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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Review

Definitions and pathophysiology of vasoplegic shock

Authors: Simon Lambden, Ben C. Creagh-Brown, Julie Hunt, Charlotte Summers, Lui G. Forni

Published in: Critical Care | Issue 1/2018

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Abstract

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.
Literature
1.
Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen DefinitionLiterature definitions applied to a retrospective cohort using automated data collection. J Am Soc Anesthesiol. 2007;107(2):213–20.CrossRef
2.
Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, Cywinski J, Thabane L, Sessler DI. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac SurgeryToward an empirical definition of hypotension. Anesthesiology. 2013;119(3):507–15.CrossRefPubMed
3.
Futier E, Lefrant J-Y, Guinot P-G, Godet T, Lorne E, Cuvillon P, Bertran S, Leone M, Pastene B, Piriou V. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial. JAMA. 2017;318(14):1346–57.CrossRefPubMedPubMedCentral
4.
Malbrain ML, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, Van Regenmortel N. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.CrossRefPubMed
5.
6.
Sterling SA, Puskarich MA, Shapiro NI, Trzeciak S, Kline JA, Summers RL, Jones AE. Characteristics and outcomes of patients with vasoplegic versus tissue dysoxic septic shock. Shock. 2013;40(1):11.CrossRefPubMedPubMedCentral
7.
8.
9.
10.
Andreis DT, Singer M. Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Med. 2016;42(9):1387–97.CrossRefPubMed
11.
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, Jaeschke R, Mebazaa A, Pinsky MR, Teboul JL. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815.CrossRefPubMedPubMedCentral
12.
13.
Leone M, Asfar P, Radermacher P, Vincent JL, Martin C. Optimizing mean arterial pressure in septic shock: a critical reappraisal of the literature. Crit Care. 2015;19:101.CrossRefPubMedPubMedCentral
14.
Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167–74.CrossRefPubMed
15.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefPubMedPubMedCentral
16.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international Sepsis definitions conference. Intensive Care Med. 2003;29(4):530–8.CrossRefPubMed
17.
Mekontso-Dessap A, Houel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg. 2001;71(5):1428–32.CrossRefPubMed
18.
Tuman KJ, McCarthy RJ, O'connor CJ, Holm WE, Ivankovich AD. Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass. Anesth Analg. 1995;80(3):473–9.CrossRefPubMed
19.
Carrel T, Englberger L, Mohacsi P, Neidhart P, Schmidli J. Low systemic vascular resistance after cardiopulmonary bypass: incidence, etiology, and clinical importance. J Card Surg. 2000;15(5):347–53.CrossRefPubMed
20.
Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-a double-blind randomized study. J Cardiothorac Surg. 2010;5(1):17.CrossRefPubMedPubMedCentral
21.
Özal E, Kuralay E, Yildirim V, Kilic S, Bolcal C, Kücükarslan N, Günay C, Demirkilic U, Tatar H. Preoperative methylene blue administration in patients at high risk for vasoplegic syndrome during cardiac surgery. Ann Thorac Surg. 2005;79(5):1615–9.CrossRefPubMed
22.
Hajjar LA, Vincent JL, Galas FRBG, Rhodes A, Landoni G, Osawa EA, Melo RR, Sundin MR, Grande SM, Gaiotto FA. Vasopressin versus norepinephrine in patients with Vasoplegic shock after cardiac SurgeryThe VANCS randomized controlled trial. Anesthesiology. 2017;126(1):85–93.CrossRefPubMed
23.
Sun X, Zhang L, Hill PC, Lowery R, Lee AT, Molyneaux RE, Corso PJ, Boyce SW. Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery? Eur J Cardiothorac Surg. 2008;34(4):820–5.CrossRefPubMed
24.
Anandaswamy TC, Rajappa GC, Krishnamachar H. Vasoplegic syndrome during Whipple procedure. J Clin Anesth. 2017;36:151–2.CrossRefPubMed
25.
Cao Z, Gao Y, Tao G. Vasoplegic syndrome during liver transplantation. Anesth Analg. 2009;108(6):1941–3.CrossRefPubMed
26.
