Skip to main content
SpringerLink
Log in

Assessment of volume status and fluid responsiveness in the emergency department: a systematic approach

Die Bestimmung des Volumenstatus und der Volumenreagibilität in der Notaufnahme – ein systematischer Ansatz

  • Übersichten
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Abstract

When treating acutely ill patients in the emergency department (ED), the successful management of a variety of medical conditions, such as sepsis, acute kidney injury, and pancreatitis, is highly dependent on the correct assessment and optimization of a patient’s intravascular volume status. Therefore, it is crucial that the ED physician knows and uses available means to assess intravascular volume status to adequately guide fluid therapy. This review focuses on techniques for volume status assessment that are available in the ED including basic clinical and laboratory findings, apparatus-based tests such as sonography and chest x-ray, and functional tests to evaluate fluid responsiveness. Furthermore, we provide an outlook on promising innovative, noninvasive technologies that might be used for advanced hemodynamic monitoring in the ED.

Zusammenfassung

Bei der Behandlung akut kranker Patienten in der Notaufnahme hängt die erfolgreiche Behandlung einer Reihe von Erkrankungen (z. B. Sepsis, akutes Nierenversagen, Pankreatitis) in hohem Maße von der korrekten Einschätzung und Optimierung des intravaskulären Volumenstatus des Patienten ab. Daher ist es entscheidend für eine adäquate Steuerung der Volumentherapie, dass der Notfallmediziner die verschiedenen Methoden zur Abschätzung des intravaskulären Volumenstatus kennt und zur Anwendung bringt. Dieser Übersichtsartikel behandelt Methoden zur Abschätzung des Volumenstatus, die in der Notaufnahme verfügbar sind, wie grundlegende klinische und laborchemische Untersuchungen, Ultraschall- und Röntgendiagnostik und funktionelle Tests zur Beurteilung der Volumenreagibilität. Desweiteren wird ein Ausblick gegeben auf vielversprechende, innovative, nicht-invasive Technologien, die für ein erweitertes hämodynamisches Monitoring in der Notaufnahme verwendet werden könnten.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BUN:

blood urea nitrogen

CO:

cardiac output

CTR:

cardiothoracic ratio

CVP:

central venous pressure

CXR:

chest x-ray

Eadyn :

dynamic arterial elastance

EABV:

effective arterial blood volume

ED:

emergency department

FEUN :

fractional excretion of urea

IVC:

inferior vena cava

PAOP:

pulmonary artery occlusion pressure

PLR:

passive leg raising

ROC-AUC:

area under the receiver operating characteristic curve

VPW:

vascular pedicle width

References

  1. Angus DC, van der Poll T (2013) Severe sepsis and septic shock. N Engl J Med 369:840–851

    Article  CAS  PubMed  Google Scholar 

  2. Wu BU, Banks PA (2013) Clinical management of patients with acute pancreatitis. Gastroenterology 144:1272–1281

    Article  PubMed  Google Scholar 

  3. Nadeau-Fredette AC, Bouchard J (2013) Fluid management and use of diuretics in acute kidney injury. Adv Chronic Kidney Dis 20:45–55

    Article  PubMed  Google Scholar 

  4. Bhave G, Neilson EG (2011) Volume depletion versus dehydration: how understanding the difference can guide therapy. Am J Kidney Dis 58:302–309

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vincent JL, De Backer D (2014) Circulatory shock. N Engl J Med 370:583

    CAS  PubMed  Google Scholar 

  6. Vincent JL, Ince C, Bakker J (2012) Clinical review: circulatory shock—an update: a tribute to Professor Max Harry Weil. Crit Care 16:239

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gross CR, Lindquist RD, Woolley AC, Granieri R, Allard K, Webster B (1992) Clinical indicators of dehydration severity in elderly patients. J Emerg Med 10:267–274

    Article  CAS  PubMed  Google Scholar 

  8. Stephan F, Flahault A, Dieudonne N, Hollande J, Paillard F, Bonnet F (2001) Clinical evaluation of circulating blood volume in critically ill patients—contribution of a clinical scoring system. Br J Anaesth 86:754–762

