References of "Lambermont, Bernard"
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See detail"Opter pour l'obligation vaccinale est un choix de société"
Muraille, Eric; De Kerchove d'Exaerde, Alban; Drion, Pierre ULiege et al

Article for general public (2021)

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See detailAge-dependent impact of the major common genetic risk factor for COVID-19 on severity and mortality.
Nakanishi, Tomoko; Pigazzini, Sara; Degenhardt, Frauke et al

in Journal of Clinical Investigation (2021), Online ahead of print.

BACKGROUND: There is considerable variability in COVID-19 outcomes amongst younger adults-and some of this variation may be due to genetic predisposition. We characterized the clinical implications of the ... [more ▼]

BACKGROUND: There is considerable variability in COVID-19 outcomes amongst younger adults-and some of this variation may be due to genetic predisposition. We characterized the clinical implications of the major genetic risk factor for COVID-19 severity, and its age-dependent effect, using individual-level data in a large international multi-centre consortium. METHOD: The major common COVID-19 genetic risk factor is a chromosome 3 locus, tagged by the marker rs10490770. We combined individual level data for 13,424 COVID-19 positive patients (N=6,689 hospitalized) from 17 cohorts in nine countries to assess the association of this genetic marker with mortality, COVID-19-related complications and laboratory values. We next examined if the magnitude of these associations varied by age and were independent from known clinical COVID-19 risk factors. FINDINGS: We found that rs10490770 risk allele carriers experienced an increased risk of all-cause mortality (hazard ratio [HR] 1·4, 95% confidence interval [CI] 1·2-1·6) and COVID-19 related mortality (HR 1·5, 95%CI 1·3-1·8). Risk allele carriers had increased odds of several COVID-19 complications: severe respiratory failure (odds ratio [OR] 2·0, 95%CI 1·6-2·6), venous thromboembolism (OR 1·7, 95%CI 1·2-2·4), and hepatic injury (OR 1·6, 95%CI 1·2-2·0). Risk allele carriers ≤ 60 years had higher odds of death or severe respiratory failure (OR 2·6, 95%CI 1·8-3·9) compared to those > 60 years OR 1·5 (95%CI 1·3-1·9, interaction p-value=0·04). Amongst individuals ≤ 60 years who died or experienced severe respiratory COVID-19 outcome, we found that 31·8% (95%CI 27·6-36·2) were risk variant carriers, compared to 13·9% (95%CI 12·6-15·2%) of those not experiencing these outcomes. Prediction of death or severe respiratory failure among those ≤ 60 years improved when including the risk allele (AUC 0·82 vs 0·84, p=0·016) and the prediction ability of rs10490770 risk allele was similar to, or better than, most established clinical risk factors. INTERPRETATION: The major common COVID-19 risk locus on chromosome 3 is associated with increased risks of morbidity and mortality-and these are more pronounced amongst individuals ≤ 60 years. The effect on COVID-19 severity was similar to, or larger than most established risk factors, suggesting potential implications for clinical risk management. FUNDING: Funding was obtained by each of the participating cohorts individually. [less ▲]

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See detailProteinuria in COVID‑19: prevalence, characterization and prognostic role
HUART, Justine ULiege; BOUQUEGNEAU, Antoine ULiege; Lutteri, Laurence ULiege et al

in Journal of Nephrology (2021), 34(3), 355-364

Abstract Background Proteinuria has been commonly reported in patients with COVID-19. However, only dipstick tests have been frequently used thus far. Here, the quantifcation and characterization of ... [more ▼]

