Mortality in patients with respiratory distress syndrome

array:23 ["pii" => "S2173572716300285" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.10.004" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "858" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:356-63" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3090 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 2109 "PDF" => 803 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569115002429" "issn" => "02105691" "doi" => "10.1016/j.medin.2015.10.007" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "858" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:356-63" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8822 "formatos" => array:3 [ "EPUB" => 214 "HTML" => 6540 "PDF" => 2068 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Mortalidad en pacientes con síndrome de distress respiratorio" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "356" "paginaFinal" => "363" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Mortality in patients with respiratory distress syndrome" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2283 "Ancho" => 960 "Tamanyo" => 96086 ] ] "descripcion" => array:1 [ "es" => "Dos mil cuatrocientos sesenta y seis pacientes ingresaron en la Unidad de Cuidados Criticos en 42 meses consecutivos entre enero de 2008 y junio de 2011, 789 requirieron ventilación mecánica, 126 pacientes presentaron síndrome de distress respiratorio agudo según criterios del consenso americano-europeo de 1994 (AECC). De estos últimos 28 fueron excluidos por presentar mejoría en menos de 24 h al ajustar la ventilación mecánica con niveles adecuados de presión positiva de fin de espiración (PEEP) y FiO2. Finalmente 98 pacientes fueron incluidos al estudio de los cuales 37 fallecieron y 61 sobrevivieron (mortalidad global del 37,7%). VM: ventilación mecánica; SDRA: síndrome de distress repiratorio agudo." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Lopez Saubidet, L.P. Maskin, P.O. Rodríguez, I. Bonelli, M. Setten, R. Valentini" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Lopez Saubidet" ] 1 => array:2 [ "nombre" => "L.P." "apellidos" => "Maskin" ] 2 => array:2 [ "nombre" => "P.O." "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Bonelli" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Setten" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Valentini" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572716300285" "doi" => "10.1016/j.medine.2015.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300285?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002429?idApp=WMIE" "url" => "/02105691/0000004000000006/v1_201607300234/S0210569115002429/v1_201607300234/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S2173572716300303" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.11.003" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "865" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:364-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1972 "formatos" => array:3 [ "EPUB" => 176 "HTML" => 1190 "PDF" => 606 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Design and application of model for training ultrasound-guided vascular cannulation in pediatric patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "370" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diseño y aplicación de un modelo de entrenamiento para la canalización vascular ecoguiada en pacientes pediátricos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1128 "Ancho" => 1801 "Tamanyo" => 217246 ] ] "descripcion" => array:1 [ "en" => "Components of the training model." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Pérez-Quevedo, J.M. López-Álvarez, J.M. Limiñana-Cañal, J.F. Loro-Ferrer" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Pérez-Quevedo" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "López-Álvarez" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Limiñana-Cañal" ] 3 => array:2 [ "nombre" => "J.F." "apellidos" => "Loro-Ferrer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300303?idApp=WMIE" "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300303/v2_201704060203/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572716300273" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.07.004" "estado" => "S300" "fechaPublicacion" => "2016-08-01" "aid" => "831" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:348-55" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2645 "formatos" => array:3 [ "EPUB" => 179 "HTML" => 1651 "PDF" => 815 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "348" "paginaFinal" => "355" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 981 "Ancho" => 1333 "Tamanyo" => 92237 ] ] "descripcion" => array:1 [ "en" => "EAHFE-3D score." