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Volumn 9, Issue 6, 2005, Pages 581-587

Clinical review: Mechanical ventilation in severe asthma

Author keywords

[No Author keywords available]

Indexed keywords

HELIOX; INHALATION ANESTHETIC AGENT; KETAMINE; MAGNESIUM SULFATE;

EID: 31744451238     PISSN: 13648535     EISSN: None     Source Type: Journal    
DOI: 10.1186/cc3733     Document Type: Review
Times cited : (62)

References (64)
  • 1
    • 0027371506 scopus 로고
    • Demographic characteristics of patients with severe life threatening asthma: Comparison with asthma deaths
    • Richards GN, Kolbe J, Fenwick J, Rea HH: Demographic characteristics of patients with severe life threatening asthma: comparison with asthma deaths. Thorax 1993, 48:1105-1109.
    • (1993) Thorax , vol.48 , pp. 1105-1109
    • Richards, G.N.1    Kolbe, J.2    Fenwick, J.3    Rea, H.H.4
  • 3
    • 0031813354 scopus 로고    scopus 로고
    • Acute severe asthma treated by mechanical ventilation: A comparison of the changing characteristics over a 17 yr period
    • Kearney SE, Graham DR, Atherton ST: Acute severe asthma treated by mechanical ventilation: a comparison of the changing characteristics over a 17 yr period. Respir Med 1998, 92: 716-721.
    • (1998) Respir Med , vol.92 , pp. 716-721
    • Kearney, S.E.1    Graham, D.R.2    Atherton, S.T.3
  • 6
    • 0029023284 scopus 로고
    • The assessment and management of adults with status asthmaticus
    • Corbridge TC, Hall JB: The assessment and management of adults with status asthmaticus. Am J Respir Crit Care Med. 1995, 151:1296-1316.
    • (1995) Am J Respir Crit Care Med. , vol.151 , pp. 1296-1316
    • Corbridge, T.C.1    Hall, J.B.2
  • 7
    • 0031947258 scopus 로고    scopus 로고
    • Medical and ventilatory management of status asthmaticus
    • Levy BD, Kitch B, Fanta CH: Medical and ventilatory management of status asthmaticus. Intensive Care Med 1998, 24:105-117.
    • (1998) Intensive Care Med , vol.24 , pp. 105-117
    • Levy, B.D.1    Kitch, B.2    Fanta, C.H.3
  • 9
    • 0037390456 scopus 로고    scopus 로고
    • A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthma attack
    • Soroksky A, Stav D, Shpirer I: A pilot prospective, randomized, placebo-controlled trial of bilevel positive airway pressure in acute asthma attack. Chest 2003, 123:1018-1025.
    • (2003) Chest , vol.123 , pp. 1018-1025
    • Soroksky, A.1    Stav, D.2    Shpirer, I.3
  • 11
    • 0030460315 scopus 로고    scopus 로고
    • Noninvasive positive pressure ventilation in status asthmaticus
    • Keenan SO, Gregor J, Sibbald WJ, Cook D, Gafni A: Noninvasive positive pressure ventilation in status asthmaticus. Chest 1996, 110:767-774.
    • (1996) Chest , vol.110 , pp. 767-774
    • Keenan, S.O.1    Gregor, J.2    Sibbald, W.J.3    Cook, D.4    Gafni, A.5
  • 13
    • 0034600516 scopus 로고    scopus 로고
    • Early use of non-invasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: A multicenter randomized controlled trial
    • Plant PK, Owen JL: Early use of non-invasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicenter randomized controlled trial. Lancet 2000, 355:1941-1935.
    • (2000) Lancet , vol.355 , pp. 1935-1941
    • Plant, P.K.1    Owen, J.L.2
  • 14
    • 0034847495 scopus 로고    scopus 로고
    • Non-invasive ventilation in acute exacerbations of chronic obstructive lung disease: Long term survival and predictors of in-hospital outcome
    • Plant PK, Owen JL, Elliott MW: Non-invasive ventilation in acute exacerbations of chronic obstructive lung disease: long term survival and predictors of in-hospital outcome. Lancet 2001, 56:708-712.
