PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome.
Identifieur interne : 000142 ( Main/Exploration ); précédent : 000141; suivant : 000143PaO2/FiO2 Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome.
Auteurs : Roberto Roncon-Albuquerque [Portugal] ; João Ferreira-Coimbra [Portugal] ; Rodrigo Vilares-Morgado [Portugal] ; Paulo Figueiredo [Portugal] ; José Artur Paiva [Portugal]Source :
- The Annals of thoracic surgery [ 1552-6259 ] ; 2016.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Durée du séjour (MeSH), Femelle (MeSH), Gazométrie sanguine (MeSH), Humains (MeSH), Modèles logistiques (MeSH), Mortalité hospitalière (MeSH), Mâle (MeSH), Mécanique respiratoire (physiologie), Oxygénation extracorporelle sur oxygénateur à membrane (MeSH), Récupération fonctionnelle (physiologie), Résultat thérapeutique (MeSH), Soins de réanimation (MeSH), Syndrome de détresse respiratoire de l'adulte (mortalité), Syndrome de détresse respiratoire de l'adulte (sang), Syndrome de détresse respiratoire de l'adulte (thérapie), Ventilation artificielle (MeSH).
- MESH :
- mortalité : Syndrome de détresse respiratoire de l'adulte.
- physiologie : Mécanique respiratoire, Récupération fonctionnelle.
- sang : Syndrome de détresse respiratoire de l'adulte.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- Adulte, Adulte d'âge moyen, Durée du séjour, Femelle, Gazométrie sanguine, Humains, Modèles logistiques, Mortalité hospitalière, Mâle, Oxygénation extracorporelle sur oxygénateur à membrane, Résultat thérapeutique, Soins de réanimation, Ventilation artificielle.
English descriptors
- KwdEn :
- Adult (MeSH), Blood Gas Analysis (MeSH), Critical Care (MeSH), Extracorporeal Membrane Oxygenation (MeSH), Female (MeSH), Hospital Mortality (MeSH), Humans (MeSH), Length of Stay (MeSH), Logistic Models (MeSH), Male (MeSH), Middle Aged (MeSH), Recovery of Function (physiology), Respiration, Artificial (MeSH), Respiratory Distress Syndrome, Adult (blood), Respiratory Distress Syndrome, Adult (mortality), Respiratory Distress Syndrome, Adult (therapy), Respiratory Mechanics (physiology), Treatment Outcome (MeSH).
- MESH :
- blood : Respiratory Distress Syndrome, Adult.
- mortality : Respiratory Distress Syndrome, Adult.
- physiology : Recovery of Function, Respiratory Mechanics.
- therapy : Respiratory Distress Syndrome, Adult.
- Adult, Blood Gas Analysis, Critical Care, Extracorporeal Membrane Oxygenation, Female, Hospital Mortality, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Respiration, Artificial, Treatment Outcome.
Abstract
BACKGROUND
During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO
METHODS
This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome.
RESULTS
In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score.
CONCLUSIONS
In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management.
DOI: 10.1016/j.athoracsur.2016.06.026
PubMed: 27592605
Affiliations:
Links toward previous steps (curation, corpus...)