Kohl BA, Deutschman CS. The inflammatory response to surgery and trauma. Curr Opin Crit Care. 2006;12(4):325–32.CrossRefPubMed
27.
Harrois A, Hamada SR, Duranteau J. Fluid resuscitation and vasopressors in severe trauma patients. Curr Opin Crit Care. 2014;20(6):632–7.CrossRefPubMed
28.
Lundy JB, Chung KK, Pamplin JC, Ainsworth CR, Jeng JC, Friedman BC. Update on severe burn management for the intensivist. J Intensive Care Med. 2016;31(8):499–510.CrossRefPubMed
29.
Karimgani I, Porter KA, Langevin RE, Banks PA. Prognostic factors in sterile pancreatic necrosis. Gastroenterology. 1992;103(5):1636–40.CrossRefPubMed
30.
Eklund A, Leppäniemi A, Kemppainen E, Pettilä V. Vasodilatory shock in severe acute pancreatitis without sepsis: is there any place for hydrocortisone treatment? Acta Anaesthesiol Scand. 2005;49(3):379–84.CrossRefPubMed
31.
Levick JR. An introduction to cardiovascular physiology. Abingdon: CRC Press; 2011.
32.
Palmer RMJ, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor. Nature. 1987;327(6122):524–6.CrossRefPubMed
33.
Förstermann U, Münzel T. Endothelial nitric oxide synthase in vascular disease: from marvel to menace. Circulation. 2006;113(13):1708–14.CrossRefPubMed
34.
Seddon MD, Chowienczyk PJ, Brett SE, Casadei B, Shah AM. Neuronal nitric oxide synthase regulates basal microvascular tone in humans in vivo. Circulation. 2008;117(15):1991–6.CrossRefPubMed
35.
Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology, and pharmacology. Pharmacol Rev. 1991;43(2):109–42.PubMed
36.
Denninger JW, Marletta MA. Guanylate cyclase and the ·NO/cGMP signaling pathway. Biochimica et Biophysica Acta. 1999;1411(2–3):334–50.CrossRefPubMed
37.
Kimmoun A, Ducrocq N, Levy B. Mechanisms of vascular hyporesponsiveness in septic shock. Curr Vasc Pharmacol. 2013;11(2):139–49.PubMed
38.
Lange M, Enkhbaatar P, Nakano Y, Traber DL. Role of nitric oxide in shock: the large animal perspective. Front Bioscie. 2009;14:1979–89.CrossRef
39.
Bakker J, Grover R, McLuckie A, Holzapfel L, Andersson J, Lodato R, Watson D, Grossman S, Donaldson J, Takala J, et al. Administration of the nitric oxide synthase inhibitor NG-methyl-L-arginine hydrochloride (546C88) by intravenous infusion for up to 72 hours can promote the resolution of shock in patients with severe sepsis: results of a randomized, double-blind, placebo-controlled multicenter study (study no. 144-002). Crit Care Med. 2004;32(1):1–12.CrossRefPubMed
40.
Lopez A, Lorente JA, Steingrub J, Bakker J, McLuckie A, Willatts S, Brockway M, Anzueto A, Holzapfel L, Breen D, et al. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock. Crit Care Med. 2004;32(1):21–30.CrossRefPubMed
41.
Wang Z, Lambden S, Taylor V, Sujkovic E, Nandi M, Tomlinson J, Dyson A, McDonald N, Caddick S, Singer M, et al. Pharmacological inhibition of DDAH1 improves survival, hemodynamics and organ function in experimental septic shock. Biochem J. 2014;460:309–16.CrossRefPubMed
42.
Dorris SL, Peebles RS. PGI2 as a regulator of inflammatory diseases. Mediat Inflamm. 2012;2012:9.CrossRef
43.
Narumiya S, Sugimoto Y, Ushikubi F. Prostanoid receptors: structures, properties, and functions. Physiol Rev. 1999;79(4):1193–226.CrossRefPubMed
44.
Parkington HC, Coleman HA, Tare M. Prostacyclin and endothelium-dependent hyperpolarization. Pharmacol Res. 2004;49(6):509–14.CrossRefPubMed
45.
