A multifaceted educational intervention improved anti-infectious measures but had no effect on mortality in patients with severe sepsis
Scientific Reports, vol. 12, pp. 3925
Abstract
Sepsis is a major reason for preventable hospital deaths. A cluster-randomized controlled trial on an educational intervention did not show improvements of sepsis management or outcome. We now aimed to test an improved implementation strategy in a second intervention phase in which new intervention hospitals (former controls) received a multifaceted educational intervention, while controls (former intervention hospitals) only received feedback of quality indicators. Changes in outcomes from the first to the second intervention phase were compared between groups using hierarchical generalized linear models controlling for possible confounders. During the two phases, 19 control hospitals included 4050 patients with sepsis and 21 intervention hospitals included 2526 patients. 28-day mortality did not show significant changes between study phases in both groups. The proportion of patients receiving antimicrobial therapy within one hour increased in intervention hospitals, but not in control hospitals. Taking at least two sets of blood cultures increased significantly in both groups. During phase 2, intervention hospitals showed higher proportion of adequate initial antimicrobial therapy and de-escalation within 5 days. A survey among involved clinicians indicated lacking resources for quality improvement. Therefore, quality improvement programs should include all elements of sepsis guidelines and provide hospitals with sufficient resources for quality improvement.Trial registration: ClinicalTrials.gov, NCT01187134. Registered 23 August 2010, https://www.clinicaltrials.gov/ct2/show/study/NCT01187134 .
Authors 89
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Daniel Schwarzkopf corresponding
Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. Daniel.Schwarzkopf@med.uni-jena.de
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. Daniel.Schwarzkopf@med.uni-jena.de
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany. Daniel.Schwarzkopf@med.uni-jena.de
Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Affiliation as printed
Department for Infectious Diseases, Protestant Hospital of Bethel Foundation University Hospital, University of Bielefeld, Bethesdaweg 10, 33617, Bielefeld, Germany
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Affiliation as printed
Department for Anaesthesia, Intensive Care Medicine and Pain Management, Vivantes-Klinikum Neukoelln, Rudower Strasse 48, 12351, Berlin, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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University Hospital Leipzig · Leipzig University
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Liebigstraße 20, 04103, Leipzig, Germany
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Universität Ulm · University Hospital Ulm
Affiliation as printed
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Berlin Institute of Health, Campus Virchow-Klinikum, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Jena University Hospital · Center for Sepsis Control and Care
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
Integrated Research and Treatment Center-Center for Sepsis Control and Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
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Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
Department of Anesthesiology and Intensive Care Medicine, Ilm‑Kreis‑Kliniken Arnstadt, Arnstadt, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Ilm‑Kreis‑Kliniken Arnstadt, Arnstadt, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Ilm‑Kreis‑Kliniken Arnstadt, Arnstadt, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Ilm‑Kreis‑Kliniken Arnstadt, Arnstadt, Germany
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Zentralklinik Bad Berka · Helios Klinikum Aue
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Helios Hospital Aue, Aue, Germany
Department of Anaesthesia and Intensive Care Medicine, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
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Zentralklinik Bad Berka · Universitätsklinikum Aachen · RWTH Aachen University
Affiliation as printed
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
Department of Anaesthesia and Intensive Care Medicine, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
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Affiliation as printed
Department of Anaesthesia and Intensive Care Medicine, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
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Humboldt-Universität zu Berlin · Zentralklinik Bad Berka · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anaesthesia and Intensive Care Medicine, Zentralklinik Bad Berka GmbH, Bad Berka, Germany
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
