Background
Methods
Objectives and design
Study population
Intervention
Mechanical ventilation
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after bronchoscopy or disconnection of the ventilated lung from the mechanical ventilator
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at start of OLV
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every 1 hour during OLV
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after re-expansion of the non-dependent lung to resume TLV
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end of surgery in supine position
RM and lung expansion maneuvers
Recruitment maneuver | 1. Increase FIO2 to 1.0 2. Set peak inspiratory pressure limit to 45 cmH2O 3. Set respiratory rate to six breaths/min 4. Set I:E ratio to 1:1 5. Increase VT in steps of approximately 2 mL/kg PBW until plateau pressure reaches 30–40 cmH2O 6. If the maximum VT allowed by the anesthesia ventilator is achieved and the plateau pressure is lower than 30 cmH2O, increase the PEEP as needed, to a maximum of 20 cmH2O 7. Allow three breaths while maintaining plateau pressure of 30–40 cmH2O 8. Set VT, PEEP, respiratory rate, and I:E ratio back to pre-recruitment values |
Lung re-expansion maneuver | 1. Keep the non-ventilated under visual inspection, whenever possible 2. Connect the CPAP device with adequate oxygen flow (FIO2 1.0) to the non-ventilated lung 3. Set CPAP to 10 cmH2O during 20 s 4. Set CPAP to 15 cmH2O during 20 s 5. Set CPAP to 20 cmH2O during 20 s 6. If performed as part of a rescue therapy for hypoxemia and oxygenation has been restored, reduce CPAP as soon as possible to 10 cmH2O, or 5 cmH2O, or disconnect the CPAP device |
Rescue strategies for intraoperative hypoxemia and intraoperative hypercapnia
If hypoxemia occurs in the high PEEP group during TLV | 1. Apply RM 2. Increase PEEP to 12 cmH2O and apply RM 3. Increase FIO2 in steps of 0.1 until 1.0 4. Consider stepwise decrease of PEEP down to 8 cmH2O |
If hypoxemia occurs in the low PEEP group during TLV | 1. Increase FIO2 in steps of 0.1 until 1.0 2. Apply RM 3. Increase PEEP to 6 cmH2O 4. Apply RM 5. Increase PEEP to 7 cmH2O 6. Apply RM |
If hypoxemia occurs in the high PEEP group during OLV | 1. Apply RM 2. Increase PEEP to 12 cmH2O and apply RM 3. Increase FIO2 in steps of 0.1 up to 1.0 4. Apply oxygen to the non-ventilated lung, consider using CPAP (see lung re-expansion maneuver) up to a pressure of 20 cmH2O, or selective oxygen insufflation via fiberscope 5. Consider stepwise decrease of PEEP of the ventilated lung to 8 cmH2O 6. Consider surgical intervention (e.g., clamping of the pulmonary artery by surgeon) 7. Consider administration of inhaled nitric oxide or prostacyclin, or intravenous almitrine (provided the drug is approved in your country/institution) 8. Switch to TLV |
If hypoxemia occurs in the low PEEP group during OLV | 1. Increase FIO2 in steps of 0.1 up to 1.0 2. Apply oxygen to the non-ventilated lung, consider CPAP therapy (re-expansion of the non-ventilated lung) up to a pressure of 20 cmH2O, or selective oxygen insufflation via fiberscope 3. Apply RM to the ventilated lung 4. Increase PEEP to 6 cmH2O 5. Apply RM to the ventilated lung 6. Increase PEEP to 7 cmH2O 7. Apply RM to the ventilated lung 8. Consider surgical intervention (e.g., clamping of the pulmonary artery by surgeon) 9. Consider administration of inhaled nitric oxide or prostacyclin, or intravenous almitrine (provided the drug is approved in your country/institution) 10. Switch to TLV |
If hypercapnia (PaCO2 > 60 mmHg) with respiratory acidosis (pHa < 7.20) occurs during OLV, these steps are applied in the high and low PEEP groups | 1. Increase the respiratory rate (maximum 30/min, while minimizing intrinsic PEEP) 2. Increase VT stepwise up to 7 mL/kg PBW 3. Switch to TLV |