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Jacob, Ò. Miró, P. Herrero, F.J. Martín-Sánchez, V. Gil, J. Tost, A. Aguirre, R. Escoda, A. Alquézar, J.A. Andueza, P. Llorens" "autores" => array:12 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Jacob" ] 1 => array:2 [ "nombre" => "Ò." "apellidos" => "Miró" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Herrero" ] 3 => array:2 [ "nombre" => "F.J." "apellidos" => "Martín-Sánchez" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Gil" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Tost" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Aguirre" ] 7 => array:2 [ "nombre" => "R." "apellidos" => "Escoda" ] 8 => array:2 [ "nombre" => "A." "apellidos" => "Alquézar" ] 9 => array:2 [ "nombre" => "J.A." "apellidos" => "Andueza" ] 10 => array:2 [ "nombre" => "P." "apellidos" => "Llorens" ] 11 => array:1 [ "colaborador" => "on behalf of ICA-SEMES Group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569115001734" "doi" => "10.1016/j.medin.2015.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115001734?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300273?idApp=WMIE" "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300273/v2_201704060203/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Mortality in patients with respiratory distress syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "356" "paginaFinal" => "363" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Lopez Saubidet, L.P. Maskin, P.O. Rodríguez, I. Bonelli, M. Setten, R. Valentini" "autores" => array:6 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Lopez Saubidet" "email" => array:1 [ 0 => "ilopezsaubidet@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L.P." "apellidos" => "Maskin" ] 2 => array:2 [ "nombre" => "P.O." "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Bonelli" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Setten" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Valentini" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad en pacientes con síndrome de distress respiratorio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2283 "Ancho" => 961 "Tamanyo" => 101778 ] ] "descripcion" => array:1 [ "en" => "A total of 2466 patients were admitted to the ICU over 42 consecutive months from January 2008 to June 2011. Of these, 789 required MV, and 126 presented ARDS according to the criteria of the American-European consensus of 1994 (AECC). Among the latter subjects, 28 were excluded due to improvement in under 24h of adjusting MV with adequate PEEP and FiO2 levels. A total of 98 patients were finally included in the study. Of these, 37 died and 61 survived (overall mortality rate 37.7%). MV: mechanical ventilation; ARDS: acute respiratory distress syndrome." ] ] ] "textoCompleto" => "IntroductionDespite improved knowledge of the physiopathology of acute respiratory distress syndrome (ARDS) and technological advances, controversy remains as to whether there has been a resulting decrease in patient mortality. In this regard, recent epidemiological studies describe a high in-hospital mortality rate despite the introduction of protective mechanical ventilation (MV) strategies.<a class="elsevierStyleCrossRefs" href="#bib0200">1,2</a> However, in patients with important hypoxemia, the use of higher positive end-expiratory pressure (PEEP) levels could reduce mortality associated to refractory hypoxemia, the need for recue therapeutic measures, and the days on MV.<a class="elsevierStyleCrossRefs" href="#bib0210">3–5</a> Likewise, and as indicated by a recent trial, MV in the prone position appears to result in significantly improved survival.<a class="elsevierStyleCrossRef" href="#bib0225">6</a> However, randomized clinical trials tend to exclude seriously ill patients and individuals with a poorer prognosis.<a class="elsevierStyleCrossRef" href="#bib0230">7</a> It therefore would be very interesting to obtain prognostic information from studies conducted outside the specific context of clinical trials, and involving protective MV strategies with low tidal volumes (Vt) and higher PEEP levels.<a class="elsevierStyleCrossRef" href="#bib0235">8</a>A recently proposed definition of ARDS has included a minimum PEEP level for considering oxygen alteration, and has classified severity according to the PaO2/FiO2 ratio.