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Trial registered on ANZCTR
Registration number
ACTRN12610000116022
Ethics application status
Approved
Date submitted
28/01/2010
Date registered
3/02/2010
Date last updated
19/09/2013
Type of registration
Prospectively registered
Titles & IDs
Public title
Augmented Renal Clearance in The Intensive Care Unit - A Multicenter Study
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Scientific title
An observation study of creatinine clearance in patients admitted to the intensive care unit for a duration greater than twenty-four hours.
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Secondary ID [1]
1366
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Nil
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Universal Trial Number (UTN)
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Trial acronym
ARCTICUS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Critical Illness
256703
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Condition category
Condition code
Infection
256856
256856
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0
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Studies of infection and infectious agents
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Inflammatory and Immune System
256857
256857
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0
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Other inflammatory or immune system disorders
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Injuries and Accidents
256858
256858
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0
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Other injuries and accidents
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
a) Eight Hour Creatinine Clearance measures
b) Collection of Demographic Data and Illness Severity Scores
c) Collection of Haemodynamic variables
d) Record of ICU and Hospital Outcome
Data will be collected on a daily basis during the entire stay in the intensive care unit (ICU).
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Intervention code [1]
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Not applicable
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Comparator / control treatment
Nil
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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The primary outcome is the incidence of augmented renal clearance (ARC) in patients admitted to the ICU. Daily 8-hour creatinine clearance measures will be used to identify this, with figures > 160ml/min/1.73m2 and > 150ml/min/1.73m2 in young men and women respectively indicating ARC.
These measures are obtained by collecting the patients urine (by means of an indwelling urinary catheter) over an 8-hour period. A blood sample is drawn during this period, and the creatinine concentration is then estimated in both urine and blood.
The creatinine clearance is then calculated as: urinary creatinine concentration x urinary volume / plasma creatinine concentration, giving a figure in ml/min. This is then adjusted using the patients body surface area to a standard figure of 1.73m2 (to allow comparison between patients).
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Assessment method [1]
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Timepoint [1]
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Daily until discharge from the ICU
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Secondary outcome [1]
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Haemodynamic variables - such as mean arterial pressure, central venous pressure, heart rate and cardiac output. These will be obtained from bed-side monitors routinely used in the ICU.
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Assessment method [1]
263089
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Timepoint [1]
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Daily (at 0800hrs) until ICU discharge
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Secondary outcome [2]
263152
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Fluid Balance (measure of the net input and output of fluids in a given patient). This will be obtained from bedside records.
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Assessment method [2]
263152
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Timepoint [2]
263152
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Daily (at 0800hrs) until ICU discharge
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Secondary outcome [3]
263153
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Inotrope use and dose. These are medications that are routinely prescribed to patients in order to improve cardiovascular performance. The dose and record of administration will be obtained from the bed-side medication chart.
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Assessment method [3]
263153
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Timepoint [3]
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Daily (at 0800hrs) until ICU discharge
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Secondary outcome [4]
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ICU and Hosptial Outcome - This will involve determining whether the patient survived to ICU and hospital discharge or died. This will be obtained from the medical record.
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Assessment method [4]
263154
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Timepoint [4]
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At ICU and hospital discharge
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Secondary outcome [5]
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APACHE II Scores on admission (Acute Physiology and Chronic Health Evaluation Score) - This is an illness severity score based on the patients pre-morbid conditions and physiological variables in the first 24hours of admission. This data will obtained from the medical chart and observation record.
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Assessment method [5]
263155
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Timepoint [5]
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During the first 24hours of ICU admission
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Secondary outcome [6]
263156
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SOFA scores - Sequential Organ Failure Assessment Scores. This score quantifies organ dysfunction in 6 key domains - Cardiovascular, Respiratory, Neurological, Haemopoietic, Hepatic and Renal. The scores are used to follow changes with treatment. Information from the medical chart and observations are used to calculate the scores.
