Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit
Purpose Hemoglobin (Hb) transfusion thresholds are established in intensive care units. A restrictive transfusion threshold (Hb 70-75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transf...
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| description | Purpose Hemoglobin (Hb) transfusion thresholds are established in intensive care units. A restrictive transfusion threshold (Hb 70-75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transfusion thresholds meet the challenges of individual patients. Methods We evaluated microvascular flow index (MFI) and proportion of perfused vessels (PPV) in the sublingual microcirculation with CytoCam-IDF microscopy and near-infrared spectroscopy (NIRS). A study team-independent, treating intensivist assigned a total of 64 patients to 1 of 2 two transfusion thresholds, 43 patients to the Hb 75 g/l threshold and 21 patients to the Hb 90 g/l threshold, at a surgical intensive care unit. We performed microcirculatory measurements 1 h before and 1 h after transfusion of 1 unit of red blood cells. Results Microcirculatory flow variables correlated negatively with pre-transfusion flow variables (Delta MFI: rho = - 0.821, p < 0.001; Delta PPV: rho = - 0.778, p < 0.001). Patients with good initial microcirculation (cutoffs: MFI > 2.84, PPV > 88%) showed a deteriorated microcirculation after red blood cell transfusion. An impaired microcirculation improved after transfusion. At both transfusion thresholds, approximately one third of the patients showed an initially impaired microcirculation. In contrast, one third in every group had good microcirculation above the cutoff variables and did not profit from the transfusion. Conclusion The data suggest that the established transfusion thresholds and other hemodynamic variables do not reflect microcirculatory perfusion of patients. Blood transfusion at both thresholds 75 g/l and 90 g/l hemoglobin can either improve or harm the microcirculatory blood flow, questioning the concept of arbitrary transfusion thresholds. |
| doi_str_mv | 10.1186/s13054-020-2728-7 |
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A restrictive transfusion threshold (Hb 70-75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transfusion thresholds meet the challenges of individual patients. Methods We evaluated microvascular flow index (MFI) and proportion of perfused vessels (PPV) in the sublingual microcirculation with CytoCam-IDF microscopy and near-infrared spectroscopy (NIRS). A study team-independent, treating intensivist assigned a total of 64 patients to 1 of 2 two transfusion thresholds, 43 patients to the Hb 75 g/l threshold and 21 patients to the Hb 90 g/l threshold, at a surgical intensive care unit. We performed microcirculatory measurements 1 h before and 1 h after transfusion of 1 unit of red blood cells. Results Microcirculatory flow variables correlated negatively with pre-transfusion flow variables (Delta MFI: rho = - 0.821, p < 0.001; Delta PPV: rho = - 0.778, p < 0.001). Patients with good initial microcirculation (cutoffs: MFI > 2.84, PPV > 88%) showed a deteriorated microcirculation after red blood cell transfusion. An impaired microcirculation improved after transfusion. At both transfusion thresholds, approximately one third of the patients showed an initially impaired microcirculation. In contrast, one third in every group had good microcirculation above the cutoff variables and did not profit from the transfusion. Conclusion The data suggest that the established transfusion thresholds and other hemodynamic variables do not reflect microcirculatory perfusion of patients. Blood transfusion at both thresholds 75 g/l and 90 g/l hemoglobin can either improve or harm the microcirculatory blood flow, questioning the concept of arbitrary transfusion thresholds.</description><identifier>ISSN: 1466-609X</identifier><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1366-609X</identifier><identifier>DOI: 10.1186/s13054-020-2728-7</identifier><identifier>PMID: 31952555</identifier><language>eng</language><publisher>LONDON: Springer Nature</publisher><subject>Aged ; Blood ; Blood flow ; Blood transfusion ; Capillary density ; Cardiogenic shock ; Critical Care Medicine ; Critical illness ; Diseases ; Erythrocyte Transfusion - classification ; Erythrocyte Transfusion - methods ; Erythrocyte Transfusion - trends ; Female ; General & Internal Medicine ; Glycosylated hemoglobin ; Health aspects ; Hemoglobins ; Humans ; Infrared spectroscopy ; Intensive