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João, Porto, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: rra_jr@yahoo.com.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Ferreira Coimbra, Joao" sort="Ferreira Coimbra, Joao" uniqKey="Ferreira Coimbra J" first="João" last="Ferreira-Coimbra">João Ferreira-Coimbra</name><affiliation wicri:level="1"><nlm:affiliation>Department of Internal Medicine, Centro Hospitalar S. João, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Internal Medicine, Centro Hospitalar S. João, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Vilares Morgado, Rodrigo" sort="Vilares Morgado, Rodrigo" uniqKey="Vilares Morgado R" first="Rodrigo" last="Vilares-Morgado">Rodrigo Vilares-Morgado</name><affiliation wicri:level="1"><nlm:affiliation>Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Figueiredo, Paulo" sort="Figueiredo, Paulo" uniqKey="Figueiredo P" first="Paulo" last="Figueiredo">Paulo Figueiredo</name><affiliation wicri:level="1"><nlm:affiliation>Department of Infectious Diseases, Centro Hospitalar S. João, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Infectious Diseases, Centro Hospitalar S. João, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Paiva, Jose Artur" sort="Paiva, Jose Artur" uniqKey="Paiva J" first="José Artur" last="Paiva">José Artur Paiva</name><affiliation wicri:level="1"><nlm:affiliation>Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author></analytic><series><title level="j">The Annals of thoracic surgery</title><idno type="eISSN">1552-6259</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Blood Gas Analysis (MeSH)</term><term>Critical Care (MeSH)</term><term>Extracorporeal Membrane Oxygenation (MeSH)</term><term>Female (MeSH)</term><term>Hospital Mortality (MeSH)</term><term>Humans (MeSH)</term><term>Length of Stay (MeSH)</term><term>Logistic Models (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Recovery of Function (physiology)</term><term>Respiration, Artificial (MeSH)</term><term>Respiratory Distress Syndrome, Adult (blood)</term><term>Respiratory Distress Syndrome, Adult (mortality)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term><term>Respiratory Mechanics (physiology)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Durée du séjour (MeSH)</term><term>Femelle (MeSH)</term><term>Gazométrie sanguine (MeSH)</term><term>Humains (MeSH)</term><term>Modèles logistiques (MeSH)</term><term>Mortalité hospitalière (MeSH)</term><term>Mâle (MeSH)</term><term>Mécanique respiratoire (physiologie)</term><term>Oxygénation extracorporelle sur oxygénateur à membrane (MeSH)</term><term>Récupération fonctionnelle (physiologie)</term><term>Résultat thérapeutique (MeSH)</term><term>Soins de réanimation (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (mortalité)</term><term>Syndrome de détresse respiratoire de l'adulte (sang)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Ventilation artificielle (MeSH)</term></keywords><keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="physiologie" xml:lang="fr"><term>Mécanique respiratoire</term><term>Récupération fonctionnelle</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Recovery of Function</term><term>Respiratory Mechanics</term></keywords><keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Blood Gas Analysis</term><term>Critical Care</term><term>Extracorporeal Membrane Oxygenation</term><term>Female</term><term>Hospital Mortality</term><term>Humans</term><term>Length of Stay</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Respiration, Artificial</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Durée du séjour</term><term>Femelle</term><term>Gazométrie sanguine</term><term>Humains</term><term>Modèles logistiques</term><term>Mortalité hospitalière</term><term>Mâle</term><term>Oxygénation extracorporelle sur oxygénateur à membrane</term><term>Résultat thérapeutique</term><term>Soins de réanimation</term><term>Ventilation artificielle</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27592605</PMID><DateCompleted><Year>2017</Year><Month>04</Month><Day>10</Day></DateCompleted><DateRevised><Year>2017</Year><Month>08</Month><Day>17</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1552-6259</ISSN><JournalIssue CitedMedium="Internet"><Volume>102</Volume><Issue>6</Issue><PubDate><Year>2016</Year><Month>Dec</Month></PubDate></JournalIssue><Title>The Annals of thoracic surgery</Title></Journal><ArticleTitle>PaO<sub>2</sub>/FiO<sub>2</sub> Deterioration During Stable Extracorporeal Membrane Oxygenation Associates With Protracted Recovery and Increased Mortality in Severe Acute Respiratory Distress Syndrome.</ArticleTitle><Pagination><MedlinePgn>1878-1885</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0003-4975(16)30733-0</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.athoracsur.2016.06.026</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">During extracorporeal membrane oxygenation (ECMO), arterial oxygen partial pressure to fractional inspired oxygen (PaO<sub>2</sub>/FiO<sub>2</sub>; PF ratio reflects native and artificial lung blood oxygenation). In this study we analyzed PF ratio during ECMO support and its association with clinical outcome.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">This was a single-center observational study of adult patients (n = 81) undergoing veno-venous ECMO support for severe acute respiratory distress syndrome.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In 37 patients (46%) PF ratio decreased from ECMO-day 1 to ECMO-day 7 (PF ratio deterioration [PF-d]; -37 ± 6.1 mm Hg), whereas in 44 patients PF ratio improved (PF-i; 65 ± 10.8 mm Hg). PF-d group required prolonged ECMO (median 21 days [interquartile range (IQR)]:14-35 days] versus 13 days [IQR: 10-20 days]) and invasive mechanical ventilation (median 33 days [IQR: 24-52 days] versus 26 days [IQR: 22-34 days]), longer intensive care unit (median 44 days [IQR: 32-74 days] versus 30 days [IQR: 25-47 days]), and hospital (median 66 days [IQR: 39-95 days] versus 36 days [IQR: 28-54 days]) lengths of stay, with higher hospital mortality rates (48.7% versus 22.7%). ECMO oxygenation did not explain PF ratio variation that remained stable in PF-d and decreased in PF-i (198 ± 12.7 mL/min versus 171 ± 8.8 mL/min). Pre-ECMO PF ratio, neuromuscular blockade, and prone position, as well as ventilatory variables did not differ between groups. The PF-d group was older (49 ± 2.1 years versus 41 ± 1.8 years) and presented lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores (0.57 ± 0.63 versus 2.2 ± 0.52). With the use of logistic regression, PF ratio variation remained an independent predictor of hospital mortality after adjusting for age or RESP score.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">In severe acute respiratory distress syndrome, PF ratio deterioration during stable ECMO associates with protracted recovery and increased mortality, not accounted for by patient baseline characteristics, acute respiratory distress syndrome severity, or pre-ECMO management.</AbstractText><CopyrightInformation>Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Roncon-Albuquerque</LastName><ForeName>Roberto</ForeName><Initials>R</Initials><Suffix>Jr</Suffix><AffiliationInfo><Affiliation>Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: rra_jr@yahoo.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ferreira-Coimbra</LastName><ForeName>João</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, Centro Hospitalar S. João, Porto, Portugal.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vilares-Morgado</LastName><ForeName>Rodrigo</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Figueiredo</LastName><ForeName>Paulo</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Infectious Diseases, Centro Hospitalar S. João, Porto, Portugal.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Paiva</LastName><ForeName>José Artur</ForeName><Initials>JA</Initials><AffiliationInfo><Affiliation>Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>09</Month><Day>01</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Ann Thorac Surg</MedlineTA><NlmUniqueID>15030100R</NlmUniqueID><ISSNLinking>0003-4975</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001784" MajorTopicYN="N">Blood Gas Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003422" MajorTopicYN="N">Critical Care</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015199" MajorTopicYN="Y">Extracorporeal Membrane Oxygenation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017052" MajorTopicYN="N">Hospital Mortality</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016015" MajorTopicYN="N">Logistic Models</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D020127" MajorTopicYN="N">Recovery of Function</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="Y">blood</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015656" MajorTopicYN="N">Respiratory Mechanics</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2016</Year><Month>02</Month><Day>19</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2016</Year><Month>05</Month><Day>05</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2016</Year><Month>06</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>9</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>4</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>9</Month><Day>6</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27592605</ArticleId><ArticleId IdType="pii">S0003-4975(16)30733-0</ArticleId><ArticleId IdType="doi">10.1016/j.athoracsur.2016.06.026</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Portugal</li></country></list><tree><country name="Portugal"><noRegion><name sortKey="Roncon Albuquerque, Roberto" sort="Roncon Albuquerque, Roberto" uniqKey="Roncon Albuquerque R" first="Roberto" last="Roncon-Albuquerque">Roberto Roncon-Albuquerque</name></noRegion><name sortKey="Ferreira Coimbra, Joao" sort="Ferreira Coimbra, Joao" uniqKey="Ferreira Coimbra J" first="João" last="Ferreira-Coimbra">João Ferreira-Coimbra</name><name sortKey="Figueiredo, Paulo" sort="Figueiredo, Paulo" uniqKey="Figueiredo P" first="Paulo" last="Figueiredo">Paulo Figueiredo</name><name sortKey="Paiva, Jose Artur" sort="Paiva, Jose Artur" uniqKey="Paiva J" first="José Artur" last="Paiva">José Artur Paiva</name><name sortKey="Vilares Morgado, Rodrigo" sort="Vilares Morgado, Rodrigo" uniqKey="Vilares Morgado R" first="Rodrigo" last="Vilares-Morgado">Rodrigo Vilares-Morgado</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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