<a class="elsevierStyleCrossRef" href="#bib0240">9</a> Since its publication, some authors have questioned the clinical usefulness of this stratification, since the PEEP value at the time of diagnosis does not appear to have prognostic relevance,<a class="elsevierStyleCrossRefs" href="#bib0245">10,11</a> at least not without adapting PaO2/FiO2 to standardized PEEP and FiO2 levels.The present study describes mortality among the patients with ARDS in our Intensive Care Unit (ICU), including only those individuals with moderate to severe ARDS and persistent hypoxemia after 24h of MV, with adjusted PEEP and FiO2 levels. Likewise, it defines the conditions associated to mortality, and determines whether the Berlin classification allows prognostic stratification of our patients.Material and methodsPatientsA review was made of the case histories of all the patients admitted to our ICU between January 2008 and June 2011. We initially selected patients over 18 years of age with a diagnosis of ARDS according to the criteria of the American-European consensus of 1994 (AECC).<a class="elsevierStyleCrossRef" href="#bib0255">12</a> We only considered patients presenting hypoxemia with PaO2/FiO2≤200mmHg on MV with PEEP levels ≥10cmH2O and with FiO2≥0.5 within the first 72h of MV, and with chest X-rays revealing bilateral infiltrates in four quadrants in the absence of cardiogenic acute lung edema. The decision to include only patients with hypoxemia under concrete PEEP and FiO2 levels was based on a previous study in which a PaO2/FiO2 ratio of ≤200mmHg with at least 10cmH2O of PEEP clearly differentiated patient prognosis.Data acquisitionThe data were collected retrospectively from the case histories of the patients admitted to the ICU of our University Hospital over a period of 42 consecutive months. We recorded demographic and etiological data, the APACHE II score upon admission, major comorbidities (active cancer disease, solid organ transplants, hematopoietic cell transplants and other immune depression states), gas exchange (pH, pCO2, pO2, PaO2/FiO2), MV parameters (peak pressure, plateau pressure [Ppl], total PEEP, working pressure [Ppl minus total PEEP], exhaled Vt, Vt per kg ideal body weight [Vt/kg], static compliance of the respiratory system) and the SOFA score for assessing organ dysfunction.<a class="elsevierStyleCrossRef" href="#bib0260">13</a> In our Unit, all patients are measured upon admission with a metric tape, recording height and ideal body weight both in the case history and in the daily monitoring table for patients on MV.The data referred to MV and organ dysfunction were recorded on days 1, 3, 7 and 10 of MV. In-hospital mortality and mortality after 6 months were documented.Refractory hypoxemia and hypercapnia were defined as the persistence of PaO2/FiO2≤80mmHg with FiO2≥0.9 during at least 1h, and pH≤7.20 with PaCO2≥80mmHg, respectively, after optimizing MV with recruitment maneuvers, reducing Vt to 4–6ml/kg ideal body weight, elevating the respiratory frequency (RF) (limited by the generation of auto-PEEP or intrinsic PEEP) and adopting patient pronation for 12h in the selected individuals. All these data were collected from the abovementioned MV monitoring table, used in all patients subjected to MV in our Unit. This table is updated every 8h from the start of MV until patient extubation or death. Mechanical ventilation in the prone position was used in patients presenting PaO2/FiO2≤100mmHg with at least 15cmH2O of PEEP, and following recruitment maneuvering.All patients were ventilated in flow assisted/controlled mode with a constant flow curve. Sedoanalgesia was administered in the form of a continuous infusion of midazolam or propofol plus fentanyl, and occasionally using muscle relaxants according to the criterion of the attending physician.Due to the retrospective nature of the study, the fact that the data were obtained from the normal patient records, and the observation of patient confidentiality, the hospital Ethics Committee approved conduction of the study without requiring the obtainment of informed consent.Statistical analysisContinuous variables were reported as the mean and standard deviation (SD) or median with the interquartile range, as applicable. Continuous variables and proportions were compared using the Student t-test and chi-squared test, respectively. A logistic regression model was developed, entering those variables that proved significant in the univariate analysis between survivors and deceased individuals, and considering mortality as final outcome or endpoint.A forward stepwise model was developed. Statistical significance was considered for p≤0.05 in all cases.ResultsDuring the study period a total of 2466 patients were admitted to the ICU and 789 required MV. Of these, 98 (12.4%) met the inclusion criteria and were finally included in the analysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Follow-up during 6 months proved possible in 52 of 61 patients discharged alive (85.2%). The demographic and physiological data are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 59 years; 57% were males; the APACHE II score upon admission was 22±7 points; and the SOFA score on day 1 was 8±3 points.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The most frequent comorbidity was active, advanced-stage solid organ cancer, present in 24 patients (24.5%). Fourteen patients (14.3%) suffered other immune depressive conditions (5 solid organ transplants, 4 cases of acute leukemia with hematopoietic cell transplantation, 2 with immunosuppressive treatment due to systemic lupus erythematosus, one with immunosuppressive treatment due to Wegener's disease, one with chronic corticosteroid use, one with CHILD class C cirrhosis due to hepatitis B infection). The main diagnoses upon admission were pneumonia (51%), extrapulmonary sepsis (24.5%), polytraumatism (11.2%) and chest surgery (7.1%).The PEEP and Vt/kg levels used in the first 48h of MV were 13.3 (±2.9)cmH2O and 6.8 (±1)ml/kg, respectively. The Ppl value was 27.4 (±4)cmH2O (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The PaO2/FiO2 ratio on day 1 of MV was 145 (±40)mmHg. In 12 cases (12.2%) rescue treatment measures were adopted due to refractory hypoxemia or hypercapnia: nitric oxide (NO) in 12 patients, with extracorporeal membrane oxygenation (ECMO) in one of them. Ventilation in the prone position was carried out in 20 patients (20.4%). Although this was not a randomized or prospective study, and no comparative analysis therefore could be made, the mortality rate among the global patients who received alternative treatments was 31%, which is lower than the global mortality rate for our series, despite the fact that these were patients with greater ventilatory and oxygenation problems.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The in-hospital and 6 months mortality rate was 37.7% (37 of 98 patients) and 43.8% (39 of 89 patients), respectively. The duration of in-ICU and in-hospital stay was 21 (range 14–39) and 34 (range 21–52) days, respectively. Mortality was higher among the patients with comorbidities (60.5% vs 23.3%, p≤0.01). All the patients with acute leukemia and hematopoietic cell transplantation died. The mortality rates in the patients with PaO2/FiO2 >100mmHg or ≤100mmHg showed no significant differences (41.2% vs 36.8%; p=0.25). In 27 patients, Ppl was >30cmH2O for at least 24h during the first 48h. The mortality rate in this group was 63% versus 28% in the cases with Ppl≤30cmH2O (p=0.002). On grouping the patients into tertiles according to increasing Ppl ranges (≤25, >25–≤30 and >30cmH2O), the mortality rate was seen to increase progressively (22.9%, 41.9% and 55%, respectively; p=0.046) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The working pressure was 14.6 (±3.7)cmH2O in the patients who survived and 16.2 cmH2O (±3.6) in those who died (p=0.04).Other factors associated to increased mortality were the presence of septic shock (67.5% vs 25.5%; p=0.03) and the SOFA score of day 1 (8.9 [±3.1] vs 7.4 [±2.7] points; p=0.01).The logistic regression model for predicting in-hospital mortality included patient age, the SOFA score, working pressure (day 1), pH (day 1), Ppl>30cmH2O for at least 24h during the first 48h, the presence of major comorbidities and septic shock. Only age, the presence of septic shock, Ppl>30cmH2O and major comorbidities were found to be independently associated to increased mortality (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionIn this study of patients with ARDS we found the mortality rate to be lower than reported in previous studies, even on considering the more seriously ill cases<a class="elsevierStyleCrossRefs" href="#bib0235">8,14–18</a> (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The factors associated to mortality were the presence of major comorbidities, age, septic shock and MV with Ppl>30cmH2O. In contrast to the proposal of the Berlin classification of ARDS, where the prognosis is stratified according to impairment of the PaO2/FiO2 ratio, we observed no significant differences in mortality between patients with moderate ARDS (PaO2/FiO2>100mmHg and ≤200mmHg) and severe ARDS (PaO2/FiO2≤100mmHg).<a class="elsevierStyleCrossRef" href="#bib0240">9</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>There is controversy as to whether the introduction of protective MV has resulted in effectively decreased mortality in ARDS. A recent systematic review including studies carried out in the protective ventilation era recorded no significant differences in mortality between the years 1994 and 2006.<a class="elsevierStyleCrossRef" href="#bib0205">2</a> However, two of the studies involving high PEEP levels (LOVS and Express) were not included in this analysis.<a class="elsevierStyleCrossRefs" href="#bib0210">3,4</a> Although these two studies revealed no improvement in survival, a metaanalysis that included both these trials and the ALVEOLI study<a class="elsevierStyleCrossRef" href="#bib0290">19</a> detected an improved prognosis in the subgroup of patients with greater oxygenation problems and exposed to high PEEP levels.In our population, the criterion for selecting PEEP initially included the level needed to obtain a Ppl of up to 28–30cmH2O (as used in the Express trial),<a class="elsevierStyleCrossRef" href="#bib0210">3</a> and in the group of patients with more intense hypoxemia, PEEP was selected on the basis of the transpulmonary pressure (Ptp) with the aim of reaching and end-expiratory Ptp of between 0 and 5cmH2O.