Abstract Background Proteinuria has been commonly reported in patients with COVID-19. However, only dipstick tests have been frequently used thus far. Here, the quantifcation and characterization of proteinuria were investigated and their association with mortality was assessed. Methods This retrospective, observational, single center study included 153 patients, hospitalized with COVID-19 between March 28th and April 30th, 2020, in whom total proteinuria and urinary α1-microglobulin (a marker of tubular injury) were measured. Association with mortality was evaluated, with a follow-up until May 7th, 2020. Results According to the Kidney Disease Improving Global Outcomes staging, 14% (n=21) of the patients had category 1 proteinuria (<150 mg/g of urine creatinine), 42% (n=64) had category 2 (between 150 and 500 mg/g) and 44% (n=68) had category 3 proteinuria (over 500 mg/g). Urine α1-microglobulin concentration was higher than 15 mg/g in 89% of patients. After a median follow-up of 27 [14;30] days, the mortality rate reached 18%. Total proteinuria and urinary α1-microglobulin were associated with mortality in unadjusted and adjusted models. This association was stronger in subgroups of patients with normal renal function and without a urinary catheter. Conclusions Proteinuria is frequent in patients with COVID-19. Its characterization suggests a tubular origin, with increased urinary α1-microglobulin. Tubular proteinuria was associated with mortality in COVID-19 in our restropective, observational study. [less ▲]

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See detailSARS-CoV-2 in carotid body
LAMBERMONT, Bernard ULiege; Davenne, Eric ULiege; MACLOT, Francois ULiege et al

in Intensive Care Medicine (2021)

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See detailClinical characteristics and day-90 outcomes of 4244 ctritically ill adults with COVID-19: a prospective cohort study
LAMBERMONT, Bernard ULiege; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators

in Intensive Care Medicine (2021)

Purpose: To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90 ... [more ▼]

Purpose: To describe acute respiratory distress syndrome (ARDS) severity, ventilation management, and the outcomes of ICU patients with laboratory-confirmed COVID-19 and to determine risk factors of 90-day mortality post-ICU admission. Methods: COVID-ICU is a multi-center, prospective cohort study conducted in 138 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, adjunctive interventions, ICU length-of-stay, and survival data were collected. Results: From February 25 to May 4, 2020, 4643 patients (median [IQR] age 63 [54-71] years and SAPS II 37 [28-50]) were admitted in ICU, with day-90 post-ICU admission status available for 4244. On ICU admission, standard oxygen therapy, high-flow oxygen, and non-invasive ventilation were applied to 29%, 19%, and 6% patients, respectively. 2635 (63%) patients were intubated during the first 24 h whereas overall 3376 (80%) received invasive mechanical ventilation (MV) at one point during their ICU stay. Median (IQR) positive end-expiratory and plateau pressures were 12 (10-14) cmH2O, and 24 (21-27) cmH2O, respectively. The mechanical power transmitted by the MV to the lung was 26.5 (18.6-34.9) J/min. Paralyzing agents and prone position were applied to 88% and 70% of patients intubated at Day-1, respectively. Pulmonary embolism and ventilator-associated pneumonia were diagnosed in 207 (9%) and 1209 (58%) of these patients. On day 90, 1298/4244 (31%) patients had died. Among patients who received invasive or non-invasive ventilation on the day of ICU admission, day-90 mortality increased with the severity of ARDS at ICU admission (30%, 34%, and 50% for mild, moderate, and severe ARDS, respectively) and decreased from 42 to 25% over the study period. Early independent predictors of 90-day mortality were older age, immunosuppression, severe obesity, diabetes, higher renal and cardiovascular SOFA score components, lower PaO2/FiO2 ratio and a shorter time between first symptoms and ICU admission. Conclusion: Among more than 4000 critically ill patients with COVID-19 admitted to our ICUs, 90-day mortality was 31% and decreased from 42 to 25% over the study period. Mortality was higher in older, diabetic, obese and severe ARDS patients. [less ▲]

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See detailOutcome Improvement Between the First Two Waves of the Coronavirus Disease 2019 Pandemic in a Single Tertiary-Care Hospital in Belgium.
Lambermont, Bernard ULiege; Rousseau, Anne-Françoise; Seidel, Laurence ULiege et al

in Critical Care Explorations (2021), 3(5), 0438

OBJECTIVES: To compare patient management and outcome during the first and second waves of the coronavirus 2019 pandemic. DESIGN: Single-center prospective cohort study. SETTING: Tertiary-care University ... [more ▼]