    Article  CAS  PubMed  Google Scholar 

  9. Koziol-McLain J, Lowenstein SR, Fuller B (1991) Orthostatic vital signs in emergency department patients. Ann Emerg Med 20:606–610

    Article  CAS  PubMed  Google Scholar 

  10. McGee S, Abernethy WB III, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029

    Article  CAS  PubMed  Google Scholar 

  11. Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT (2005) Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 294:1944–1956

    Article  CAS  PubMed  Google Scholar 

  12. Badgett RG, Lucey CR, Mulrow CD (1997) Can the clinical examination diagnose left-sided heart failure in adults? JAMA 277:1712–1719

    Article  CAS  PubMed  Google Scholar 

  13. Killip T III, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  14. Saugel B, Ringmaier S, Holzapfel K, Schuster T, Phillip V, Schmid RM et al (2011) Physical examination, central venous pressure, and chest radiography for the prediction of transpulmonary thermodilution-derived hemodynamic parameters in critically ill patients: a prospective trial. J Crit Care 26:402–410

    Article  PubMed  Google Scholar 

  15. Chung HM, Kluge R, Schrier RW, Anderson RJ (1987) Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 83:905–908

    Article  CAS  PubMed  Google Scholar 

  16. Dossetor JB (1966) Creatininemia versus uremia. The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia. Ann Intern Med 65:1287–1299

    Article  CAS  PubMed  Google Scholar 

  17. Schrier RW (2007) Decreased effective blood volume in edematous disorders: what does this mean? J Am Soc Nephrol 18:2028–2031

    Article  PubMed  Google Scholar 

  18. Swedko PJ, Clark HD, Paramsothy K, Akbari A (2003) Serum creatinine is an inadequate screening test for renal failure in elderly patients. Arch Intern Med 163:356–360

    Article  CAS  PubMed  Google Scholar 

  19. Carvounis CP, Nisar S, Guro-Razuman S (2002) Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int 62:2223–2229

    Article  CAS  PubMed  Google Scholar 

  20. Pepin MN, Bouchard J, Legault L, Ethier J (2007) Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kidney Dis 50:566–573

    Article  PubMed  Google Scholar 

  21. Wo CC, Shoemaker WC, Appel PL, Bishop MH, Kram HB, Hardin E (1993) Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness. Crit Care Med 21:218–223

    Article  CAS  PubMed  Google Scholar 

  22. Kjelland CB, Djogovic D (2010) The role of serum lactate in the acute care setting. J Intensive Care Med 25:286–300

    Article  PubMed  Google Scholar 

  23. Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI (2007) Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med 33:1892–1899

    Article  PubMed  Google Scholar 

  24. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA et al (2004) Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med 32:1637–1642

    Article  PubMed  Google Scholar 

  25. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713 (quiz 86–8)

    Article  PubMed  Google Scholar 

  26. Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837

    Article  PubMed  Google Scholar 

  27. Weekes AJ, Tassone HM, Babcock A, Quirke DP, Norton HJ, Jayarama K et al (2011) Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med 18:912–921

    Article  PubMed  Google Scholar 

  28. Tetsuka T, Ando Y, Ono S, Asano Y (1995) Change in inferior vena caval diameter detected by ultrasonography during and after hemodialysis. ASAIO J 41:105–110

    CAS  PubMed  Google Scholar 

  29. Fields JM, Lee PA, Jenq KY, Mark DG, Panebianco NL, Dean AJ (2011) The interrater reliability of inferior vena cava ultrasound by bedside clinician sonographers in emergency department patients. Acad Emerg Med 18:98–101

    Article  PubMed  Google Scholar 

  30. Yanagawa Y, Nishi K, Sakamoto T, Okada Y (2005) Early diagnosis of hypovolemic shock by sonographic measurement of inferior vena cava in trauma patients. J Trauma 58:825–829