Endo H, Akahoshi T, Kashiwazaki S. Additive effects of IL-1 and TNF on induction of prostacyclin synthesis in human vascular endothelial cells. Biochem Biophys Res Commun. 1988;156(2):1007–14.CrossRefPubMed
46.
Stuart MJ, Setty Y, Walenga RW, Graeber JE, Ganley C. Effects of hyperoxia and hypoxia on vascular prostacyclin formation in vitro. Pediatrics. 1984;74(4):548–53.PubMed
47.
Riedo FX, Munford RS, Campbell WB, Reisch JS, Chien KR, Gerard RD. Deacylated lipopolysaccharide inhibits plasminogen activator inhibitor-1, prostacyclin, and prostaglandin E2 induction by lipopolysaccharide but not by tumor necrosis factor-alpha. J Immunol. 1990;144(9):3506–12.PubMed
48.
Bernard GR, Wheeler AP, Russell JA, Schein R, Summer WR, Steinberg KP, Fulkerson WJ, Wright PE, Christman BW, Dupont WD, et al. The effects of ibuprofen on the physiology and survival of patients with Sepsis. N Engl J Med. 1997;336(13):912–8.CrossRefPubMed
49.
Sellers MM, Stallone JN. Sympathy for the devil: the role of thromboxane in the regulation of vascular tone and blood pressure. Am J Phys Heart Circ Phys. 2008;294(5):H1978–86.
50.
Yu Y, Ricciotti E, Scalia R, Tang SY, Grant G, Yu Z, Landesberg G, Crichton I, Wu W, Puré E, et al. Vascular COX-2 modulates blood pressure and thrombosis in mice. Sci Transl Med. 2012;4(132):132ra154.CrossRef
51.
52.
Yamada T, Fujino T, Yuhki K-i, Hara A, Karibe H, Takahata O, Okada Y, Xiao C-Y, Takayama K, Kuriyama S, et al. Thromboxane A<sub>2</sub> Regulates Vascular Tone via Its Inhibitory Effect on the Expression of Inducible Nitric Oxide Synthase. Circulation. 2003;108(19):2381–6.CrossRefPubMed
53.
Boffa J-J, Just A, Coffman TM, Arendshorst WJ. Thromboxane receptor mediates renal vasoconstriction and contributes to acute renal failure in Endotoxemic mice. J Am Soc Nephrol. 2004;15(9):2358–65.CrossRefPubMed
54.
Oettinger W, Peskar BA, Beger HG. Profiles of endogenous prostaglandin F2 alpha, thromboxane A2 and prostacyclin with regard to cardiovascular and organ functions in early septic shock in man. Eur Surg Res. 1987;19(2):65–77.CrossRefPubMed
55.
Yanagisawa M, Kurihara H, Kimura S, Tomobe Y, Kobayashi M, Mitsui Y, Yazaki Y, Goto K, Masaki T. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature. 1988;332(6163):411–5.CrossRefPubMed
56.
Luscher TF, Barton M. Endothelins and endothelin receptor antagonists: therapeutic considerations for a novel class of cardiovascular drugs. Circulation. 2000;102(19):2434–40.CrossRefPubMed
57.
Hynynen MM, Khalil RA. The vascular endothelin system in hypertension--recent patents and discoveries. Recent Pat Cardiovasc Drug Discov. 2006;1(1):95–108.CrossRefPubMedPubMedCentral
58.
Yeager ME, Belchenko DD, Nguyen CM, Colvin KL, Ivy DD, Stenmark KR. Endothelin-1, the unfolded protein response, and persistent inflammation: role of pulmonary artery smooth muscle cells. Am J Respir Cell Mol Biol. 2012;46(1):14–22.CrossRefPubMedPubMedCentral
59.
Kowalczyk A, Kleniewska P, Kolodziejczyk M, Skibska B, Goraca A. The role of Endothelin-1 and endothelin receptor antagonists in inflammatory response and Sepsis. Arch Immunol Ther Exp. 2015;63:41–52.CrossRef
60.