    • (2001) Lancet , vol.56 , pp. 708-712
    • Plant, P.K.1    Owen, J.L.2    Elliott, M.W.3
  • 15
    • 0029871006 scopus 로고    scopus 로고
    • Noninvasive mechanical ventilation imporves the immediate and long-term outcome of COPD patients with acute respiratory failure
    • Confalonieri M, Parigi P, Scartabellati A, Aiolfi S, Scorsetti S, Nava S, Gandola L: Noninvasive mechanical ventilation imporves the immediate and long-term outcome of COPD patients with acute respiratory failure. Eur Respir J 1996, 9: 422-430.
    • (1996) Eur Respir J , vol.9 , pp. 422-430
    • Confalonieri, M.1    Parigi, P.2    Scartabellati, A.3    Aiolfi, S.4    Scorsetti, S.5    Nava, S.6    Gandola, L.7
  • 16
    • 0027956437 scopus 로고
    • Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: Determinants of success and failure
    • Soo Hoo GW, Santiago S, Williams A: Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med 1994, 22:1253-1261.
    • (1994) Crit Care Med , vol.22 , pp. 1253-1261
    • Soo Hoo, G.W.1    Santiago, S.2    Williams, A.3
  • 17
    • 0029018269 scopus 로고
    • Randomized, prospective trial of noninvasive positive pressure ventilaiton in acute respiratory failure
    • Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS: Randomized, prospective trial of noninvasive positive pressure ventilaiton in acute respiratory failure. Am J Resp Crit Care Med 1995, 151:1799-1806.
    • (1995) Am J Resp Crit Care Med , vol.151 , pp. 1799-1806
    • Kramer, N.1    Meyer, T.J.2    Meharg, J.3    Cece, R.D.4    Hill, N.S.5
  • 18
    • 3242669604 scopus 로고    scopus 로고
    • Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure
    • Sinuff T, Keenan SP: Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure. J Crit Care 2004, 19:82-91.
    • (2004) J Crit Care , vol.19 , pp. 82-91
    • Sinuff, T.1    Keenan, S.P.2
  • 20
    • 0141835487 scopus 로고    scopus 로고
    • National Heart, Lung and Blood Institute: Publication number 97-4051. Bethesda: National Institutes of Health
    • National Heart, Lung and Blood Institute: Guidelines for the Diagnosis and Management of Asthma, Expert Panel Report 2. Publication number 97-4051. Bethesda: National Institutes of Health; 1997.
    • (1997) Guidelines for the Diagnosis and Management of Asthma, Expert Panel Report 2
  • 21
    • 0023726378 scopus 로고
    • Clinical features and outcomes in patients with acute asthma presenting with hypercapnia
    • Mountain RD, Sahn S: Clinical features and outcomes in patients with acute asthma presenting with hypercapnia. Am Rev Respir Dis 1988, 138:535-539.
    • (1988) Am Rev Respir Dis , vol.138 , pp. 535-539
    • Mountain, R.D.1    Sahn, S.2
  • 22
    • 0029870574 scopus 로고    scopus 로고
    • Occult, occult auto-PEEP in status asthmaticus
    • Stewart TE, Slutsky AS: Occult, occult auto-PEEP in status asthmaticus. Crit Care Med 1996, 24:379-380.
    • (1996) Crit Care Med , vol.24 , pp. 379-380
    • Stewart, T.E.1    Slutsky, A.S.2
  • 23
    • 0029872446 scopus 로고    scopus 로고
    • Low measured auto-positive end-expiratory pressure during mechanical ventilation of patients with severe asthma: Hidden auto-positive end-expiratory pressure
    • Leatherman JW, Ravenscraft SA: Low measured auto-positive end-expiratory pressure during mechanical ventilation of patients with severe asthma: hidden auto-positive end-expiratory pressure. Crit Care Med 1996, 24:541-546.