OBJECTIVES: To compare patient management and outcome during the first and second waves of the coronavirus 2019 pandemic. DESIGN: Single-center prospective cohort study. SETTING: Tertiary-care University Hospital. PATIENTS: All adult patients admitted in either the first (from March 15 to May 15, 2020) or second (from October 1 to November 30, 2020) wave of coronavirus disease 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was 30-day mortality. During the second wave of the coronavirus disease 2019 pandemic, 33 patients (4.8%) were transferred due to overcrowding and excluded from analysis. There were 341 (first wave of the coronavirus disease 2019 pandemic) and 695 (second wave of the coronavirus disease 2019 pandemic) coronavirus disease 2019 patients admitted to the hospital, with median age first wave of the coronavirus disease 2019 pandemic as 68 (57-80) and second wave of the coronavirus disease 2019 pandemic as 71 (60-80) (p = 0.15), and similar admission severity. For the first wave of the coronavirus disease 2019 pandemic versus second wave of the coronavirus disease 2019 pandemic, 30-day mortality was 74/341 (22%) and 98/662 (15%) (p = 0.007). In the ward, 11/341 (3.2%) and 404/662 (61%) received dexamethasone (p < 0.001); 6/341 (2%) and 79/662 (12%) received high-flow nasal oxygen (p < 0.0001); 2/341 (0.6%) and 88/662 (13.3%) received remdesivir (p < 0.0001); 249/341 (73%) and 0/662 (0%) received hydroxychloroquine (p < 0.0001); and 87/341 (26%) and 128/662 (19%) (p = 0.024) patients were transferred to ICU. On ICU admission, median Sequential Organ Failure Assessment was 6 (3-7) and 4 (3-6) (p = 0.02). High-flow nasal oxygen was given to 16/87 (18%) and 102/128 (80%) (p < 0.001); 69/87 (79%) and 56/128 (44%) received mechanical ventilation (p < 0.001) with durations 17 days (10-26 d) and 10 days (5-17 d) (p = 0.01). Median ICU length of stay was 14 days (5-27 d) and 6 days (3-11 d) (p < 0.001). Finally, 16/87 (18%) and 8/128 (6%) received renal replacement therapy (p = 0.0055); and 64/87 (74%) and 51/128 (40%) needed vasopressor support (p < 0.001). CONCLUSIONS: The main therapeutic changes between the first wave of the coronavirus disease 2019 pandemic and the second wave of the coronavirus disease 2019 pandemic were use of steroids, unrestrictive use of high-flow nasal oxygen for hypoxemic patients, and transfer of patients to other geographic areas in the case of ICU overcrowding. These changes were associated with a decrease in 30-day mortality, ICU admission, and organ support. [less ▲]

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See detailPost‐intensive care syndrome after critical COVID‐19 pneumonia.
Bougard, Laurine ULiege; MINGUET, Pauline ULiege; COLSON, Camille ULiege et al

in Intensive Care Medicine Experimental (2021), 9(1),

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See detailNovel method of transpulmonary pressure measurement with an air‑flled esophageal catheter
MASSION, Paul ULiege; Berg, Julien ULiege; SAMALEA SUAREZ, Nicolas ULiege et al

in Intensive Care Medicine Experimental (2021)

Background: There is a strong rationale for proposing transpulmonary pressureguided protective ventilation in acute respiratory distress syndrome. The reference esophageal balloon catheter method requires ... [more ▼]