care ; Intensive care unit ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Investigations ; Life Sciences & Biomedicine ; Male ; Measurement ; Microcirculation ; Microcirculation - physiology ; Microscopy ; Middle Aged ; Mortality ; Mouth Floor - blood supply ; Mouth Floor - physiopathology ; Observational studies ; Patient outcomes ; Pay-per-view television ; Physiological aspects ; Prospective Studies ; Science & Technology ; Shock ; Spectroscopy ; Spectroscopy, Near-Infrared - methods ; Sublingual microcirculation ; Transfusion ; Transfusion Medicine - methods ; Transfusion Medicine - standards ; Vessel perfusion</subject><ispartof>Critical care (London, England), 2020-01, Vol.24 (1), p.18-18, Article 18</ispartof><rights>COPYRIGHT 2020 BioMed Central Ltd.</rights><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>16</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000513554300001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c560t-1b64e8a9a8a108255da9133488dae77276ca2a1c07a05ab8ad4f35afba37949f3</citedby><cites>FETCH-LOGICAL-c560t-1b64e8a9a8a108255da9133488dae77276ca2a1c07a05ab8ad4f35afba37949f3</cites><orcidid>0000-0002-1453-4180 ; 0000-0002-2013-4140</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969438/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969438/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2115,27929,27930,28253,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31952555$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scheuzger, Jonas</creatorcontrib><creatorcontrib>Zehnder, Anna</creatorcontrib><creatorcontrib>Meier, Vera</creatorcontrib><creatorcontrib>Yeginsoy, Desiree</creatorcontrib><creatorcontrib>Flukiger, Julian</creatorcontrib><creatorcontrib>Siegemund, Martin</creatorcontrib><title>Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit</title><title>Critical care (London, England)</title><addtitle>CRIT CARE</addtitle><addtitle>Crit Care</addtitle><description>Purpose Hemoglobin (Hb) transfusion thresholds are established in intensive care units. A restrictive transfusion threshold (Hb 70-75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transfusion thresholds meet the challenges of individual patients. Methods We evaluated microvascular flow index (MFI) and proportion of perfused vessels (PPV) in the sublingual microcirculation with CytoCam-IDF microscopy and near-infrared spectroscopy (NIRS). A study team-independent, treating intensivist assigned a total of 64 patients to 1 of 2 two transfusion thresholds, 43 patients to the Hb 75 g/l threshold and 21 patients to the Hb 90 g/l threshold, at a surgical intensive care unit. We performed microcirculatory measurements 1 h before and 1 h after transfusion of 1 unit of red blood cells. Results Microcirculatory flow variables correlated negatively with pre-transfusion flow variables (Delta MFI: rho = - 0.821, p < 0.001; Delta PPV: rho = - 0.778, p < 0.001). Patients with good initial microcirculation (cutoffs: MFI > 2.84, PPV > 88%) showed a deteriorated microcirculation after red blood cell transfusion. An impaired microcirculation improved after transfusion. At both transfusion thresholds, approximately one third of the patients showed an initially impaired microcirculation. In contrast, one third in every group had good microcirculation above the cutoff variables and did not profit from the transfusion. Conclusion The data suggest that the established transfusion thresholds and other hemodynamic variables do not reflect microcirculatory perfusion of patients. Blood transfusion at both thresholds 75 g/l and 90 g/l hemoglobin can either improve or harm the microcirculatory blood flow, questioning the concept of arbitrary transfusion thresholds.</description><subject>Aged</subject><subject>Blood</subject><subject>Blood flow</subject><subject>Blood transfusion</subject><subject>Capillary density</subject><subject>Cardiogenic shock</subject><subject>Critical Care Medicine</subject><subject>Critical illness</subject><subject>Diseases</subject><subject>Erythrocyte Transfusion - classification</subject><subject>Erythrocyte Transfusion - methods</subject><subject>Erythrocyte Transfusion - trends</subject><subject>Female</subject><subject>General & Internal Medicine</subject><subject>Glycosylated hemoglobin</subject><subject>Health aspects</subject><subject>Hemoglobins</subject><subject>Humans</subject><subject>Infrared spectroscopy</subject><subject>Intensive care</subject><subject>Intensive care unit</subject><subject>Intensive Care Units - organization & administration</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Investigations</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Measurement</subject><subject>Microcirculation</subject><subject>Microcirculation - physiology</subject><subject>Microscopy</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mouth Floor - blood supply</subject><subject>Mouth Floor - physiopathology</subject><subject>Observational studies</subject><subject>Patient outcomes</subject><subject>Pay-per-view television</subject><subject>Physiological aspects</subject><subject>Prospective Studies</subject><subject>Science & Technology</subject><subject>Shock</subject><subject>Spectroscopy</subject><subject>Spectroscopy, Near-Infrared - methods</subject><subject>Sublingual microcirculation</subject><subject>Transfusion</subject><subject>Transfusion Medicine - methods</subject><subject>Transfusion Medicine - standards</subject><subject>Vessel perfusion</subject><issn>1466-609X</issn><issn>1364-8535</issn><issn>1364-8535</issn><issn>1466-609X</issn><issn>1366-609X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqNUk2LFDEQbURx19Uf4EUavAjSa9L56PRFWAY_FhY8qOAtVKfTMxl6kjFJj-xf8ldaPbOOjohIDpVU3nuVqryieErJJaVKvkqUEcErUpOqbmpVNfeKc8okr5Rg4j7uuZSVJO2Xs-JRSmtCaKMke1icMdqKWghxXnz_OHWj88sJxnLjTAzGRTONkF3wZR9sKn3IZbTDaM0c-7IbQ-hLY8exzBF8GqY0Y_Mq2rQKY59KN58shmx9cjtbGoi2nLzLFZTbGNIWteZ86JKNu30tLJ_y1N_-g_y4eDDAmOyTu3hRfH775tPifXXz4d314uqmMkKSXNFOcqugBQWUKOyyh5YyxpXqwTZN3UgDNVBDGiACOgU9H5iAoQPWtLwd2EVxfdDtA6z1NroNxFsdwOl9IsSlhpidGa1uobNC0hYorTlRTScFp3LglApKWtGj1uuD1nbqNrY31uPMxhPR0xvvVnoZdlq2suVMocCLO4EYvk42Zb1xaR4-eBumpGuGBfHPyQx9_gd0HaaIk92jCD6zJvwXagnYgPNDwLpmFtVXkqqmJoQJRF3-BYWrt-iS4O3gMH9CoAcCWigl9MuxR0r0bFZ9MKtGs-rZrLpBzrPfh3Nk_HQnAtQB8M12YUjGWW_sEUYIEZQJwRnuCF24vHfSIkw-I_Xl_1PZDzRXCFM</recordid><startdate>20200117</startdate><enddate>20200117</enddate><creator>Scheuzger, Jonas</creator><creator>Zehnder, Anna</creator><creator>Meier, Vera</creator><creator>Yeginsoy, Desiree</creator><creator>Flukiger, Julian</creator><creator>Siegemund, Martin</creator><general>Springer Nature</general><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1453-4180</orcidid><orcidid>https://orcid.org/0000-0002-2013-4140</orcidid></search><sort><creationdate>20200117</creationdate><title>Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit</title><author>Scheuzger, Jonas ; Zehnder, Anna ; Meier, Vera ; Yeginsoy, Desiree ; Flukiger, Julian ; Siegemund, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c560t-1b64e8a9a8a108255da9133488dae77276ca2a1c07a05ab8ad4f35afba37949f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Blood</topic><topic>Blood flow</topic><topic>Blood transfusion</topic><topic>Capillary density</topic><topic>Cardiogenic shock</topic><topic>Critical Care Medicine</topic><topic>Critical illness</topic><topic>Diseases</topic><topic>Erythrocyte Transfusion - classification</topic><topic>Erythrocyte Transfusion - methods</topic><topic>Erythrocyte Transfusion - trends</topic><topic>Female</topic><topic>General & Internal Medicine</topic><topic>Glycosylated hemoglobin</topic><topic>Health aspects</topic><topic>Hemoglobins</topic><topic>Humans</topic><topic>Infrared spectroscopy</topic><topic>Intensive care</topic><topic>Intensive care unit</topic><topic>Intensive Care Units - organization & administration</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Investigations</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Measurement</topic><topic>Microcirculation</topic><topic>Microcirculation - physiology</topic><topic>Microscopy</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mouth Floor - blood supply</topic><topic>Mouth Floor - physiopathology</topic><topic>Observational studies</topic><topic>Patient outcomes</topic><topic>Pay-per-view television</topic><topic>Physiological aspects</topic><topic>Prospective Studies</topic><topic>Science & Technology</topic><topic>Shock</topic><topic>Spectroscopy</topic><topic>Spectroscopy, Near-Infrared - methods</topic><topic>Sublingual microcirculation</topic><topic>Transfusion</topic><topic>Transfusion Medicine - methods</topic><topic>Transfusion Medicine - standards</topic><topic>Vessel perfusion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scheuzger, Jonas</creatorcontrib><creatorcontrib>Zehnder, Anna</creatorcontrib><creatorcontrib>Meier, Vera</creatorcontrib><creatorcontrib>Yeginsoy, Desiree</creatorcontrib><creatorcontrib>Flukiger, Julian</creatorcontrib><creatorcontrib>Siegemund, Martin</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Proquest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scheuzger, Jonas</au><au>Zehnder, Anna</au><au>Meier, Vera</au><au>Yeginsoy, Desiree</au><au>Flukiger, Julian</au><au>Siegemund, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit</atitle><jtitle>Critical