    Article  PubMed  Google Scholar 

  31. Yanagawa Y, Sakamoto T, Okada Y (2007) Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma 63:1245–1248 (discussion 8)

    Article  PubMed  Google Scholar 

  32. Sefidbakht S, Assadsangabi R, Abbasi HR, Nabavizadeh A (2007) Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients. Emerg Radiol 14:181–185

    Article  CAS  PubMed  Google Scholar 

  33. Corl K, Napoli AM, Gardiner F (2012) Bedside sonographic measurement of the inferior vena cava caval index is a poor predictor of fluid responsiveness in emergency department patients. Emerg Med Australas 24:534–539

    Article  PubMed  Google Scholar 

  34. Neskovic AN, Hagendorff A, Lancellotti P, Guarracino F, Varga A, Cosyns B et al (2013) Emergency echocardiography: the European Association of Cardiovascular Imaging recommendations. Eur Heart J Cardiovasc Imaging 14:1–11

    Article  PubMed  Google Scholar 

  35. Lancellotti P, Price S, Edvardsen T, Cosyns B, Neskovic AN, Dulgheru R et al (2015) The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care 4:3–5

    Article  PubMed  Google Scholar 

  36. Levitov A, Marik PE (2012) Echocardiographic assessment of preload responsiveness in critically ill patients. Cardiol Res Pract 2012:819696

    PubMed  Google Scholar 

  37. Ely EW, Haponik EF (2002) Using the chest radiograph to determine intravascular volume status: the role of vascular pedicle width. Chest 121:942–950

    Article  PubMed  Google Scholar 

  38. Halperin BD, Feeley TW, Mihm FG, Chiles C, Guthaner DF, Blank NE (1985) Evaluation of the portable chest roentgenogram for quantitating extravascular lung water in critically ill adults. Chest 88:649–652

    Article  CAS  PubMed  Google Scholar 

  39. Milne EN, Pistolesi M, Miniati M, Giuntini C (1984) The vascular pedicle of the heart and the vena azygos. Part I: the normal subject. Radiology 152:1–8

    Article  CAS  PubMed  Google Scholar 

  40. Ely EW, Smith AC, Chiles C, Aquino SL, Harle TS, Evans GW et al (2001) Radiologic determination of intravascular volume status using portable, digital chest radiography: a prospective investigation in 100 patients. Crit Care Med 29:1502–1512

    Article  CAS  PubMed  Google Scholar 

  41. Theodoro D, Owens PL, Olsen MA, Fraser V (2014) Rates and timing of central venous cannulation among patients with sepsis and respiratory arrest admitted by the emergency department. Crit Care Med 42:554–564

    Article  PubMed  PubMed Central  Google Scholar 

  42. Reade MC, Huang DT, Bell D, Coats TJ, Cross AM, Moran JL et al (2010) Variability in management of early severe sepsis. Emerg Med J 27:110–115

    Article  PubMed  Google Scholar 

  43. Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693

    Article  CAS  PubMed  Google Scholar 

  44. Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper DJ et al (2014) Goal-directed resuscitation for patients with early septic shock. N Engl J Med 371:1496–1506

    Article  CAS  PubMed  Google Scholar 

  45. Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL (2003) Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124:1900–1908

    Article  PubMed  Google Scholar 

  46. Marik PE, Baram M, Vahid B (2008) Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134:172–178

    Article  PubMed  Google Scholar 

  47. Marik PE, Cavallazzi R (2013) Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med 41:1774–1781

    Article  PubMed  Google Scholar 

  48. Cannesson M, Ramsingh D, Rinehart J, Demirjian A, Vu T, Vakharia S et al (2015) Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study. Crit Care 19:261

    Article  PubMed  PubMed Central  Google Scholar 

  49. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR et al (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407

    Article  PubMed  Google Scholar 

  50. Jabot J, Teboul JL, Richard C, Monnet X (2009) Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med 35:85–90

    Article  PubMed  Google Scholar 

  51. Monnet X, Teboul JL (2008) Passive leg raising. Intensive Care Med 34:659–663

    Article  PubMed  Google Scholar 

  52. Preau S, Saulnier F, Dewavrin F, Durocher A, Chagnon JL (2010) Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Crit Care Med 38:819–825