Standard procedures
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Use of inhaled isoflurane, desflurane or sevoflurane, intravenous propofol, remifentanil or sufentanil, and cisatracurium, atracurium, vecuronium, or rocuronium (as required)
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Use of sugammadex or a balanced solution of prostigmine, or neostigmine and atropine or glycopyrrolate for reversal of muscle relaxation, guided by neuromuscular function monitoring (for example, train-of-four stimulation)
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For postoperative pain management to achieve a VAS pain score below 3 use regional anesthesia, including epidural, paravertebral, and intercostal blockade, and consideration of indications, contra-indications, and local preferences is encouraged, but not obligatory
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Use of physiotherapy by early mobilization, deep breathing exercises with and without incentive spirometry, and stimulation of cough in the postoperative period
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Avoid fluid underload and overload
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Use of invasive measurement of arterial blood pressure whenever indicated
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Use of appropriate prophylactic antibiotics whenever indicated
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Use of gastric tubes, urinary bladder catheters, and more invasive monitoring according to individual needs, as well as local practice and/or guidelines
Minimization of bias
Study endpoints
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aspiration pneumonitis (defined as respiratory failure after the inhalation of regurgitated gastric contents)
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moderate respiratory failure (SpO2 < 90% or PaO2 < 60 mmHg for 10 min in room air, responding to oxygen > 2 L/min)
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severe respiratory failure (need for non-invasive or invasive mechanical ventilation due to poor oxygenation)
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adult respiratory distress syndrome (mild, moderate, or severe according to the Berlin definition [24])
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pulmonary infection (defined as new or progressive radiographic infiltrate plus at least two of the following: antibiotic treatment, tympanic temperature > 38 °C, leukocytosis or leucopenia (white blood cell (WBC) count < 4000 cells/mm3 or > 12,000 cells/mm3) and/or purulent secretions)
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atelectasis (suggested by lung opacification with shift of the mediastinum, hilum, or hemidiaphragm towards the affected area, and compensatory over-inflation in the adjacent non-atelectatic lung)
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cardiopulmonary edema (defined as clinical signs of congestion, including dyspnea, edema, rales, and jugular venous distention, with the chest x-ray demonstrating increase in vascular markings and diffuse alveolar interstitial infiltrates)
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pleural effusion (chest x-ray demonstrating blunting of the costophrenic angle, loss of the sharp silhouette of the ipsilateral hemidiaphragm in upright position, evidence of displacement of adjacent anatomical structures, or (in supine position) a hazy opacity in one hemithorax with preserved vascular shadows)
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pneumothorax (defined as air in the pleural space with no vascular bed surrounding the visceral pleura)
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pulmonary infiltrates (chest x-ray demonstrating new monolateral or bilateral infiltrate without other clinical signs)