Liaudet L, Rosenblatt-Velin N, Pacher P. Role of peroxynitrite in the cardiovascular dysfunction of septic shock. Curr Vasc Pharmacol. 2013;11(2):196–207.PubMed
61.
Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, vitamin C and thiamine for the treatment of severe Sepsis and septic shock: a retrospective before-after study. Chest. 2017;151(6):1229–38.
62.
Macarthur H, Westfall TC, Riley DP, Misko TP, Salvemini D. Inactivation of catecholamines by superoxide gives new insights on the pathogenesis of septic shock. Proc Natl Acad Sci U S A. 2000;97(17):9753–8.CrossRefPubMedPubMedCentral
63.
Szabo C. Hydrogen sulphide and its therapeutic potential. Nat Rev Drug Discov. 2007;6(11):917–35.CrossRefPubMed
64.
Li L, Bhatia M, Zhu YZ, Zhu YC, Ramnath RD, Wang ZJ, Anuar FB, Whiteman M, Salto-Tellez M, Moore PK. Hydrogen sulfide is a novel mediator of lipopolysaccharide-induced inflammation in the mouse. FASEB J. 2005;19(9):1196–8.CrossRefPubMed
65.
Koenitzer JR, Isbell TS, Patel HD, Benavides GA, Dickinson DA, Patel RP, Darley-Usmar VM, Lancaster JR Jr, Doeller JE, Kraus DW. Hydrogen sulfide mediates vasoactivity in an O2-dependent manner. Am J Phys Heart Circ Phys. 2007;292(4):H1953–60.
66.
Dorman DC, Moulin FJ, McManus BE, Mahle KC, James RA, Struve MF. Cytochrome oxidase inhibition induced by acute hydrogen sulfide inhalation: correlation with tissue sulfide concentrations in the rat brain, liver, lung, and nasal epithelium. Toxicol Sci. 2002;65(1):18–25.CrossRefPubMed
67.
Laggner H, Hermann M, Esterbauer H, Muellner MK, Exner M, Gmeiner BM, Kapiotis S. The novel gaseous vasorelaxant hydrogen sulfide inhibits angiotensin-converting enzyme activity of endothelial cells. J Hypertens. 2007;25(10):2100–4.CrossRefPubMed
68.
Ali MY, Ping CY, Mok YY, Ling L, Whiteman M, Bhatia M, Moore PK. Regulation of vascular nitric oxide in vitro and in vivo; a new role for endogenous hydrogen sulphide? Br J Pharmacol. 2006;149(6):625–34.CrossRefPubMedPubMedCentral
69.
Hosoki R, Matsuki N, Kimura H. The possible role of hydrogen sulfide as an endogenous smooth muscle relaxant in synergy with nitric oxide. Biochem Biophys Res Commun. 1997;237(3):527–31.CrossRefPubMed
70.
Blackstone E, Roth MB. Suspended animation-like state protects mice from lethal hypoxia. Shock. 2007;27(4):370–2.CrossRefPubMed
71.
Morrison ML, Blackwood JE, Lockett SL, Iwata A, Winn RK, Roth MB. Surviving blood loss using hydrogen sulfide. J Trauma. 2008;65(1):183–8.CrossRefPubMed
72.
Sodha NR, Clements RT, Feng J, Liu Y, Bianchi C, Horvath EM, Szabo C, Sellke FW. The effects of therapeutic sulfide on myocardial apoptosis in response to ischemia-reperfusion injury. Eur J Cardiothorac Surg. 2008;33(5):906–13.CrossRefPubMedPubMedCentral
73.
Landry DW, Oliver JA. The ATP-sensitive K+ channel mediates hypotension in endotoxemia and hypoxic lactic acidosis in dog. J Clin Invest. 1992;89(6):2071–4.CrossRefPubMedPubMedCentral
74.
Davies NW. Modulation of ATP-sensitive K+ channels in skeletal muscle by intracellular protons. Nature. 1990;343(6256):375–7.CrossRefPubMed
75.
76.
Vanelli G, Hussain SN, Dimori M, Aguggini G. Cardiovascular responses to glibenclamide during endotoxaemia in the pig. Vet Res Commun. 1997;21(3):187–200.CrossRefPubMed
77.