    Article  PubMed  Google Scholar 

  53. Teboul JL, Monnet X (2008) Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity. Curr Opin Crit Care 14:334–339

    Article  PubMed  Google Scholar 

  54. Monnet X, Teboul JL (2015) Passive leg raising: five rules, not a drop of fluid! Crit Care 19:18

    Article  PubMed  PubMed Central  Google Scholar 

  55. Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C et al (2010) Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med 36:1475–1483

    Article  PubMed  Google Scholar 

  56. AWMF (2014) Intravasale Volumentherapie beim Erwachsenen. Leitliniendetailansicht. www.awmf.org/leitlinien/detail/ll/001-020.html. Accessed 12 Oct 2015

  57. Lakhal K, Ehrmann S, Benzekri-Lefevre D, Runge I, Legras A, Dequin PF et al (2012) Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction. Ann Fr Anesth Reanim 31:e67–e72

    Article  CAS  PubMed  Google Scholar 

  58. Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL (2007) Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 33:1125–1132

    Article  PubMed  Google Scholar 

  59. Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B et al (2007) Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med 25:637–642

    Article  PubMed  Google Scholar 

  60. Cecconi M, Parsons AK, Rhodes A (2011) What is a fluid challenge? Curr Opin Crit Care 17:290–295

    Article  PubMed  Google Scholar 

  61. Vincent JL, Weil MH (2006) Fluid challenge revisited. Crit Care Med 34:1333–1337

    Article  PubMed  Google Scholar 

  62. Cherpanath TG, Aarts LP, Groeneveld JA, Geerts BF (2014) Defining fluid responsiveness: a guide to patient-tailored volume titration. J Cardiothorac Vasc Anesth 28:745–754

    Article  PubMed  Google Scholar 

  63. Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008

    Article  PubMed  Google Scholar 

  64. Muller L, Louart G, Teboul JL, Mahamat A, Polge A, Bertinchant JP et al (2009) Could B-type Natriuretic Peptide (BNP) plasma concentration be useful to predict fluid responsiveness [corrected] in critically ill patients with acute circulatory failure? Ann Fr Anesth Reanim 28:531–536

    Article  CAS  PubMed  Google Scholar 

  65. Araghi A, Bander JJ, Guzman JA (2006) Arterial blood pressure monitoring in overweight critically ill patients: invasive or noninvasive? Crit Care 10:R64

    Article  PubMed  PubMed Central  Google Scholar 

  66. Anastas ZM, Jimerson E, Garolis S (2008) Comparison of noninvasive blood pressure measurements in patients with atrial fibrillation. J Cardiovasc Nurs 23:519–524 (quiz 25–26)

    Article  PubMed  Google Scholar 

  67. Lehman LW, Saeed M, Talmor D, Mark R, Malhotra A (2013) Methods of blood pressure measurement in the ICU. Crit Care Med 41:34–40

    Article  PubMed  PubMed Central  Google Scholar 

  68. Wagner JY, Prantner JS, Meidert AS, Hapfelmeier A, Schmid RM, Saugel B (2014) Noninvasive continuous versus intermittent arterial pressure monitoring: evaluation of the vascular unloading technique (CNAP device) in the emergency department. Scand J Trauma Resusc Emerg Med 22:8

    Article  PubMed  PubMed Central  Google Scholar 

  69. Nowak RM, Sen A, Garcia AJ, Wilkie H, Yang JJ, Nowak MR et al (2011) Noninvasive continuous or intermittent blood pressure and heart rate patient monitoring in the ED. Am J Emerg Med 29:782–789