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prolonged air leakage (air leak requiring at least 7 days of postoperative chest tube drainage)
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purulent pleuritic (receiving antibiotics for a suspected infection, as far as not explained by the preoperative patient condition alone)
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pulmonary embolism (as documented by pulmonary arteriogram or autopsy, or supported by ventilation/perfusion radioisotope scans, or documented by echocardiography and receiving specific therapy)
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lung hemorrhage (bleeding through the chest tubes requiring reoperation, or three or more red blood cell packs)
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extended PPC, including bronchospasm (defined as newly detected expiratory wheezing treated with bronchodilators) or mild respiratory failure (SpO2 < 90% or PaO2 < 60 mmHg for 10 min in room air, responding to oxygen ≤ 2 L/min)
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intraoperative complications (use of continuous positive airway pressure for the non-ventilated lung, use of inhaled nitric oxide/prostacycline, use of selective fiberoscope insufflation, hypotension unresponsive to fluids and/or vasoactive drugs, new arrhythmias unresponsive to intervention, need for high dosage of vasoactive drugs (a dosage at the tolerance limit of the treating physician), need for massive transfusion, life-threatening surgical complication including major bleeding, tension pneumothorax, intracranial injury, hypoxemia and hypercapnia rescue maneuvers, deviation from prescribed PEEP or VT)
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postoperative extrapulmonary complications
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need for unexpected intensive care unit admission or readmission
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number of hospital-free days at day 28
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90-day survival
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in-hospital survival
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arterial blood gas analysis during surgery (PaO2, PaCO2, pHa)
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any postoperative respiratory intervention (new requirement of non-invasive ventilation or mechanical ventilation)
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systemic inflammatory response syndrome (presence of two or more of the following findings: body temperature < 36 °C or > 38 °C, heart rate > 90 beats per minute, respiratory rate > 20 breaths per minute or, on blood gas, a PaCO2 < 32 mmHg (4.3 kPa), WBC count < 4000 cells/mm3 or > 12,000 cells/mm3, or > 10% band forms)
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sepsis (systemic inflammatory response syndrome in response to a confirmed infectious process; infection can be suspected or proven (by culture, stain, or polymerase chain reaction), or a clinical syndrome pathognomonic for infection)
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specific evidence for infection includes WBCs in normally sterile fluid (such as urine or cerebrospinal fluid, evidence of a perforated viscera (free air on abdominal x-ray or computer tomography scan, signs of acute peritonitis), abnormal chest x-ray consistent with pneumonia (with focal opacification), or petechiae, purpura, or purpura fulminans)
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severe sepsis (sepsis with organ dysfunction, hypoperfusion, or hypotension), septic shock (sepsis with refractory arterial hypotension or hypoperfusion abnormalities in spite of adequate fluid resuscitation); signs of systemic hypoperfusion may be either end-organ dysfunction or serum lactate greater than 4 mmol/dL, other signs include oliguria and altered mental status