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Assessment method [6]
263156
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Timepoint [6]
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Daily (0800hrs) until ICU discharge
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Eligibility
Key inclusion criteria
Any patient requiring admission to the ICU with:
a) Expected length of stay (LOS) > 24hours
b) Normal renal function (admission serum creatinine < 120 umol/L)
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1)Absence of invasive haemodynamic monitoring as a part of routine management
2) Absence of an indwelling urinary catheter (IDC) as a part of routine management
3) Evidence of renal impairment
4) 'At Risk' of acute kidney injury (AKI) (> 1.5 fold increase in Serum Creatinine from baseline or urine output (UO) < 0.5ml/kg/hr for > 6hrs prior to enrolment
5) Age < 18years
6) Pregnancy
7) Lack of informed consent
8) Rhabdomyolysis is suspected clinically or serum creatinine kinase > 5000
9) Clinician considers the patient is unsuitable for enrolment
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Study design
Purpose
Screening
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Duration
Cross-sectional
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/04/2010
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Actual
5/04/2010
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Date of last participant enrolment
Anticipated
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Actual
16/02/2011
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
281
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment outside Australia
Country [1]
2449
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Singapore
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State/province [1]
2449
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Singapore
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Country [2]
5426
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Hong Kong
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State/province [2]
5426
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Shantin, NT
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Country [3]
5427
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Portugal
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State/province [3]
5427
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Coimbra
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Royal Brisbane and Womens Hospital
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Address [1]
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Butterfield Street, Herston
Queensland, 4029
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Country [1]
256430
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Australia
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Primary sponsor type
Hospital
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Name
Royal Brisbane and Womens Hospital
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Address
Butterfield Street, Herston
Queensland, 4029
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
255734
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Country [1]
255734
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Other collaborator category [1]
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Hospital
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Name [1]
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Changi General Hospital
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Address [1]
1091
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2 Simei Street 3
Singapore, 529889
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Country [1]
1091
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Singapore
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Other collaborator category [2]
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Hospital
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Name [2]
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Prince of Wales Hospital
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Address [2]
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Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital 30-32 Ngan Shing Street, Shantin, New Territories, Hong Kong SAR
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Country [2]
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Hong Kong
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Other collaborator category [3]
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Hospital
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Name [3]
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Coimbra University Hospital
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Address [3]
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Servico de Medicina Intensiva, Hospitais da Universidade de Coimbra, EPE Praceta Prof. Mota Pinto, Av. Bissaya Barreto 3000-075, Coimbra, Portugal
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Country [3]
277624
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Portugal
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
258486
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Royal Brisbane and Womens Hospital, Human Research Ethics Committee
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Ethics committee address [1]
258486
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Royal Brisbane and Womens Hospital Butterfield Street Herston, Brisbane, Queensland 4029
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Ethics committee country [1]
258486
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Australia
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Date submitted for ethics approval [1]
258486
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Approval date [1]
258486
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03/08/2009
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Ethics approval number [1]
258486
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HREC/09/QRBW/192
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Summary
Brief summary
The kidneys have a range of essential functions in the body. Central to their role in the excretion of waste products and pharmaceuticals is the filtration of plasma (the non-cellular component of blood). During this process, substances (such as glucose, amino acids, electrolytes, waste products and some drugs) leave the circulation and enter the renal tubule. Subsequently, drugs / metabolites can be added to or reabsorbed from the filtrate as it passes along the tubule prior to excretion in the urine. In this manner the kidney is responsible for the elimination of a wide range of drugs and toxins. The rate at which plasma is filtered by the kidneys is referred to as the glomerular filtration rate (GFR) and is largely determined by renal blood blow (RBF). Ideal filtration markers (substances that are only filtered and neither secreted nor reabsorbed by the kidneys) are used to accurately measure GFR (eg Sinistrin), although are not routinely available in a clinical setting. Creatinine is a small molecular weight amino acid derivative that is freely filtered and secreted (10%) by the kidneys. A clinically useful measure of GFR involves calculating a timed creatinine clearance, which reflects the rate at which plasma is cleared of creatinine over a given period of time. Although research has largely focused on patients with declining renal function, there has been little attention on those with augmented renal clearances (ARC). We believe this phenomenon is likely to be common in patients on admission to the intensive care unit, and to date, has been largely under appreciated, although the implications are significant. For example, more rapid excretion of antibiotics may result in sub therapeutic levels, treatment failure or the selection of resistant micro-organisms. These complications in turn could significantly impact on morbidity and mortality associated with the patients ICU stay. This study will investigate this phenomenon in a population considered “at risk”, and define the role of commonly employed therapeutic inventions in promoting augmented clearances. This research will lead to further prospective work on tailoring dosage regimens in patients admitted to the ICU.
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Trial website
Nil
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Trial related presentations / publications
Pending
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Public notes
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Contacts
Principal investigator
Name
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Dr Andrew Udy
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Address
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Royal Brisbane and Womens Hospital, Butterfield Street, Herston, Queensland, 4029
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Country
30782
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Australia
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Phone
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+617364681111
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Dr. Andrew Udy
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Address
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C/- Department of Intensive Care Medicine
Royal Brisbane and Womens Hospital
Butterfield Street, Herston, Brisbane
4029, Queensland
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Country
14029
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Australia
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Phone
14029
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+61 7 36368111
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Dr. Andrew Udy
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Address
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C/- Department of Intensive Care Medicine
Royal Brisbane and Womens Hospital
Butterfield Street, Herston, Brisbane
4029, Queensland
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Country
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Australia
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Phone
4957
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+61 7 36368111
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Fax
4957
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Email
4957
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF