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Advancing the Management of Nontraumatic Brain Injuries with Hypertonic Saline and Mannitol. 利用高渗盐水和甘露醇推进非创伤性脑损伤的治疗。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-07-01 DOI: 10.5005/jp-journals-10071-24756
Rajesh Mohan Shetty

How to cite this article: Shetty RM. Advancing the Management of Nontraumatic Brain Injuries with Hypertonic Saline and Mannitol. Indian J Crit Care Med 2024;28(7):634-636.

如何引用本文:Shetty RM.用高渗盐水和甘露醇治疗非创伤性脑损伤。Indian J Crit Care Med 2024;28(7):634-636.
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引用次数: 0
Author Response: Unanswered Questions and Contradictory Statements in the Antibiotics Prescription Guidelines. 作者回应:抗生素处方指南中的未解之谜和自相矛盾的说法。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-07-01 DOI: 10.5005/jp-journals-10071-24750
Gopi C Khilnani, Pawan Tiwari, Saurabh Mittal

How to cite this article: Khilnani GC, Tiwari P, Mittal S. Author Response: Unanswered Questions and Contradictory Statements in the Antibiotics Prescription Guidelines. Indian J Crit Care Med 2024;28(7):717-718.

如何引用本文:Khilnani GC, Tiwari P, Mittal S. Author Response:抗生素处方指南中的未解之谜和矛盾之处。Indian J Crit Care Med 2024;28(7):717-718.
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引用次数: 0
Nutritional Prescription in ICU Patients: Does it Matter? 重症监护病房患者的营养处方:这重要吗?
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-07-01 DOI: 10.5005/jp-journals-10071-24755
Amarja Ashok Havaldar, Sumithra Selvam

Background: The nutritional status of the patients before critical illness and nutrition support given during the critical illness play an important role in the recovery. We aimed to evaluate the nutritional prescription and its effect on ICU mortality.

Materials and methods: This was a prospective observational study conducted after institutional ethical committee approval (IEC 94/2018, CTRI/2018/06/014625) in a case-mixed (medical and surgical) ICU. Patients admitted to the ICU were enrolled within 24 hours of admission. The amount of calories and proteins prescribed and received by the patients was collected for 7 days. The primary outcome was ICU mortality.

Results: A total of 100 patients were included. The mean age was 48.63 (16.25) years, and 62% were males. The acute physiology and chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA), and modified Nutric (mNUTRIC) scores were comparable between the two groups. The ICU mortality was 30%. The calorie and protein deficits were comparable between survivors and non-survivors. Among the secondary outcomes, a significant time effect (p = 0.013) and interaction effect (p = 0.004) were noted for maximum glucose levels. The glucose variability calculated by coefficient of variation (CV) was significantly higher in non-survivors than survivors (p = 0.031).

Conclusion: The calorie and protein deficits did not affect ICU mortality. The maximum glucose variability and CV were significant parameters associated with ICU mortality.

How to cite this article: Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024;28(7):657-661.

背景:危重病人发病前的营养状况和发病期间的营养支持对其康复起着重要作用。我们旨在评估营养处方及其对重症监护病房死亡率的影响:这是一项前瞻性观察研究,经机构伦理委员会批准(IEC 94/2018,CTRI/2018/06/014625)后在病例混合型(内科和外科)重症监护病房进行。重症监护室收治的患者均在入院 24 小时内登记。研究人员收集了患者在7天内的热量和蛋白质处方量和摄入量。主要结果是重症监护室死亡率:结果:共纳入 100 名患者。平均年龄为 48.63(16.25)岁,男性占 62%。两组患者的急性生理学和慢性健康评估(APACHE II)、序贯器官衰竭评估(SOFA)和改良营养学(mNUTRIC)评分相当。重症监护室死亡率为 30%。存活者和非存活者的卡路里和蛋白质缺乏率相当。在次要结果中,最大血糖水平存在显著的时间效应(p = 0.013)和交互效应(p = 0.004)。用变异系数(CV)计算,非幸存者的血糖变异性明显高于幸存者(p = 0.031):结论:卡路里和蛋白质的缺乏不会影响重症监护病房的死亡率。结论:卡路里和蛋白质的缺乏并不影响重症监护室的死亡率,最大葡萄糖变异性和CV是与重症监护室死亡率相关的重要参数:Havaldar AA, Selvam S. ICU患者的营养处方:重要吗?Indian J Crit Care Med 2024;28(7):657-661.
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引用次数: 0
Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study. 重症患者颈内静脉和下腔静脉塌陷指数与直接中心静脉压测量的相关性:一项观察性研究。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24741
Anuj Kumar, Alok K Bharti, Mumtaz Hussain, Sanjeev Kumar, Arvind Kumar