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septic shock id defined as sepsis plus hypotension after aggressive fluid resuscitation, typically upwards of 6 L or 40 mL/kg of crystalloid
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extra-pulmonary infection (wound infection + any other infection)
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coma (Glasgow Coma Score < 8 in the absence of therapeutic coma or sedation)
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acute myocardial infarction (detection of rise and/or fall of cardiac markers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit, together with symptoms of ischemia, electrocardiography changes indicative of new ischemia, development of pathological Q-waves, or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality or sudden unexpected cardiac death, involving cardiac arrest with symptoms suggestive of cardiac ischemia (but death occurring before the appearance of cardiac markers in blood))
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acute renal failure (renal failure documented as follows: Risk: increased creatinine × 1.5 or glomerular filtration rate (GFR) decrease > 25% or urine output (UO) < 0.5 mL/kg/h × 6 h; Injury: increased creatinine × 2 or GFR decrease > 50% or UO < 0.5 mL/kg/h × 12 h; Failure: increased creatinine × 3 or GFR decrease > 75% or UO < 0.3 mL/kg/h × 24 h or anuria × 12 h; Loss: persistent acute renal failure = complete loss of kidney function > 4 weeks)
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disseminated intravascular coagulation (score documented as follows: platelet count < 50 (2 points), < 100 (1 point), or ≥ 100 (0 points); D-dimer > 4 μg/mL (2 points), > 0.39 μg/mL (1 point) or ≤ 0.39 μg/mL (0 points); prothrombin time > 20.5 s (2 points), > 17.5 s (1 point), or ≤ 17.5 s (0 points), if ≥ 5 points: overt disseminated intravascular coagulation)
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stroke (new clinical signs of stroke lasting longer than 24 h and corresponding findings in radiologic imaging)
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hepatic failure (hepatic failure during short-term follow-up (5 postoperative days) is considered as follows: bilirubin serum level > 2 mg/dL + elevation of alanine amino transferase/aspartate amino transferase + lactate dehydrogenase × 2 above normal values; during long-term follow-up (until postoperative day 90) at new presence of hepatic encephalopathy and coagulopathy (international normalized ratio (INR) > 1.5) within 8 weeks after initial signs of liver injury (e.g., jaundice) without evidence for chronic liver disease)
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gastrointestinal failure (any type of gastrointestinal bleeding or gastrointestinal failure score documented as follows: 0 = normal gastrointestinal function; 1 = enteral feeding with under 50% of calculated needs or no feeding 3 days after abdominal surgery; 2 = food intolerance or intra-abdominal hypertension; 3 = food intolerance and intra-abdominal hypertension; and 4 = abdominal compartment syndrome)
Study visits and data collection
Study dropouts
Handling of data
Sample size calculations
Look | Information fraction |
N
| Cumulative alpha spent | Cumulative beta spent | Z-efficacy/harm | Z-futility | Boundary crossing probabilities under H1 | |
---|---|---|---|---|---|---|---|---|
Efficacy | Futility | |||||||
1 | 0.2 | 452 | 0.001 | 0.008 | ±3.252 | ±0.031 | 0.042 | 0.008 |
2 | 0.4 | 904 | 0.004 | 0.019 | ±2.986 | ±0.152 | 0.17 | 0.011 |