    • (1996) Crit Care Med , vol.24 , pp. 541-546
    • Leatherman, J.W.1    Ravenscraft, S.A.2
  • 24
    • 0019989011 scopus 로고
    • Occult positive end-expiratory pressure in mechanically ventilated paitents with airflow obstruction. The auto-PEEP effect
    • Pepe PE, Marini JJ: Occult positive end-expiratory pressure in mechanically ventilated paitents with airflow obstruction. The auto-PEEP effect. Am Rev Resp Dis 1982, 126:166-170.
    • (1982) Am Rev Resp Dis , vol.126 , pp. 166-170
    • Pepe, P.E.1    Marini, J.J.2
  • 25
    • 0023603475 scopus 로고
    • The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe air-flow obtruction
    • Tuxen DV, Lane S: The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe air-flow obtruction. Am Rev Respir Dis 1987, 136:872-879.
    • (1987) Am Rev Respir Dis , vol.136 , pp. 872-879
    • Tuxen, D.V.1    Lane, S.2
  • 26
    • 0026447061 scopus 로고
    • Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma
    • Tuxen DV, Williams TJ, Scheinkestel CD, Czarny D, Bowes G: Use of a measurement of pulmonary hyperinflation to control the level of mechanical ventilation in patients with acute severe asthma. Am Rev Respir Dis 1992, 146:1136-1142.
    • (1992) Am Rev Respir Dis , vol.146 , pp. 1136-1142
    • Tuxen, D.V.1    Williams, T.J.2    Scheinkestel, C.D.3    Czarny, D.4    Bowes, G.5
  • 27
    • 0037254236 scopus 로고    scopus 로고
    • The pulmonary physician in critical care: Acute severe asthma in the intensive care unit
    • Phipps P, Gerrard CS: The pulmonary physician in critical care: acute severe asthma in the intensive care unit. Thorax 2003, 58:81-88.
    • (2003) Thorax , vol.58 , pp. 81-88
    • Phipps, P.1    Gerrard, C.S.2
  • 28
    • 0028041517 scopus 로고
    • Life-threatening asthma
    • Leatherman J: Life-threatening asthma. Clin Chest Med 1994, 15:453-479.
    • (1994) Clin Chest Med , vol.15 , pp. 453-479
    • Leatherman, J.1
  • 29
    • 3242667737 scopus 로고    scopus 로고
    • Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease
    • Kondili E, Alexopoulou C, Prinianakis G, Xirouchaki N, Georgopoulos D: Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease. Intensive Care Med 2004, 30: 1311-1318.
    • (2004) Intensive Care Med , vol.30 , pp. 1311-1318
    • Kondili, E.1    Alexopoulou, C.2    Prinianakis, G.3    Xirouchaki, N.4    Georgopoulos, D.5
  • 30
    • 0036014516 scopus 로고    scopus 로고
    • Lung emptying in patients with acute respiratory distress syndrome: Effects of positive end-expiratory pressure
    • Kondili E, Prinianakis G, Athanasakis D, Georgopoulos D: Lung emptying in patients with acute respiratory distress syndrome: effects of positive end-expiratory pressure. Eur Respir J 2002, 19:811-819.
    • (2002) Eur Respir J , vol.19 , pp. 811-819
    • Kondili, E.1    Prinianakis, G.2    Athanasakis, D.3    Georgopoulos, D.4
  • 31
    • 0026799254 scopus 로고
    • Risk factors for morbidity in mechanically ventilated patients with acute severe asthma
    • Williams TJ, Tuxen DV, Scheinkestel CD, Czarny D, Bowes G: Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 1992, 146:607-615.