Background and aims: Prompt assessments and quick replacement of intravascular fluid are critical steps to resuscitate hypovolemic patients. Intravascular volume assessment by direct central venous pressure (CVP) measurement is an invasive, time-consuming, and labor-intensive procedure. Nowadays, bedside ultrasound-guided volume assessment of the internal jugular vein (IJV) or inferior vena cava (IVC) is commonly employed as a proxy for direct CVP.Therefore, we examined the strength of association between CVP and collapsibility index (CI) of the IJV and IVC for evaluating the volume status of critically ill patients.

Methods: Bedside USG-guided A-P diameter and cross-sectional area of the right IJV and IVC were measured, and their corresponding collapsibility indices were deduced. The results of the IJV and IVC indices were correlated with CVP.

Results: About 60 out of 70 enrolled patients were analyzed. The baseline clinical parameters of patients are shown in Table 1. For CSA and AP diameter, the correlations between CVP and IJV-CI at 0° were r = -0.107 (p = 0.001) and r = -0.092 (p = 0.001). Correlations between CVP and IJV-CI at 30° for CSA and diameter, however, were (r = -0.109, p = 0.001) and (r = -0.117, p = 0.001), respectively. Table 2 depicts the correlation between CVP and IVC-CI r = -0.503, p = 0.001 for CSA and r = -0.452, p = 0.001 for diameter.

Conclusion: The IVC and IJV collapsibility indices can be used in place of invasive CVP monitoring to assess fluid status in critically ill patients.

How to cite this article: Kumar A, Bharti AK, Hussain M, Kumar S, Kumar A. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients: An Observational Study. Indian J Crit Care Med 2024;28(6):595-600.

背景和目的:及时评估和快速补充血管内液体是抢救低血容量患者的关键步骤。通过直接测量中心静脉压(CVP)来评估血管内容量是一项有创、耗时且劳动密集型的程序。因此,我们研究了 CVP 与颈内静脉和下腔静脉塌陷指数(CI)之间的关联强度,以评估重症患者的血容量状况:方法: 在床旁 USG 引导下测量右侧 IJV 和 IVC 的 A-P 直径和横截面积,并推导出相应的塌缩度指数。IJV 和 IVC 指数结果与 CVP 相关:对 70 名登记患者中的约 60 人进行了分析。患者的基线临床参数见表 1。对于 CSA 和 AP 直径,0° 时 CVP 与 IJV-CI 的相关性分别为 r = -0.107 (p = 0.001) 和 r = -0.092 (p = 0.001)。然而,CVP 与 30° 时 IJV-CI 的 CSA 和直径之间的相关性分别为 (r = -0.109, p = 0.001) 和 (r = -0.117, p = 0.001)。表 2 显示了 CVP 与 IVC-CI 之间的相关性:CSA 为 r = -0.503,p = 0.001;直径为 r =-0.452,p = 0.001:IVC和IJV塌陷度指数可代替有创CVP监测来评估重症患者的体液状况:Kumar A, Bharti AK, Hussain M, Kumar S, Kumar A. Correlation of Internal Jugular Vein and Inferior Vena Cava Collapsibility Index with Direct Central Venous Pressure Measurement in Critically-ill Patients:一项观察性研究。Indian J Crit Care Med 2024;28(6):595-600.
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引用次数: 0
Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care. 内科重症监护患者深静脉血栓形成的发生率和风险因素及其对预后的影响。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24723
Adhiti Krishnamoorthy, Samuel G Hansdak, John V Peter, Kishore Pichamuthu, Sudha J Rajan, Thomas I Sudarsan, Sridhar Gibikote, Lakshmanan Jeyaseelan, Thambu D Sudarsanam

Objectives: This study evaluated the incidence and risk factors for deep venous thrombosis (DVT) while on thromboprophylaxis, in patients admitted to the medical intensive care unit (MICU), and to assess its impact on outcomes.