Background: There is a strong rationale for proposing transpulmonary pressureguided protective ventilation in acute respiratory distress syndrome. The reference esophageal balloon catheter method requires complex in vivo calibration, expertise and specifc material order. A simple, inexpensive, accurate and reproducible method of measuring esophageal pressure would greatly facilitate the measure of transpulmonary pressure to individualize protective ventilation in the intensive care unit. Results: We propose an air-flled esophageal catheter method without balloon, using a disposable catheter that allows reproducible esophageal pressure measurements. We use a 49-cm-long 10 Fr thin suction catheter, positioned in the lower-third of the esophagus and connected to an air-flled disposable blood pressure transducer bound to the monitor and pressurized by an air-flled infusion bag. Only simple calibration by zeroing the transducer to atmospheric pressure and unit conversion from mmHg to cmH2O are required. We compared our method with the reference balloon catheter both ex vivo, using pressure chambers, and in vivo, in 15 consecutive mechanically ventilated patients. Esophageal-to-airway pressure change ratios during the dynamic occlusion test were close to one (1.03±0.19 and 1.00±0.16 in the controlled and assisted modes, respectively), validating the proper esophageal positioning. The Bland– Altman analysis revealed no bias of our method compared with the reference and good precision for inspiratory, expiratory and delta esophageal pressure measurements in both the controlled (largest bias −0.5 cmH2O [95% confdence interval: −0.9; −0.1] cmH2O; largest limits of agreement −3.5 to 2.5 cmH2O) and assisted modes (largest bias −0.3 [−2.6; 2.0] cmH2O). We observed a good repeatability (intra-observer, intraclass correlation coefcient, ICC: 0.89 [0.79; 0.96]) and reproducibility (inter-observer ICC: 0.89 [0.76; 0.96]) of esophageal measurements. The direct comparison with pleural pressure in two patients and spectral analysis by Fourier transform confrmed the reliability of the air-flled catheter-derived esophageal pressure as an accurate surrogate of pleural pressure. A calculator for transpulmonary pressures is available online. Conclusions: We propose a simple, minimally invasive, inexpensive and reproducible method for esophageal pressure monitoring with an air-flled esophageal catheter without balloon. It holds the promise of widespread bedside use of transpulmonary pressure-guided protective ventilation in ICU patients. [less ▲]

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See detailMapping the human genetic architecture of COVID-19 by worldwide meta-analysis
The COVID-19 Host Genetics Initiative; Gazon, Hélène; JUSZCZAK, Danusia ULiege et al

in Nature (2021)

The genetic makeup of an individual contributes to susceptibility and response to viral infection. While environmental, clinical and social factors play a role in exposure to SARS-CoV-2 and COVID-19 ... [more ▼]

The genetic makeup of an individual contributes to susceptibility and response to viral infection. While environmental, clinical and social factors play a role in exposure to SARS-CoV-2 and COVID-19 disease severity, host genetics may also be important. Identifying host-specific genetic factors indicate biological mechanisms of therapeutic relevance and clarify causal relationships of modifiable environmental risk factors for SARS-CoV-2 infection and outcomes. We formed a global network of researchers to investigate the role of human genetics in SARS-COV-2 infection and COVID-19 severity. We describe the results of three genome-wide association meta-analyses comprising 49,562 COVID-19 patients from 46 studies across 19 countries worldwide. We reported 15 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases. They also represent potentially actionable mechanisms in response to infection. We further identified smoking and body mass index as causal risk factors for severe COVID-19. The identification of novel host genetic factors associated with COVID-19, with unprecedented speed, was enabled by prioritization of shared resources and analytical frameworks. This working model of international collaboration a blue-print for future genetic discoveries in the event of pandemics or for any complex human disease. [less ▲]

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See detailIn-Parallel Ventilator Sharing during an Acute Shortage: Too Much Risk for a Wider Uptake
Chase, J Geoffrey ULiege; Chiew, Yeong Shiong ULiege; LAMBERMONT, Bernard ULiege et al

in American Journal of Respiratory and Critical Care Medicine (2020)

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See detailTranslating A Risk-Based Glycaemic Control Framework for Critically Ill Patients: STAR-Liège
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

in IFAC-PapersOnLine (2020, July)

Glycaemic control (GC) in the intensive care unit (ICU) has been widely debated over the last 20 years. While many studies showed benefits, many others failed to replicate the results, blaming the ... [more ▼]

