesato L, Lavi R, Bainbridge D (2018) Is routine chest x-ray after ultrasound-guided central venous catheter insertion choosing wisely?: a population-based retrospective study of 6,875 patients. Chest. https://doi.org/10.1016/j.chest.2018.02.017

    Article  PubMed  Google Scholar 

  66. Amir R, Knio ZO, Mahmood F, Oren-Grinberg A, Leibowitz A, Bose R, Shaefi S, Mitchell JD, Ahmed M, Bardia A, Talmor D, Matyal R (2017) Ultrasound as a screening tool for central venous catheter positioning and exclusion of pneumothorax. Crit Care Med 45:1192–1198. https://doi.org/10.1097/CCM.0000000000002451

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Iowa, Iowa City, IA, USA

    G. A. Schmidt

  2. Department of Emergency Medicine, St. Francis Hospital, University of South Carolina School of Medicine, Columbus, GA, USA

    M. Blaivas

  3. Ike Muslow MD Endowed Chair of Health Informatics, Louisiana State University Health Sciences Center, Shreveport, LA, USA

    S. A. Conrad

  4. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy

    F. Corradi

  5. Ente Ospedaliero Ospedali Galliera, Genova, Italy

    F. Corradi

  6. Division of Pulmonary, Critical Care, and Sleep Medicine, Hofstra Northwell School of Medicine, New Hyde Park, NY, USA

    S. Koenig

  7. Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE

    M. Lamperti

  8. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    B. Saugel

  9. Friedrich Schiller University Jena, Jena, Germany

    W. Schummer

  10. Helios Spital Ueberlingen, Ueberlingen, Germany

    W. Schummer

  11. Unité de médecine intensive-réanimation, CHU Sud, Amiens, France

    M. Slama

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  1. G. A. Schmidt
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Conflicts of interest

Dr. Blaivas consults for and receives consulting fees from EchoNous, Inc. Dr. Lamperti is a scientific advisor of MEDTRONIC, received travel support from Fesenius Kabi and VYGON and honoraria from Draeger, Masimo, and MEDTRONIC. None of these relationships presents conflicts with regards to the content of this manuscript.

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Supplementary material 1 (DOCX 11 kb)

Supplementary material 2 (DOCX 13 kb)

134_2019_5564_MOESM3_ESM.avi

Supplementary material 3 (AVI 4698 kb) Epigastric and subcostal acoustic windows along the short heart axis focusing on superior cava vein outflow tract in the right atrium allow to confirm the correct catheter placement with the visualization of numerous microbubbles indistinguishable separately with linear flow coming from superior vena cava

134_2019_5564_MOESM4_ESM.avi

Supplementary material 4 (AVI 1747 kb) Malposition with clear direct visualization of catheter tip into the right atrium and numerous microbubbles indistinguishable separately with turbulent flow coming from atrium

134_2019_5564_MOESM5_ESM.avi

Supplementary material 5 (AVI 2849 kb) B-mode ultrasound through the epigastric and subcostal acoustic windows along the short heart axis allowing us to see both cava veins and right atrium at the same time confirming correct catheter placement

Supplementary material 6 (MP4 4897 kb) PIV insertion using a long-axis, in-plane approach using a manikin trainer

Supplementary material 7 (MP4 4898 kb) PIV insertion using a long-axis, in-plane approach and modified Seldinger technique with wire insertion using a manikin trainer

Supplementary material 8 (MP4 54,261 kb) Operator inserting IO into himself: Here a clinician is placing an IO into his own tibia using a commercially available drill. Pain is minimal and the procedure can be performed rapidly. The operator confirms proper placement with aspiration and flush. (Courtesy Mark Piehl, MD)

Supplementary material 9 (MP4 1032 kb) IO failure with flow above cortex: blood flow is seen on color Doppler above the bony cortex in this failed IO placement

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Schmidt, G.A., Blaivas, M., Conrad, S.A. et al. Ultrasound-guided vascular access in critical illness. Intensive Care Med 45, 434–446 (2019). https://doi.org/10.1007/s00134-019-05564-7

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