Methods: Consecutive patients admitted to the MICU underwent compression ultrasound of the jugular, axillary, femoral, and popliteal veins at admission, day 3 and 7 to screen for DVT. All patients were on pharmacological and/or mechanical thromboprophylaxis as per protocol. The primary outcome was the incidence of DVT (defined as occurrence on day 3 or 7). Secondary outcomes were death and duration of hospitalization. Risk factors for DVT were explored using bivariate and multivariable logistic regression analysis and expressed as risk ratio (RR) with 95% confidence intervals (CIs).

Results: The incidence of DVT was 17.2% (95% CI 12.0, 22.3) (n = 35/203); two-thirds were catheter associated (23/35). There was no difference in mortality between those with and without incident DVT (9/35 vs 40/168, p = 0.81). The mean (SD) duration of hospitalization was longer in the DVT group (20.1 (17) vs 12.9 (8.5) days, p = 0.007). Although day 3 INR (RR 2.1, 95% CI 0.9-5.3), age >40 years (2.1, 0.8-5.3), vasopressor use (1.0, 0.4-2.9) and SOFA score (0.9, 0.85-1.1) were associated with the development of DVT on bivariate analysis, only central venous catheters (15.97, 1.9-135.8) was independently associated with DVT on multivariable analysis.

Conclusions: Despite thromboprophylaxis, 17% of ICU patients develop DVT. The central venous catheter is the main risk factor. DVT is not associated with increased mortality in the setting of prophylaxis.

How to cite this article: Krishnamoorthy A, Hansdak SG, Peter JV, Pichamuthu K, Rajan SJ, Sudarsan TI, et al. Incidence and Risk Factors for Deep Venous Thrombosis and Its Impact on Outcome in Patients Admitted to Medical Critical Care. Indian J Crit Care Med 2024;28(6):607-613.

研究目的本研究评估了内科重症监护室(MICU)住院患者在接受血栓预防治疗期间深静脉血栓形成(DVT)的发生率和风险因素,并评估其对预后的影响:方法: MICU连续收治的患者在入院时、第3天和第7天均接受了颈静脉、腋静脉、股静脉和腘静脉加压超声检查,以筛查深静脉血栓。所有患者均按方案接受药物和/或机械血栓预防治疗。主要结果是深静脉血栓的发生率(定义为在第3天或第7天发生)。次要结果是死亡和住院时间。使用双变量和多变量逻辑回归分析探讨了深静脉血栓的风险因素,并以风险比(RR)和95%置信区间(CI)表示:深静脉血栓发生率为 17.2% (95% CI 12.0, 22.3) (n = 35/203);三分之二与导管相关(23/35)。发生和未发生深静脉血栓的患者死亡率没有差异(9/35 vs 40/168,P = 0.81)。深静脉血栓组的平均(标清)住院时间更长(20.1 (17) 天 vs 12.9 (8.5) 天,p = 0.007)。虽然在双变量分析中,第 3 天 INR(RR 2.1,95% CI 0.9-5.3)、年龄大于 40 岁(2.1,0.8-5.3)、使用血管加压药(1.0,0.4-2.9)和 SOFA 评分(0.9,0.85-1.1)与深静脉血栓形成的发生有关,但在多变量分析中,只有中心静脉导管(15.97,1.9-135.8)与深静脉血栓形成独立相关:结论:尽管采取了血栓预防措施,但仍有 17% 的重症监护病房患者发生深静脉血栓。结论:尽管采取了血栓预防措施,但仍有 17% 的重症监护病房患者发生深静脉血栓,中心静脉导管是主要的风险因素。在采取预防措施的情况下,深静脉血栓与死亡率升高无关:Krishnamoorthy A、Hansdak SG、Peter JV、Pichamuthu K、Rajan SJ、Sudarsan TI 等:《内科重症监护患者深静脉血栓的发生率和风险因素及其对预后的影响》。Indian J Crit Care Med 2024;28(6):607-613.
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引用次数: 0
Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study. 氯胺酮亚剂量给药与芬太尼和咪达唑仑在术后重症监护室患者中的量子意识指数和量子毒性指数比较:一项前瞻性观察研究。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24734
Alegra R Masharto, Andriamuri P Lubis, Chrismas G Bangun, Arlinda S Wahyuni

Aims and background: In postoperative patients in the intensive care units (ICUs), not only analgesics are needed but also sedation so that the patient can remain calm during treatment, especially patients with mechanical ventilation. By using the measurement parameters of the quantum consciousness index (qCON) and quantum noxious index (qNOX) in measuring the depth of sedation and adequacy of analgesics, the use of subdose ketamine instead of fentanyl and midazolam as sedative, analgesic agents can be performed as a new alternative to nociceptive monitoring methods with more objective results. This study aims to obtain results of comparing qCON and qNOX in postoperative patients by administering subdose ketamine compared with a combination of fentanyl and midazolam in RSUP Haji Adam Malik Medan.