    • (1992) Am Rev Respir Dis , vol.146 , pp. 607-615
    • Williams, T.J.1    Tuxen, D.V.2    Scheinkestel, C.D.3    Czarny, D.4    Bowes, G.5
  • 32
    • 0028224272 scopus 로고
    • Asthma requiring mechanical ventilation. A low morbidity approach
    • Bellomo R, McLaughlin P, Tai E, Parkin G: Asthma requiring mechanical ventilation. A low morbidity approach. Chest 1994, 105:891-896.
    • (1994) Chest , vol.105 , pp. 891-896
    • Bellomo, R.1    McLaughlin, P.2    Tai, E.3    Parkin, G.4
  • 33
    • 0021357957 scopus 로고
    • Mechanical controlled hypoventilation in status asthmaticus
    • Darioli R, Perret C: Mechanical controlled hypoventilation in status asthmaticus. Am Rev Respir Dis 1984, 129:385-387.
    • (1984) Am Rev Respir Dis , vol.129 , pp. 385-387
    • Darioli, R.1    Perret, C.2
  • 35
    • 0036180180 scopus 로고    scopus 로고
    • Ventilation of patients with asthma and chronic obstructive pulmonary disease
    • Peigang Y, Marini JJ: Ventilation of patients with asthma and chronic obstructive pulmonary disease. Curr Opin Crit Care 2002, 8:70-76.
    • (2002) Curr Opin Crit Care , vol.8 , pp. 70-76
    • Peigang, Y.1    Marini, J.J.2
  • 36
    • 1642284303 scopus 로고    scopus 로고
    • Acute asthma in adults: A review
    • Rodrigo GJ, Rodrigo C, Hall JB: Acute asthma in adults: a review. Chest 2004, 125:1081-1102.
    • (2004) Chest , vol.125 , pp. 1081-1102
    • Rodrigo, G.J.1    Rodrigo, C.2    Hall, J.B.3
  • 37
    • 3142677774 scopus 로고    scopus 로고
    • Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated paitents with severe asthma
    • Leatherman JW, McArthur C, Shapiro RS: Effect of prolongation of expiratory time on dynamic hyperinflation in mechanically ventilated paitents with severe asthma. Crit Care Med 2004, 32:1542-1545.
    • (2004) Crit Care Med , vol.32 , pp. 1542-1545
    • Leatherman, J.W.1    McArthur, C.2    Shapiro, R.S.3
  • 40
    • 0033033927 scopus 로고    scopus 로고
    • Myopathy following mechanical ventilation for acute severe asthma: The role of muscle relaxants and corticosteroids
    • Behbehani NA, Al-Mane F, D'yachkova Y, Pare P, FitzGerald JM: Myopathy following mechanical ventilation for acute severe asthma: the role of muscle relaxants and corticosteroids. Chest 1999, 115:1627-1631.
    • (1999) Chest , vol.115 , pp. 1627-1631
    • Behbehani, N.A.1    Al-Mane, F.2    D'yachkova, Y.3    Pare, P.4    FitzGerald, J.M.5
  • 42
    • 0033801714 scopus 로고    scopus 로고
    • Effect of PEEP on work of breathing in mechanically ventilated COPD patients
    • Guerin C, Milic-Emili J, Fournier G: Effect of PEEP on work of breathing in mechanically ventilated COPD patients. Intensive Care Med 2000, 26:1207-1214.
    • (2000) Intensive Care Med , vol.26 , pp. 1207-1214
    • Guerin, C.1    Milic-Emili, J.2    Fournier, G.3
  • 43
    • 0024327547 scopus 로고
    • Detrimental effects of positive end-expiratory pressure during controlled mechanical ventilation of patients with severe airflow obstruction
    • Tuxen DV: Detrimental effects of positive end-expiratory pressure during controlled mechanical ventilation of patients with severe airflow obstruction. Am Rev Respir Dis 1989, 140:5-10.