3 | 0.6 | 1355 | 0.009 | 0.036 | ±2.692 | ±0.631 | 0.281 | 0.017 |
4 | 0.8 | 1807 | 0.022 | 0.062 | ±2.374 | ±1.344 | 0.263 | 0.026 |
5 | 1.0 | 2259 | 0.05 | 0.1 | ±2.025 | ±2.025 | 0.143 | 0.038 |
Statistical analysis
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Count analysis – the number of positive component events (i.e., ‘count’) across the composite will be assessed. The groups will be compared on the count using a Mann–Whitney test, and the odds ratio with the 95% confidence interval will be assessed with a proportional odds logistic regression model
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Individual component analysis – the effect of the intervention in each component will be analyzed using a generalized linear model using a Bonferroni correction for multiple comparisons; the 99.64% Bonferroni-corrected confidence intervals will be reported (1 – 0.05/14 = 0.9964)
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Common effect test – a multivariate (i.e., multiple outcomes per subject) generalized estimating equations (GEE) model will be used to estimate a common effect odds ratio across the components
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Average relative effect test – the average relative effect test will be assessed by averaging the component-specific treatment effect from the distinct effects model, and testing whether the average is equal to zero; in the GEE distinct effect model, a distinct treatment effect is estimated for each component
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Heterogeneity of treatment effect – heterogeneity of treatment effect across components will be assessed by a treatment-by-component interaction test in the distinct effects GEE model
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Clinical severity weight – each component will be weighted by a clinical severity weight determined a posteriori; a multivariate (i.e., multiple outcomes per subject) GEE model will be used to estimate a common effect odds ratio across the components while applying the severity weights
Sub-studies
Trial organization
Discussion
Trial status
Site name | Collaborator surname | Collaborator name | Email address |
Military Medical Academy, Belgrade, Serbia | Neskovic | Vojislava |
vojkan43@gmail.com
|
Radovic | Nevena |
nevence1@yahoo.com
| |
Rondovic | Goran |
grondovic@gmail.com
| |
Stamenkovic | Dusica |
dusicastamenkovic@yahoo.com
| |
Vukovic | Rade |
radvuk@gmail.com
| |
Zeba | Snjezana |
snjezanazeba@hotmail.com
| |
Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany | Rossaint | Rolf |
rrossaint@ukaachen.de
|
Coburn | Mark |
mcoburn@ukaachen.de
| |
Kowark | Ana |
akowark@ukaachen.de
| |
Ziemann | Sebastian |
sziemann@ukaachen.de
| |
van Waesberghe | Julia |
jvanwaesberg@ukaachen.de
| |
Department of Anesthesiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands | Bauer | Wolfgang |
w.o.bauer@amc.uva.nl
|
Terwindt | Lotte |
l.e.terwindt@amc.uva.nl
| |
Attikon University Hospital, Athens, Greece | Kostopanagiotou | Kostas |
kostop@hotmail.co.uk
|
Kostroglou | Andreas |
andreaskostr@gmail.com
| |
Kyttari | Katerina |
akyttari@gmail.com
| |
Sidiropoulou | Tatiana |
tatianasid@gmail.com
| |
University Hospital Clínic de Barcelona, Spain | Jiménez Andújar | María-José |
jjimenez@somclinic.cat
|
López-Baamonde | Manuel |
lopez10@clinic.cat
| |
Navarro Ripoll | Ricard |
rnavarr1@clinic.cat
| |
Rivera Vallejo | Lorena |
lorivera@clinic.cat
| |
Weill Cornell Medicine, Department of Anesthesiology, New York, USA | Henry | Matthew |
mah2065@med.cornell.edu
|
Jegarl | Anita |
anj2024@med.cornell.edu
| |
Murrell | Matthew |
mtm9006@med.cornell.edu
| |
O’Hara | Patrick |
pao2011@med.cornell.edu
| |
Steinkamp | Michele |
mls9004@med.cornell.edu
| |
Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thoraxchirurgie | Kraßler | Jens |
krasslerj@fachkrankenhaus-coswig.de
|
Schäfer | Susanne |
schaefers@fachkrankenhaus-coswig.de
| |
Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Dresden, Germany | Becker | Charlotte |
charlotte-becker@gmx.net
|
Birr | Katja |
katjabirr@gmail.com
| |
Bluth | Thomas |
thomas.bluth@uniklinikum-dresden.de
| |
Gama de Abreu | Marcelo |
mgabreu@uniklinikum-dresden.de
| |
Hattenhauer | Sara |
sara.hattenhauer@uniklinikum-dresden.de
| |
Kiss | Thomas |
thomas.kiss@uniklinikum-dresden.de
| |
Scharffenberg | Martin |
martin.scharffenberg@uniklinikum-dresden.de
| |
Teichmann | Robert |
teichmannrobert@aol.com
| |
Wittenstein | Jakob |
jakob.wittenstein@uniklinikum-dresden.de
| |
Department of Morpholo gy, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy | Vitali | Costanza |
costanza.vitali@student.unife.it
|
Spadaro | Savino |
savinospadaro@gmail.com
| |
Volta | Carlo Alberto |
vlc@unife.it
| |
Ragazzi | Riccardo |
rgc@unife.it
| |
Calandra | Camilla |
camilla.calandra@gmail.com
| |
Dept of Anesthesia and Intensive Care, University of Foggia, Italy, OO Riuniti Hospital | |||
Mariano | Karim |
karim_mariano@hotmail.it
| |
Mirabella | Lucia |
lucia.mirabella@unifg.it
| |
Mollica | Giuseppina |
giusymollica@virgilio.it
| |
Montrano | luigi |
luigi.montrano@unifg.it
| |
Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany | Loop | Torsten |
torsten.loop@uniklinik-freiburg.de
|
Semmelmann | Axel |
axel.semmelmann@uniklinik-freiburg.de
| |
Wirth | Steffen |
steffen.wirth@uniklinik-freiburg.de
| |
Department of Anesthesiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China | Miao | Changhong |
miaochh@aliyun.com
|
Zhong | Jing |
ziteng1934@163.com
| |
Lv | Hu |
lvhu086@126.com
| |
Wang | Hui |
2502425738@qq.com
| |
Zhang | Xue |
zx02190554@126.com
| |
Zhang | Yue |
aileencheung0807@163.com
| |
IRCCS San Martino Policlinico Hospital, Genoa, Italy | Pelosi | Paolo |
ppelosi@hotmail.com
|
Corsi | Laura |
corsilaura@yahoo.it
| |
Partroniti | Nicolò |
nicoloantonino.patroniti@unige.it
| |
Mandelli | Maura |
maura.mandelli@gmail.com
| |
Bonatti | Giulia |
giulia.bonatti@gmail.com
| |
Simonassi | Francesca |
francesca.simonassi@gmail.com
| |
Gratarola | Angelo |
a.gratarola@gmail.com
| |
Insular Hospital, Gran Canaria, Spain | Rodriguez Ruiz | Juan José |
juanjo.rodriguezruiz@gmail.com
|
Socorro | Tania |
austania@gmail.com
| |
University Hospital of Heraklion, Heraklion, Greece | Christofaki | Maria |
mchristofaki@yahoo.gr
|
Nyktari | Vasileia |
vnyktari@gmail.com
| |
Papaioannou | Alexandra |
papaioaa@uoc.gr
| |
University Istanbul University, Istanbul Medical Faculty, Department of Anaesthesiology and Intensive Care, Istanbul, Turkey | Şentürk | Nüzhet Mert |
senturkm@istanbul.edu.tr
|
Bingul | Emre |
dremrebingul@gmail.com
| |
Orhan Sungur | Mukadder |
mukadder.orhan@gmail.com
| |
Sungur | Zerrin |
zerrin_sr@yahoo.com
| |
University Hospital of Munich, Munich, Germany | Heidegger | Manuel |
manuel.heidegger@campus.lmu.de
|
Dossow | Vera |
vera.dossow@med.uni-muenchen.de
| |
Jerichow | Wiebke |
w.jerichow@web.de
| |
Kammerer | Tobias |
tobias.kammerer@med.uni-muenchen.de
| |
Richter | Julia |
julia.richter@richtersisters.de
| |
Schuba | Barbara |
barbara.schuba@med.uni-muenchen.de
| |
Speck | Eike |
eike.speck@med.uni-muenchen.de
| |
Stierle | Anna-Lisa |
anna@stierle-mail.de
| |
University Hospital of Prague, Prague, Czech Republic | Bruthans | Jan |
jan.bruthans@vfn.cz
|
Matek | Jan |
jan.matek@vfn.cz
| |
Michálek | Pavel |
pavel.michalek@vfn.cz
| |
Radboud University Medical Centre Nijmegen, The Netherlands | Didden | Loes |
loes.didden@radboudumc.nl
|
Hofland | Jan |
jan.hofland@radboudumc.nl
| |
Kuut | Marieke |
marieke.kuut@radboudumc.nl
| |
Mourisse | Jo |
jo.mourisse@radboudumc.nl
| |
Hospital Universitario de la Ribera, Alzira, Spain | Aragon | Sonsoles |
aragon_son@gva.es
|
Esturi | Rafael |
esturi_raf@gva.es
| |
Miñana | Encarna |
minyana_enc@gva.es
| |
Sanchez | Fernando |
sanchez_fergar@gva.es
| |
Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, ‘Sotiria’ Chest Diseases Hospital, Athens, Greece | Sfikas | Elaine |
elaisfikas@hotmail.com
|
Kapezanos | Athanasios |
a.kapezanos@yahoo.com
| |
Papamichail | Konstantinos |
kospapam@yahoo.gr
| |
Toufektzian | Levon |
tlevon@gmail.com
| |
Voyagis | Gregorios |
gsvgasman@yahoo.com
| |
Hospital General Universitario of Valencia, Valencia, Spain | Granell Gil | Manuel |
mgranellg@hotmail.com
|
Vergara Sánchez | Asunción |
asuncionvergara@gmail.com
| |
De Andres | Jose |
deandres_jos@gva.es
| |
Morales Sarabia | Javier |
jems.com@gmail.com
| |
Broseta Lleó | Ana |
ana.broseta@gmail.com
| |
Hernández Laforet | Javier |
jaherla@hotmail.com
| |
Murcia Anaya | Mercedes |
merxemurcia@gmail.com
| |
Hospital Álvaro Cunqueiro, Vigo, Spain | Pereira Matalobos | Denis |
denispema@gmail.com
|
Aguirre Puig | Pilar |
pilaraguirrepuig@yahoo.es
| |
Division Anesthesiology and ICU, Department of Thoracic Surgery Jordanovac University Hospital Centre Zagreb, Zagreb,Croatia | Špiček Macan | Jasna |
mspicekj@hotmail.com
|
Karadza | Vjekoslav |
vkaradza@xnet.hr
| |
Kolaric | Nevenka |
nevenkakolaric@yahoo.com
| |
University Medical Centre Ljubljana, Slovenia | Andjelković | Lea |
lea.andjelkovic@gmail.com
|
Drnovšek Globokar | Mojca |
mojca.drnovsek@gmail.com
| |
Gorjup | Kristina |
kristinagorjup@gmail.com
| |
Mavko | Ana |
ana.mavko@gmail.com
| |
Pirc | Dejan |
pirc.dejan@gmail.com
| |
Institutul de Pneumoftiziologie, Bucharest, Romania | Genoveva | Cadar |
genovevacadar@hotmail.com
|
Istrate | Raluca |
raluca_crintea@yahoo.com
| |
Stoica | Radu |
raduati1957@gmail.com
| |
Central Military Emergency University Hospital, Bucharest, Romania | Corneci | Dan |
dcorneci@yahoo.com
|
Tanase | Narcis Valentin |
tanasenv@yahoo.com
| |
Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia | Radmilo | Jankovic |
jankovic.radmilo@gmail.com
|
Cvetanovic | Vladan |
vladan.cvetanovic@gmail.com
| |
Dinic | Vesna |
vesnadinic1981@gmail.com
| |
Grbesa | Tijana |
grbesatijana@gmail.com
| |
Jovic | Katarina |
katarina.jovic76@gmail.com
| |
Nikolic | Aleksandar |
draleksandarnikolic@hotmail.com
| |
Stojanovic | Milena |
milenastojanoviclaci@gmail.com
| |
Veselinovic | Ines |
inesveselinovic@gmail.com
| |
Vukovic | Anita |
anita83ptr@gmail.com
| |
Merheim Hospital, Cologne, Germany | Wappler | Frank |
wapplerf@kliniken-koeln.de
|
Defosse | Jerome Michel |
defossej@kliniken-koeln.de
| |
Wehmeier | Stefanie |
wehmeiers@kliniken-koeln.de
| |
University Hospital Münster, Department of Anesthesiology, Intensive Care and Pain Medicine, Münster, Germany | Ermert | Thomas |
ermert@uni-muenster.de
|
Zarbock | Alexander |
zarbock@uni-muenster.de
| |
Wenk | Manuel |
manuelwenk@uni-muenster.de
| |
Hospital Marie Lannelongue, Le Plessis-Robinson, France | Ion | Daniela Iolanda |
iolandaion@yahoo.com
|
Ionescu | Cristian |
iraducristi@yahoo.com
| |
Department of Anesthesiology and Intensive Care Medicine, University Hospital Otto von Guericke, Magdeburg, Germany | Schilling | Thomas |
thomas.schilling@med.ovgu.de
|
Macharadze | Tamar |
tamrikomacharadze@hotmail.com
| |
Taichung Veterans General Hospital, Taichung City, Taiwan | Li | Pei-Ching |
pei9502@gmail.com
|
Chang | Yi-Ting |
kikicoco36@gmail.com
| |
Anestesia e Rianimazione, Policlinico Univ. G. Martino, Messina, Italy | Noto | Alberto |
dralbert@unime.it
|
Calì | Placido |
placidocali@alice.it
| |
Desalvo | Giovanni |
giannidesalvo@gmail.com
| |
Deluca | Raffaele |
delucaraffa@gmail.com
| |
Giofre’ | Nicola |
ngiofre@hotmail.it
|