Department of Anesthesiology and Intensive Care Medicine, Hufeland‑Klinikum, Bad Langensalza, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Hufeland‑Klinikum, Bad Langensalza, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Hufeland‑Klinikum, Bad Langensalza, Germany
Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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Vivantes Klinikum · Bundeswehr
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
Department for Anaesthesia, Intensive Care Medicine and Pain Management, Vivantes-Klinikum Neukoelln, Rudower Strasse 48, 12351, Berlin, Germany
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Vivantes Klinikum · Helios Hospital Berlin-Buch
Affiliation as printed
Department for Anaesthesia, Intensive Care Medicine and Pain Management, Vivantes-Klinikum Neukoelln, Rudower Strasse 48, 12351, Berlin, Germany
Department of Intensive Care Medicine, Helios Hospital Berlin‑Buch, Berlin, Germany
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Affiliation as printed
Department of Intensive Care Medicine, Helios Hospital Berlin‑Buch, Berlin, Germany
Department of Anesthesiology, Emergency and Intensive Care Medicine, and Pain Therapy, Protestant Hospital of Bethel Foundation University Hospital, Bielefeld, Germany
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Affiliation as printed
Department of Anesthesiology, Emergency and Intensive Care Medicine, and Pain Therapy, Protestant Hospital of Bethel Foundation University Hospital, Bielefeld, Germany
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Affiliation as printed
Department of Anesthesiology, Emergency and Intensive Care Medicine, and Pain Therapy, Protestant Hospital of Bethel Foundation University Hospital, Bielefeld, Germany
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Affiliation as printed
Department of Anesthesiology, Emergency and Intensive Care Medicine, and Pain Therapy, Protestant Hospital of Bethel Foundation University Hospital, Bielefeld, Germany
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Affiliation as printed
Department of Anesthesiology, Emergency and Intensive Care Medicine, and Pain Therapy, Protestant Hospital of Bethel Foundation University Hospital, Bielefeld, Germany
Department of Anesthesiology, Helios‑Hospital St. Josefs‑Hospital Bochum‑Linden, Bochum, Germany
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Affiliation as printed
Department of Anesthesiology, Helios‑Hospital St. Josefs‑Hospital Bochum‑Linden, Bochum, Germany
Department of Anesthesiology and Intensive Care Medicine, St. Georg Hospital Eisenach, Eisenach, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, St. Georg Hospital Eisenach, Eisenach, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, St. Georg Hospital Eisenach, Eisenach, Germany
Department of Anesthesiology and Intensive Care Medicine, Hospital Rudolf Elle, Eisenberg, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Hospital Rudolf Elle, Eisenberg, Germany
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Waldkrankenhaus Rudolf Elle · Helios Klinikum Emil von Behring
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Hospital Rudolf Elle, Eisenberg, Germany
Department of Interdisciplinary Intensive Care and Emergency Medicine, Helios‑Hospital Emil‑von Behring, Berlin, Germany
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Helios Klinikum Emil von Behring
Affiliation as printed
Department of Interdisciplinary Intensive Care and Emergency Medicine, Helios‑Hospital Emil‑von Behring, Berlin, Germany
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Helios Klinikum Emil von Behring · Helios Klinikum Erfurt
Affiliation as printed
Department of Interdisciplinary Intensive Care and Emergency Medicine, Helios‑Hospital Emil‑von Behring, Berlin, Germany
Department of Anesthesiology and Intensive Care Medicine, Helios‑Hospital Erfurt, Erfurt, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Helios‑Hospital Erfurt, Erfurt, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Helios‑Hospital Erfurt, Erfurt, Germany
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Katholisches Krankenhaus St. Johann Nepomuk
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
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Katholisches Krankenhaus St. Johann Nepomuk
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
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Katholisches Krankenhaus St. Johann Nepomuk
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Catholic Hospital St. Johann Nepomuk, Erfurt, Germany
Department of Internal Medicine, Hospital Friedberg, Friedberg, Germany
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Affiliation as printed
Department of Internal Medicine, Hospital Friedberg, Friedberg, Germany
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Affiliation as printed
Department of Internal Medicine, Hospital Friedberg, Friedberg, Germany
Department of Anesthesiology and Intensive Care Medicine, SRH Waldklinikum Gera, Gera, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, SRH Waldklinikum Gera, Gera, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, SRH Waldklinikum Gera, Gera, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, SRH Waldklinikum Gera, Gera, Germany
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Universitätsmedizin Greifswald · Universität Greifswald · SRH Wald-Klinikum Gera
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, SRH Waldklinikum Gera, Gera, Germany
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Department of Anaesthesiology, University Hospital of Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
Department of Anesthesiology and Intensive Care Medicine, Hospital Ilmenau, Ilmenau, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Hospital Ilmenau, Ilmenau, Germany
Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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University Hospital Schleswig-Holstein
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
Department of Anesthesiology and Surgical Intensive Care Medicine, Hospital Landshut‑Achdorf, Landshut, Germany
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Affiliation as printed
Department of Anesthesiology and Surgical Intensive Care Medicine, Hospital Landshut‑Achdorf, Landshut, Germany
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University Hospital Leipzig · Leipzig University
Affiliation as printed
Department of Anesthesiology and Surgical Intensive Care Medicine, Hospital Landshut‑Achdorf, Landshut, Germany
Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Liebigstraße 20, 04103, Leipzig, Germany
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University Hospital Leipzig · Leipzig University
Affiliation as printed
Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig Medical Centre, Liebigstraße 20, 04103, Leipzig, Germany
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Affiliation as printed
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Affiliation as printed
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Affiliation as printed
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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Affiliation as printed
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
Department of Intensive Care and Emergency Medicine, Hospital Meiningen, Meiningen, Germany
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Affiliation as printed
Department of Intensive Care and Emergency Medicine, Hospital Meiningen, Meiningen, Germany
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Affiliation as printed
Department of Intensive Care and Emergency Medicine, Hospital Meiningen, Meiningen, Germany
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Affiliation as printed
Department of Intensive Care and Emergency Medicine, Hospital Meiningen, Meiningen, Germany
Department of Anesthesiology and Intensive Care Medicine, Saale‑Unstrut‑Hospital Naumburg, Naumburg, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Saale‑Unstrut‑Hospital Naumburg, Naumburg, Germany
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Hospital Oldenburg, Oldenburg, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Hospital Oldenburg, Oldenburg, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Hospital Oldenburg, Oldenburg, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Hospital Oldenburg, Oldenburg, Germany
Department of Anesthesiology and Intensive Care Medicine, Thüringen‑Klinik Pößneck, Pößneck, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Thüringen‑Klinik Pößneck, Pößneck, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Thüringen‑Klinik Pößneck, Pößneck, Germany
Department of Intensive Care and Emergency Medicine, Asklepios Hospital Radeberg, Radeberg, Germany
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Affiliation as printed
Department of Intensive Care and Emergency Medicine, Asklepios Hospital Radeberg, Radeberg, Germany
Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Thüringen‑Kliniken Saalfeld, Saalfeld, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Thüringen‑Kliniken Saalfeld, Saalfeld, Germany
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Diakonie Klinikum Jung-Stilling
Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Thüringen‑Kliniken Saalfeld, Saalfeld, Germany
Department of Anesthesiology, Intensive Care, and Emergency Medicine, Ev. Jung‑Stilling Hospital, Siegen, Germany
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Diakonie Klinikum Jung-Stilling
Affiliation as printed
Department of Anesthesiology, Intensive Care, and Emergency Medicine, Ev. Jung‑Stilling Hospital, Siegen, Germany
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Diakonie Klinikum Jung-Stilling · Universitätsklinikum Tübingen
Affiliation as printed
Department of Anesthesiology, Intensive Care, and Emergency Medicine, Ev. Jung‑Stilling Hospital, Siegen, Germany
Department of Anesthesiology, University Hospital Tübingen, Tübingen, Germany
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Affiliation as printed
Department of Anesthesiology, University Hospital Tübingen, Tübingen, Germany
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