    Article  PubMed  Google Scholar 

  70. Saugel B, Dueck R, Wagner JY (2014) Measurement of blood pressure. Best Pract Res Clin Anaesthesiol 28:309–322

    Article  PubMed  Google Scholar 

  71. Saugel B, Meidert AS, Hapfelmeier A, Eyer F, Schmid RM, Huber W (2013) Non-invasive continuous arterial pressure measurement based on radial artery tonometry in the intensive care unit: a method comparison study using the T-Line TL-200pro device. Br J Anaesth 111:185–190

    Article  CAS  PubMed  Google Scholar 

  72. Meidert AS, Huber W, Muller JN, Schofthaler M, Hapfelmeier A, Langwieser N et al (2014) Radial artery applanation tonometry for continuous non-invasive arterial pressure monitoring in intensive care unit patients: comparison with invasively assessed radial arterial pressure. Br J Anaesth 112:521–528

    Article  CAS  PubMed  Google Scholar 

  73. Saugel B, Meidert AS, Langwieser N, Wagner JY, Fassio F, Hapfelmeier A et al (2014) An autocalibrating algorithm for non-invasive cardiac output determination based on the analysis of an arterial pressure waveform recorded with radial artery applanation tonometry: a proof of concept pilot analysis. J Clin Monit Comput 28:357–362

    Article  PubMed  Google Scholar 

  74. Wagner JY, Sarwari H, Schon G, Kubik M, Kluge S, Reichenspurner H et al (2015) Radial artery applanation tonometry for continuous noninvasive cardiac output measurement: a comparison with intermittent pulmonary artery thermodilution in patients after cardiothoracic surgery. Crit Care Med 43:1423–1428

    Article  PubMed  Google Scholar 

  75. Saugel B, Cecconi M, Wagner JY, Reuter DA (2015) Noninvasive continuous cardiac output monitoring in perioperative and intensive care medicine. Br J Anaesth 114:562–575

    Article  CAS  PubMed  Google Scholar 

  76. Cecconi M, Monge Garcia MI, Gracia Romero M, Mellinghoff J, Caliandro F, Grounds RM et al (2015) The use of pulse pressure variation and stroke volume variation in spontaneously breathing patients to assess dynamic arterial elastance and to predict arterial pressure response to fluid administration. Anesth Analg 120(1):76–84

    Article  PubMed  Google Scholar 

  77. Saugel B, Reuter DA (2014) Are we ready for the age of non-invasive haemodynamic monitoring? Br J Anaesth 113:340–343

    Article  CAS  PubMed  Google Scholar 

  78. Wagner JY, Saugel B (2015) When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput 29:1–3

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675, München, Germany

    C. Maurer MD & R. M. Schmid MD

  2. Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    J. Y. Wagner MD & B. Saugel MD

Authors
  1. C. Maurer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Y. Wagner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. M. Schmid MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Saugel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Saugel MD.

Ethics declarations

Conflict of interest

B. Saugel collaborates with Pulsion Medical Systems SE (Feldkirchen, Germany) as a member of the Medical Advisory Board. Saugel received honoraria for giving lectures and refunds of travel expenses from Pulsion Medical Systems SE (Feldkirchen, Germany).

Saugel received institutional research grants, unrestricted research grants, and refunds of travel expenses from Tensys Medical Inc. (San Diego, CA, USA). BS received honoraria for giving lectures and refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria).

J.Y. Wagner received institutional research grants, unrestricted research grants, and refunds of travel expenses from Tensys Medical Inc. (San Diego, CA, USA). J.Y. Wagner received refunds of travel expenses from CNSystems Medizintechnik AG (Graz, Austria).

For C. Maurer and R.M. Schmid there is no conflict of interest to disclose.

This article does not contain studies on human or animal subjects.

Additional information

Redaktion

M. Buerke, Siegen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maurer, C., Wagner, J.Y., Schmid, R.M. et al. Assessment of volume status and fluid responsiveness in the emergency department: a systematic approach. Med Klin Intensivmed Notfmed 112, 326–333 (2017). https://doi.org/10.1007/s00063-015-0124-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-015-0124-x

Keywords

Schlüsselwörter

Search

Navigation