    • (1989) Am Rev Respir Dis , vol.140 , pp. 5-10
    • Tuxen, D.V.1
  • 44
    • 0020596541 scopus 로고
    • Combined ventilator and bicarbonate strategy in the management of status asthmaticus
    • Menitove SM, Goldring RM: Combined ventilator and bicarbonate strategy in the management of status asthmaticus. Am J Med 1983, 74:898-901.
    • (1983) Am J Med , vol.74 , pp. 898-901
    • Menitove, S.M.1    Goldring, R.M.2
  • 45
    • 0033812383 scopus 로고    scopus 로고
    • Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature
    • Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr: Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med 2000, 36:181-190.
    • (2000) Ann Emerg Med , vol.36 , pp. 181-190
    • Rowe, B.H.1    Bretzlaff, J.A.2    Bourdon, C.3    Bota, G.W.4    Camargo Jr., C.A.5
  • 47
    • 0030950854 scopus 로고    scopus 로고
    • The effect of isofluorane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation
    • Rooke GA, Choi JH, Bishop M: The effect of isofluorane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiol 1997, 86:1294-1299.
    • (1997) Anesthesiol , vol.86 , pp. 1294-1299
    • Rooke, G.A.1    Choi, J.H.2    Bishop, M.3
  • 48
    • 31744450621 scopus 로고
    • Respiratory mechanics in status asthmaticus. Effects of inhalational anesthesia
    • Maltais F, Sovilj M, Goldberg P, Gottfried SB: Respiratory mechanics in status asthmaticus. Effects of inhalational anesthesia. Chest 1994, 116:296-300.
    • (1994) Chest , vol.116 , pp. 296-300
    • Maltais, F.1    Sovilj, M.2    Goldberg, P.3    Gottfried, S.B.4
  • 49
    • 0025726975 scopus 로고
    • Isoflurane anesthesia for the treatment of refractory status asthmaticus
    • Otte RW, Fireman P: Isoflurane anesthesia for the treatment of refractory status asthmaticus. Ann Allergy 1991, 66:305-309.
    • (1991) Ann Allergy , vol.66 , pp. 305-309
    • Otte, R.W.1    Fireman, P.2
  • 51
    • 0015369983 scopus 로고
    • Ketamine in the anesthetic management of asthmatic patients
    • Corseen G, Guitierrez J, Reves JG, Huber FC: Ketamine in the anesthetic management of asthmatic patients. Anesth Analg 1972, 51:588-596.
    • (1972) Anesth Analg , vol.51 , pp. 588-596
    • Corseen, G.1    Guitierrez, J.2    Reves, J.G.3    Huber, F.C.4
  • 52
    • 0026557017 scopus 로고
    • Use of ketamine in acute severe asthma
    • Sarma V: Use of ketamine in acute severe asthma. Acta Anaesthesiol Scand 1992, 36:106-107.
    • (1992) Acta Anaesthesiol Scand , vol.36 , pp. 106-107
    • Sarma, V.1
  • 53
    • 0028276268 scopus 로고
    • Ketamine in the treatment of bronchospasm during mechanical ventilation
    • Hemmingsen C, Nielsen PK, Odorico J: Ketamine in the treatment of bronchospasm during mechanical ventilation. Am J Emerg Med 1994, 12:417-420.
    • (1994) Am J Emerg Med , vol.12 , pp. 417-420
    • Hemmingsen, C.1    Nielsen, P.K.2    Odorico, J.3
  • 54
    • 0028143037 scopus 로고
    • Combined bronchoscopy and mucolytic therapy for patients with severe refractory status asthmaticus on mechanical ventilation: A case report and review of the literature
    • Henke CA, Hertz M, Gustafson P: Combined bronchoscopy and mucolytic therapy for patients with severe refractory status asthmaticus on mechanical ventilation: a case report and review of the literature. Crit Care Med 1994, 22:1880-1883.