Materials and methods: A randomized clinical trial with a double-blind approach has been used in this study. A total of 44 experimental samples were gathered and randomly split into two groups after meeting the criteria for inclusion. Group A administered a ketamine subdose, whereas Group B administered a mixture of fentanyl and midazolam. The research data obtained were tested using Statistical Product and Science Service (SPSS).

Results: There were differences in the median, minimum, and maximum values of qCON and qNOX in the groups given subdose ketamine and fentanyl and midazolam, but these were not statistically significant (p > 0.05) at T0, T1, and T2.

Conclusion: Administering a subdose of ketamine can provide sedation and analgesia comparable to fentanyl and midazolam.

How to cite this article: Masharto AR, Lubis AP, Bangun CG, Wahyuni AS. Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study. Indian J Crit Care Med 2024;28(6):581-586.

目的和背景:重症监护室(ICU)中的术后患者不仅需要镇痛剂,还需要镇静剂,以便患者在治疗过程中保持镇静,尤其是使用机械通气的患者。通过使用量子意识指数(qCON)和量子有害指数(qNOX)测量参数来测量镇静深度和镇痛剂的充分性,可以使用亚剂量氯胺酮代替芬太尼和咪达唑仑作为镇静、镇痛剂,作为痛觉监测方法的一种新的替代方法,其结果更加客观。本研究的目的是在棉兰哈吉-亚当-马利克医疗中心(RSUP Haji Adam Malik Medan)对术后患者施用亚剂量氯胺酮与芬太尼和咪达唑仑联合镇静剂后,对qCON和qNOX进行比较:本研究采用了双盲随机临床试验方法。共收集了 44 份实验样本,在符合纳入标准后随机分成两组。A 组使用氯胺酮亚剂量,B 组使用芬太尼和咪达唑仑混合物。研究数据使用统计产品和科学服务(SPSS)进行检验:亚剂量氯胺酮组与芬太尼和咪达唑仑组的 qCON 和 qNOX 的中值、最小值和最大值存在差异,但在 T0、T1 和 T2 时差异无统计学意义(P > 0.05):结论:给予亚剂量氯胺酮可提供与芬太尼和咪达唑仑相当的镇静和镇痛效果:Masharto AR, Lubis AP, Bangun CG, Wahyuni AS.ICU术后患者氯胺酮亚剂量给药与芬太尼和咪达唑仑相比的量子意识指数和量子毒性指数:一项前瞻性观察研究。Indian J Crit Care Med 2024;28(6):581-586.
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引用次数: 0
The Rise of Irrational Antimicrobial Combinations: Need for Clinical Jurisprudence? 不合理抗菌药组合的兴起:是否需要临床法理学?
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24718
Riddhi Kundu, Tanima Baronia, Prachee Sathe

How to cite this article: Kundu R, Baronia T, Sathe P. The Rise of Irrational Antimicrobial Combinations: Need for Clinical Jurisprudence? Indian J Crit Care Med 2024;28(6):618-619.

如何引用本文:Kundu R, Baronia T, Sathe P. The Rise of Irrational Antimicrobial Combinations:临床判例的必要性?Indian J Crit Care Med 2024;28(6):618-619.
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引用次数: 0
Author Response: Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters. 作者回复:血管通路范式的转变:深入了解锁骨上入路的未知领域。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24732
Pooja Jaiswal, Priyanka H Chhabra, Suman Saini

How to cite this article: Jaiswal P, Chhabra PH, Saini S. Author Response: Shifting Paradigms in Vascular Access: A Deep Dive into the Supraclavicular Approach's Uncharted Waters. Indian J Crit Care Med 2024;28(6):624.

如何引用本文:Jaiswal P, Chhabra PH, Saini S. 作者回复:血管通路范式的转变:深入了解锁骨上入路的未知领域。Indian J Crit Care Med 2024;28(6):624.
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引用次数: 0
Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication. 协同生存:将急性胃肠道损伤等级和疾病严重程度评分结合到重症监护预后中。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24735
Rohit Kumar Patnaik, Nupur Karan

How to cite this article: Patnaik RK, Karan N. Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication. Indian J Crit Care Med 2024;28(6):529-530.

如何引用本文:Patnaik RK, Karan N. Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication.Indian J Crit Care Med 2024;28(6):529-530.
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引用次数: 0
Impact of Iron Profile and Vitamin D Levels on Clinical Outcomes in Patients with Sepsis and Septic Shock: A Cross-sectional Analysis at a Tertiary Care Center. 铁概况和维生素 D 水平对败血症和脓毒性休克患者临床疗效的影响: 一家三级医疗中心的横断面分析。
IF 1.5 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-06-01 DOI: 10.5005/jp-journals-10071-24726
Mukesh Bairwa, Basavaraj Jatteppanavar, Ravi Kant, Mahendra Singh, Arnab Choudhury

Aim and background: Sepsis is a major global health affecting millions worldwide, hence understanding its contributing factors becomes paramount. This cross-sectional study at a tertiary care center explores the relationship between iron profile, vitamin D levels, and outcomes in sepsis and septic shock patients. The primary objective was to explore the prevalence of iron profile and vitamin D parameters during early intensive care unit (ICU) admission and their association with 28-day mortality.

Materials and methods: Spanning 18 months, the study enrolled adult patients meeting sepsis or septic shock criteria at the ICU. Data collection included demographic information, clinical characteristics, and blood samples for iron profile and vitamin D levels at admission. Disease severity was assessed using sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) scores, and treatment was administered as per surviving sepsis-3 guidelines.

Results: The research involved 142 participants, uncovering prevalent organisms such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Noteworthy connections to mortality were identified for factors including vasopressor support, ICU stay duration, SOFA score, and APACHE-II score. Interestingly, age, gender, and vitamin D levels showed no significant associations. However, the study did reveal a significant association between iron, ferritin, and transferrin saturation levels with increased 28-day mortality.

Conclusion: Our study concluded that low Iron, elevated ferritin, and decreased transferrin saturation levels maintained associations with the outcome of interest. While no such relationship was established with vitamin D levels. These results suggest potential implications for patient management and prognosis, warranting further exploration in future research.

How to cite this article: Bairwa M, Jatteppanavar B, Kant R, Singh M, Choudhury A. Impact of Iron Profile and Vitamin D Levels on Clinical Outcomes in Patients with Sepsis and Septic Shock: A Cross-sectional Analysis at a Tertiary Care Center. Indian J Crit Care Med 2024;28(6):569-574.

目的和背景:败血症是影响全球数百万人健康的重大全球性疾病,因此了解其诱因至关重要。本横断面研究在一家三级护理中心进行,探讨了败血症和脓毒性休克患者的铁概况、维生素 D 水平与预后之间的关系。主要目的是探讨重症监护病房(ICU)早期入院时铁概况和维生素 D 参数的患病率及其与 28 天死亡率之间的关系:该研究历时18个月,研究对象为符合脓毒症或脓毒性休克标准的重症监护病房成年患者。数据收集包括人口统计学信息、临床特征以及入院时检测铁概况和维生素 D 水平的血液样本。疾病严重程度通过序贯器官衰竭评估(SOFA)和急性生理学和慢性健康评估II(APACHE II)评分进行评估,并根据脓毒症-3存活指南进行治疗:研究涉及 142 名参与者,发现了鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌等流行病菌。值得注意的是,血管加压支持、重症监护室住院时间、SOFA评分和APACHE-II评分等因素都与死亡率有关。有趣的是,年龄、性别和维生素 D 水平没有显示出明显的关联。然而,该研究确实发现铁、铁蛋白和转铁蛋白饱和度水平与 28 天死亡率增加之间存在显著关联:我们的研究得出结论,低铁、铁蛋白升高和转铁蛋白饱和度降低与相关结果有关联。而维生素 D 水平则没有这种关系。这些结果表明了对患者管理和预后的潜在影响,值得在今后的研究中进一步探讨:Bairwa M, Jatteppanavar B, Kant R, Singh M, Choudhury A. Iron Profile and Vitamin D Levels on Clinical Outcomes in Patients with Sepsis and Septic Shock: A Cross-sectional Analysis at a Tertiary Care Center.Indian J Crit Care Med 2024;28(6):569-574.
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引用次数: 0
期刊
Indian Journal of Critical Care Medicine
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