Glycaemic control (GC) in the intensive care unit (ICU) has been widely debated over the last 20 years. While many studies showed benefits, many others failed to replicate the results, blaming the increased related risk of hypoglycaemia. Current ICU guidelines thus often suggest higher glycaemic target ranges, led by the fear of hypoglycaemia – permissive hyperglycaemia. However, recent studies have shown improved safety and performance in GC outcome, using model-based computerised methods. The Stochastic-Targeted (STAR) framework is a patient-specific risk-based dosing protocol modulating insulin and nutrition. This study presents recent intermediate results of the STAR-Liège clinical trial, targeting 4.4-8.0 mmol/L glycaemic band. Clinical data from patients controlled under STAR and STAR insulin only (STAR-IO) are compared to retrospective data under the standard protocol (SP), targeting higher 5.6-8.3 mmol/L glycaemic ranges. Overall, STAR performance was significantly higher (88% blood glucose measurements in the 4.4-8.0 mmol/L or 80-145 mg/dL target band) compared to STAR-IO (78%) and SP (55%). Incidence of hypoglycaemia was similar (1% below target), while hyperglycaemia was much higher for SP (31% above target) compared to STAR (9%) and STAR-IO (11%). The resulting lower median blood glucose (BG) levels in STAR (6.5 mmol/L), compared to STAR-IO (6.7 mmol/L) and SP (7.7 mmol/L), was achieved with less variability, but required higher clinical workload for STAR (12 measurements per day) compared to SP (7 measurements per day). Compliance to protocol was higher for STAR (98%) compared to STAR-IO (90%) and SP (79%). Although targeting lower glycaemic ranges, STAR provided better GC compared to the SP. Typically, the full version of STAR also modulating nutrition, was able to better control extremely insulin resistant patients, further improving glycaemic control results. The results of this clinical trial indicate the capability to provide the safe, effective control for all patients required to improve outcomes. [less ▲]

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See detailModel-Based Weaning Tests for VA-ECLS Therapy
Habran, Simon; Desaive, Thomas ULiege; MORIMONT, Philippe ULiege et al

in Computational and Mathematical Methods in Medicine (2020), 2020

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See detailStochastic TARgeted (STAR) glycaemic control: improved performances and safety for all
Uyttendaele, Vincent ULiege; Knopp, Jennifer L.; PIROTTE, Marc ULiege et al

Poster (2020, January 07)

Rationale: Whether more intensive glycemic control (GC) is beneficial or harmful for critically ill patient has been debated over the last decades. GC has been shown hard to achieve safely and effectively ... [more ▼]

Rationale: Whether more intensive glycemic control (GC) is beneficial or harmful for critically ill patient has been debated over the last decades. GC has been shown hard to achieve safely and effectively in intensive care. The associated increased hypoglycemia and glycemic variability is associated with worsened outcomes. However, model-based risk-based dosing approach have recently shown potential benefits, improving significantly GC safety and performances. Objective: The Stochastic TARgeted (STAR) GC framework is a model-based controller using a unique risk-based dosing approach. STAR identifies model-based patient-specific insulin sensitivity and assesses its potential variability over the next hours. These predictions are used to assess hypoglycemic risks associated with a specific insulin and/or nutrition intervention to reach a specific target band. This study analyzes preliminary clinical trial results of STAR in a Belgian ICU compared to the local standard protocol (SP). Patients and Methods: Ethics approval was granted by the local University Hospital Ethics Committee. Patient are included if two BG measurements > 145 mg/dL. STAR target band is 80-145 mg/dL compared to 100-150mg/dL for the SP. Nutrition is administered enterally, and insulin infusion intra-venously. GC is stopped if BG is stable (6 hours in target band) or after 72 hours of control. Safety is assessed by %BG <80mg/dL and %BG >180 mg/dL. Performance is assessed by %BG in target band. Clinical data from 10 patients is used and compared to 20 retrospective patients under the SP. Results: STAR outperformed the SP. Results summary is presented in Table 1. Despite the lower BG target, STAR safety was improved with lower %BG<80mg/dL (0.5% vs. 1%), and significantly lower %BG>145 mg/dL (11% vs. 44%) and %BG>180mg/dL (2% vs 13%). STAR was highly effective with 89% BG in target band compared to 54% for the SP. Median [IQR] BG and nutrition rates achieved were lower for STAR (118 [109 129] vs. 139 [117 160] mg/dL and 7.0 [4.7 8.2] vs. 9.8 [8.6 11.5] g/h), while higher insulin rates were administered in STAR (3.0 [2.0 4.0] vs. 2.5 [2.0 3.0] U/h). However, workload was increased under STAR (12 vs. 7 measurements per day), as expected from measurement interval difference between STAR (3-hourly) and the SP (4-hourly). Conclusion: This unique patient-specific risk-based dosing approach GC framework was successful in controlling all patients safely and effectively. These preliminary results are encouraging and show GC can be achieved safely and effectively at lower target bands. In turns, these improved GC outcomes could improve patient outcomes. [less ▲]