care (London, England)</jtitle><stitle>CRIT CARE</stitle><addtitle>Crit Care</addtitle><date>2020-01-17</date><risdate>2020</risdate><volume>24</volume><issue>1</issue><spage>18</spage><epage>18</epage><pages>18-18</pages><artnum>18</artnum><issn>1466-609X</issn><issn>1364-8535</issn><eissn>1364-8535</eissn><eissn>1466-609X</eissn><eissn>1366-609X</eissn><abstract>Purpose Hemoglobin (Hb) transfusion thresholds are established in intensive care units. A restrictive transfusion threshold (Hb 70-75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transfusion thresholds meet the challenges of individual patients. Methods We evaluated microvascular flow index (MFI) and proportion of perfused vessels (PPV) in the sublingual microcirculation with CytoCam-IDF microscopy and near-infrared spectroscopy (NIRS). A study team-independent, treating intensivist assigned a total of 64 patients to 1 of 2 two transfusion thresholds, 43 patients to the Hb 75 g/l threshold and 21 patients to the Hb 90 g/l threshold, at a surgical intensive care unit. We performed microcirculatory measurements 1 h before and 1 h after transfusion of 1 unit of red blood cells. Results Microcirculatory flow variables correlated negatively with pre-transfusion flow variables (Delta MFI: rho = - 0.821, p < 0.001; Delta PPV: rho = - 0.778, p < 0.001). Patients with good initial microcirculation (cutoffs: MFI > 2.84, PPV > 88%) showed a deteriorated microcirculation after red blood cell transfusion. An impaired microcirculation improved after transfusion. At both transfusion thresholds, approximately one third of the patients showed an initially impaired microcirculation. In contrast, one third in every group had good microcirculation above the cutoff variables and did not profit from the transfusion. Conclusion The data suggest that the established transfusion thresholds and other hemodynamic variables do not reflect microcirculatory perfusion of patients. Blood transfusion at both thresholds 75 g/l and 90 g/l hemoglobin can either improve or harm the microcirculatory blood flow, questioning the concept of arbitrary transfusion thresholds.</abstract><cop>LONDON</cop><pub>Springer Nature</pub><pmid>31952555</pmid><doi>10.1186/s13054-020-2728-7</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-1453-4180</orcidid><orcidid>https://orcid.org/0000-0002-2013-4140</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Blood Blood flow Blood transfusion Capillary density Cardiogenic shock Critical Care Medicine Critical illness Diseases Erythrocyte Transfusion - classification Erythrocyte Transfusion - methods Erythrocyte Transfusion - trends Female General & Internal Medicine Glycosylated hemoglobin Health aspects Hemoglobins Humans Infrared spectroscopy Intensive care Intensive care unit Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Investigations Life Sciences & Biomedicine Male Measurement Microcirculation Microcirculation - physiology Microscopy Middle Aged Mortality Mouth Floor - blood supply Mouth Floor - physiopathology Observational studies Patient outcomes Pay-per-view television Physiological aspects Prospective Studies Science & Technology Shock Spectroscopy Spectroscopy, Near-Infrared - methods Sublingual microcirculation Transfusion Transfusion Medicine - methods Transfusion Medicine - standards Vessel perfusion |
| title | Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit-a prospective observational study in the intensive care unit |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-14T10%3A58%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sublingual%20microcirculation%20does%20not%20reflect%20red%20blood%20cell%20transfusion%20thresholds%20in%20the%20intensive%20care%20unit-a%20prospective%20observational%20study%20in%20the%20intensive%20care%20unit&rft.jtitle=Critical%20care%20(London,%20England)&rft.au=Scheuzger,%20Jonas&rft.date=2020-01-17&rft.volume=24&rft.issue=1&rft.spage=18&rft.epage=18&rft.pages=18-18&rft.artnum=18&rft.issn=1466-609X&rft.eissn=1364-8535&rft_id=info:doi/10.1186/s13054-020-2728-7&rft_dat=%3Cgale_proqu%3EA618720035%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2340619204&rft_id=info:pmid/31952555&rft_galeid=A618720035&rft_doaj_id=oai_doaj_org_article_9abe5619a1124087b65416f41151095d&rfr_iscdi=true |