Vanelli G, Hussain SN, Aguggini G. Glibenclamide, a blocker of ATP-sensitive potassium channels, reverses endotoxin-induced hypotension in pig. Exp Physiol. 1995;80(1):167–70.CrossRefPubMed
78.
Warrillow S, Egi M, Bellomo R. Randomized, double-blind, placebo-controlled crossover pilot study of a potassium channel blocker in patients with septic shock. Crit Care Med. 2006;34(4):980–5.CrossRefPubMed
79.
Buckley JF, Singer M, Clapp LH. Role of KATP channels in sepsis. Cardiovasc Res. 2006;72(2):220–30.CrossRefPubMed
80.
McMillan M, Chernow B, Roth BL. Hepatic alpha 1-adrenergic receptor alteration in a rat model of chronic sepsis. Circ Shock. 1986;19(2):185–93.PubMed
81.
Roth BL, Spitzer JA. Altered hepatic vasopressin and alpha 1-adrenergic receptors after chronic endotoxin infusion. Am J Phys. 1987;252(5 Pt 1):E699–702.
82.
Hwang TL, Lau YT, Huang SF, Chen MF, Liu MS. Changes of alpha 1-adrenergic receptors in human liver during intraabdominal sepsis. Hepatology. 1994;20(3):638–42.CrossRefPubMed
83.
Beishuizen A, Thijs LG, Vermes I. Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma. Intensive Care Med. 2001;27(10):1584–91.CrossRefPubMed
84.
Hadoke PWF, Iqbal J, Walker BR. Therapeutic manipulation of glucocorticoid metabolism in cardiovascular disease. Br J Pharmacol. 2009;156(5):689–712.CrossRefPubMedPubMedCentral
85.
Prigent H, Maxime V, Annane D. Clinical review: Corticotherapy in sepsis. Crit Care. 2004;8(2):122–9.CrossRefPubMed
86.
Hadoke PW, Macdonald L, Logie JJ, Small GR, Dover AR, Walker BR. Intra-vascular glucocorticoid metabolism as a modulator of vascular structure and function. Cell Mol Life Sci. 2006;63(5):565–78.CrossRefPubMed
87.
Lowenberg M, Stahn C, Hommes DW, Buttgereit F. Novel insights into mechanisms of glucocorticoid action and the development of new glucocorticoid receptor ligands. Steroids. 2008;73(9–10):1025–9.CrossRefPubMed
88.
89.
Schroeder S, Wichers M, Klingmuller D, Hofer M, Lehmann LE, von Spiegel T, Hering R, Putensen C, Hoeft A, Stuber F. The hypothalamic-pituitary-adrenal axis of patients with severe sepsis: altered response to corticotropin-releasing hormone. Crit Care Med. 2001;29(2):310–6.CrossRefPubMed
90.
91.
Soni A, Pepper GM, Wyrwinski PM, Ramirez NE, Simon R, Pina T, Gruenspan H, Vaca CE. Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels. Am J Med. 1995;98(3):266–71.CrossRefPubMed
92.
Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002;288(7):862–71.CrossRefPubMed
93.
Annane D, Sebille V, Bellissant E. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Crit Care Med. 2006;34(1):22–30.CrossRefPubMed
94.
Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008;358(2):111–24.CrossRefPubMed
95.
Landry DW, Levin HR, Gallant EM, Ashton RC Jr, Seo S, D'Alessandro D, Oz MC, Oliver JA. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation. 1997;95(5):1122–5.CrossRefPubMed
96.
Barrett LK, Singer M, Clapp LH. Vasopressin: mechanisms of action on the vasculature in health and in septic shock. Crit Care Med. 2007;35(1):33–40.CrossRefPubMed
97.
Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, Busse LW, Altaweel L, Albertson TE, Mackey C. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377:419–30.
Metadata
Title
Definitions and pathophysiology of vasoplegic shock
Authors
Simon Lambden
Ben C. Creagh-Brown
Julie Hunt
Charlotte Summers
Lui G. Forni
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2102-1

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