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See detailPredictors of Mortality and Effect of Drug Therapies in Mechanically Ventilated Patients With Coronavirus Disease 2019: A Multicenter Cohort Study
Lambermont, Bernard ULiege; Ernst, Marie ULiege; Demaret, Pierre et al

in Critical Care Explorations (2020), 2(12), 0305

We conducted a multicenter cohort study to determine the effect of drug therapies on survival in mechanically ventilated patients with coronavirus disease 2019. All consecutive adult patients admitted to ... [more ▼]

We conducted a multicenter cohort study to determine the effect of drug therapies on survival in mechanically ventilated patients with coronavirus disease 2019. All consecutive adult patients admitted to ICU for coronavirus disease 2019 from March 1, 2020, to April 25, 2020, and under invasive mechanical ventilation for more than 24 hours were included. Out of 2,003 patients hospitalized for coronavirus disease 2019, 361 were admitted to ICU, 257 were ventilated for more than 24 hours, and 247 were included in the study. Simple and multiple time-dependent Cox regression models were used to assess the effects of factors on survival. Methylprednisolone administration during the first week of mechanical ventilation was associated with a decrease in mortality rate from 48% to 34% (p = 0.01). Mortality was significantly associated with older age, higher creatinine, lower lymphocyte count, and mean arterial pressure lower than 70 mm Hg on the day of admission. [less ▲]

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See detailSingle-center experience of patients with interstitial lung diseases during the early days of te COVID-19 pandemic.
GUIOT, Julien ULiege; HENKET, Monique ULiege; Frix, Anne-Noëlle ULiege et al

in Respiratory Investigation (2020), 58(6), 437-9

Introduction: Patients with interstitial lung diseases (ILD) can be suspected to be at risk of experiencing a rapid flare-up due to COVID-19. However, no specific data are currently available for these ... [more ▼]

Introduction: Patients with interstitial lung diseases (ILD) can be suspected to be at risk of experiencing a rapid flare-up due to COVID-19. However, no specific data are currently available for these patients. <br /> <br />Methods: We retrospectively analyzed a cohort of 401 patients with ILD and determined the proportion of patients hospitalized for proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and specific symptoms of COVID-19. <br /> <br />Results: We found that 1% of patients (n = 4) were hospitalized (1 in ICU) for COVID-19. In total, 310 of the 401 patients answered the phone call. Only 33 patients (0.08%) experienced specific symptoms of SARS-CoV-2 infection. <br /> <br />Conclusion: Our study did not demonstrate any increased occurrence of severe COVID-19 in ILD patients compared to the global population. Based on our findings, we could not make any conclusion on the incidence rate of SARS-CoV-2 infection in patients with ILDs, or on the overall outcome of immunocompromised patients affected by COVID-19. [less ▲]

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See detailCan noble metal coating reduce the incidence of ventilator associated pneumoniae (VAP): a multicenter double blind randomized pilot study
KISOKA, Grâce ULiege; PIRET, Sonia ULiege; LEGRAIN, Caroline et al

in Intensive Care Medicine Experimental (2020)

This is the first report of a randomized double blind study with Bactiguard tubes which will allow to define the number of patients for a confirmatory larger study.

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