    • (1994) Crit Care Med , vol.22 , pp. 1880-1883
    • Henke, C.A.1    Hertz, M.2    Gustafson, P.3
  • 55
    • 0022570340 scopus 로고
    • Acute severe asthma treated by mechanical ventilation: 10 years' experience from a district general hospital
    • Luksza AR, Smith P, Coakley J, Gordan IJ, Atherton ST: Acute severe asthma treated by mechanical ventilation: 10 years' experience from a district general hospital. Thorax 1986, 41: 459-463.
    • (1986) Thorax , vol.41 , pp. 459-463
    • Luksza, A.R.1    Smith, P.2    Coakley, J.3    Gordan, I.J.4    Atherton, S.T.5
  • 56
    • 0025130061 scopus 로고
    • Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis
    • Gluck EH, Onorato DJ, Castriotta R: Helium-oxygen mixtures in intubated patients with status asthmaticus and respiratory acidosis. Chest 1990, 98:693-698.
    • (1990) Chest , vol.98 , pp. 693-698
    • Gluck, E.H.1    Onorato, D.J.2    Castriotta, R.3
  • 57
    • 0033399224 scopus 로고    scopus 로고
    • Oxygenation in status asthmaticus improves during ventilation with helium-oxygen
    • Schaeffer EM, Pohlman A, Morgan S, Hall JB: Oxygenation in status asthmaticus improves during ventilation with helium-oxygen. Crit Care Med 1999, 27:2666-2670.
    • (1999) Crit Care Med , vol.27 , pp. 2666-2670
    • Schaeffer, E.M.1    Pohlman, A.2    Morgan, S.3    Hall, J.B.4
  • 58
    • 0032796175 scopus 로고    scopus 로고
    • The effect of heliox in acute severe asthma: A randomized controlled trial
    • Kass JE, Terregino CA: The effect of heliox in acute severe asthma: a randomized controlled trial. Chest 1999, 116:296-300.
    • (1999) Chest , vol.116 , pp. 296-300
    • Kass, J.E.1    Terregino, C.A.2
  • 59
    • 0033843250 scopus 로고    scopus 로고
    • Effects of helium-oxygen on intrinsic Positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease
    • Tassaux D, Jolliet P, Roeseler J, Chevrolet JC: Effects of helium-oxygen on intrinsic Positive end-expiratory pressure in intubated and mechanically ventilated patients with severe chronic obstructive pulmonary disease. Crit Care Med 2000, 28:2721-2728.
    • (2000) Crit Care Med , vol.28 , pp. 2721-2728
    • Tassaux, D.1    Jolliet, P.2    Roeseler, J.3    Chevrolet, J.C.4
  • 60
    • 0029966593 scopus 로고    scopus 로고
    • Evaluation of heliox in children hospitalized with acute severe asthma: A randomized crossover trial
    • Carter LER, Webb CCR, Moffitt CER: Evaluation of heliox in children hospitalized with acute severe asthma: a randomized crossover trial. Chest 1996, 109:1256-1261.
    • (1996) Chest , vol.109 , pp. 1256-1261
    • Carter, L.E.R.1    Webb, C.C.R.2    Moffitt, C.E.R.3
  • 63
    • 0027153335 scopus 로고
    • Extracorporeal life support for status asthmaticus
    • Shapiro MB, Kleaveland AC, Bartlett RH: Extracorporeal life support for status asthmaticus. Chest 1993, 103:1651-1654.
    • (1993) Chest , vol.103 , pp. 1651-1654
    • Shapiro, M.B.1    Kleaveland, A.C.2    Bartlett, R.H.3
  • 64
    • 0008417668 scopus 로고    scopus 로고
    • Status asthmaticus
    • Edited by Hall JB, Schmidt GA, Wood LD. McGraw Hill
    • Corbridge TC, Hall JB: Status asthmaticus. In Principles of Critical Care. Edited by Hall JB, Schmidt GA, Wood LD. McGraw Hill; 1998:579-595.
    • (1998) Principles of Critical Care , pp. 579-595
    • Corbridge, T.C.1    Hall, J.B.2


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