<a class="elsevierStyleCrossRef" href="#bib0295">20</a> These selection methods surely resulted in the application of higher PEEP levels, which in addition to the strict selection of low Vt values, may have contributed to the decrease in mortality observed in a group of patients with mild ARDS. In this group the application of high PEEP levels may be deleterious.<a class="elsevierStyleCrossRef" href="#bib0220">5</a>A previous study, involving stratification according to FiO2 and PEEP in the group of patients with PaO2/FiO2≤200mmHg and at least 10cmH2O of PEEP (i.e., similar to the criteria used in selecting our own patients), reported higher mortality<a class="elsevierStyleCrossRef" href="#bib0235">8</a> – though statistical significance cannot be inferred, due in part to the size of the populations in the two studies. Of the different factors that could account for this difference, mention must be made of the utilization of PEEP levels lower than those used in our study (11.45±3.09 vs 13.3±2.9cmH2O), and the lesser use of rescue measures in refractory cases. In our population, special rescue therapies were applied in 12% of the patients, particularly ON inhalation, and ECMO in a single case.Controversy remains regarding the role of rescue therapies in the management of ARDS. As an example, no improvement in patient survival has been demonstrated with the use of NO, though in this case the clinical trials were carried out before the introduction of protective MV strategies, and generally involved patients without severely impaired oxygenation.<a class="elsevierStyleCrossRef" href="#bib0300">21</a> On the other hand, the utilization of ECMO has gained renewed impulse in recent years thanks to technological developments and the results of a clinical trial demonstrating benefit in terms of survival among selected patients.<a class="elsevierStyleCrossRefs" href="#bib0305">22–25</a>Another ventilation strategy that may have contributed to the improved survival observed could be the use of ventilation in the prone position, which was more widely employed than in some previous studies,<a class="elsevierStyleCrossRef" href="#bib0325">26</a> reaching 20.4% of the population. To date, only some trials had evaluated the effect of ventilation in the prone position, with no observation of increased benefits. However, a recent study has recorded significant improvement in survival with ventilation in the prone position introduced early and with longer sessions, together with protective MV measures.<a class="elsevierStyleCrossRef" href="#bib0225">6</a>Another aspect to be considered in the ventilation strategy is the general recommendation to maintain Ppl levels of <30cmH2O.<a class="elsevierStyleCrossRef" href="#bib0330">27</a> It has been questioned whether this recommendation applies to all patients, taking into account that the true pressure that distends the lungs is Ptp.<a class="elsevierStyleCrossRef" href="#bib0335">28</a> Nevertheless, a Ppl of >30cmH2O was independently associated to increased mortality. In this sense, some studies have demonstrated the presence of alveolar overdistension and the release of inflammatory mediators with Ppl levels even >25cmH2O.<a class="elsevierStyleCrossRefs" href="#bib0295">20,29</a> The subgroup of patients in which Ppl levels of >30cmH2O were allowed surely represents the cases most refractory to treatment despite the selection of high PEEP levels, strict reduction of Vt, and the application of recruitment maneuvering. The observation of increased mortality in the patients with Ppl>30cmH2O could warrant the earlier introduction of alternative therapies which through the extracorporeal removal of CO2 could allow even further lowering of the applied Vt to below 4ml/kg.<a class="elsevierStyleCrossRef" href="#bib0345">30</a>The difference in mortality between the different cohorts could also be explained by other factors such as the patient screening criteria used, the clinical characteristics, the severity of ARDS, and comorbidities. The previous clinical characteristics of the patients are important in relation to the prognosis, particularly the presence of major comorbidities such as cancer or immune depression. In our study all the patients with hematopoietic cell transplantation and neutropenia who developed severe ARDS died. The mortality rate in patients with immune impairment or active malignancy remains high, since the cause giving rise to ARDS is usually difficult to revert. Furthermore, it is not uncommon for these patients to present several subsequent complications.<a class="elsevierStyleCrossRefs" href="#bib0350">31,32</a>Another factor associated to increased mortality was the concomitant presence of septic shock and its association to multiorgan failure, which could explain the poorer prognosis in comparison with other etiologies of ARDS.<a class="elsevierStyleCrossRefs" href="#bib0285">18,33</a> Lastly, older age was also associated to poorer survival. Although the usefulness of age as a prognostic marker in certain diseases has been questioned,<a class="elsevierStyleCrossRef" href="#bib0365">34</a> in the case of ARDS the association has been previously established by a number of studies.<a class="elsevierStyleCrossRefs" href="#bib0285">18,35</a>A new definition of ARDS has recently been proposed: the Berlin definition, based on the PaO2/FiO2 ratio in patients ventilated with at least 5cmH2O of PEEP.<a class="elsevierStyleCrossRef" href="#bib0240">9</a> Likewise, a prognostic stratification based on the PaO2/FiO2 ratio has been proposed. In our series, in the same way as in some recent studies published after the Berlin classification,<a class="elsevierStyleCrossRefs" href="#bib0245">10,11</a> we observed no significant differences in mortality between the groups of patients with PaO2/FiO2 above or below 100mmHg. The application of ventilation in the prone position in patients with greater gas exchange alterations, and the option of using special rescue measures, possibly may have contributed to reduce mortality in the more serious cases. On the other hand, the mortality associated to ARDS depends not only on the degree of lung injury but also on the patient basal conditions and the presence of other organ dysfunctions.Although there were some missing data in the registry of mortality after 6 months in our study (9 patients were lost), only two of the patients discharged from hospital died in the course of the follow-up period, and both of them had pre-existing comorbidities. The epidemiological studies in general only report in-hospital mortality and/or mortality after 90 days.<a class="elsevierStyleCrossRefs" href="#bib0265">14–18</a> In series involving longer follow-up, pulmonary, cognitive, neuromuscular and psychological defects have been recorded as long as 5 years after the ARDS episode.<a class="elsevierStyleCrossRefs" href="#bib0375">36–39</a> In an epidemiological study with 109 survivors, the mortality rate after 12 months was reported as 11%, with most of the fatalities occurring in the first few months.<a class="elsevierStyleCrossRef" href="#bib0380">37</a>Our study has several limitations. Firstly, its retrospective nature increases the risk of missing data. Nevertheless, we were able to compile full information on most of the patients, even after discharge. Secondly, as this was a single-center study, its external validity may be questioned. Likewise, other conditions that could have an impact upon survival, such as ventilator-associated pneumonia (VAP) or pneumothorax, were not contemplated. Lastly, although we evaluated mortality over the long term, no analysis was made of morbidity, chronic MV dependency or other disabilities.If the introduction of protective MV is found to result in an improved patient prognosis beyond the context of controlled studies, multicenter epidemiological studies involving large patient samples would be needed for confirmation purposes.In conclusion, our findings suggest that mortality associated to severe ARDS is less than reported in earlier years, and is independently correlated to patient age, septic shock, MV with Ppl>30cmH2O, and the existence of previous comorbidities. Mechanical ventilation using low Vt and high PEEP levels, together with ventilation in the prone position and the adoption of rescue measures in patients with refractory hypoxemia or hypercapnia may have contributed to this potential benefit in terms of survival. In those patients discharged from hospital, we observed no increase in mortality upon assessment after 6 months. Lastly, the Berlin classification did not allow stratification of the prognosis between cases of severe ARDS and moderate ARDS.Conflicts of interestThe authors have received no financial support for the conduction of this study, and declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres825211" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec821701" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres825212" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec821700" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Data acquisition" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-13" "fechaAceptado" => "2015-10-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec821701" "palabras" => array:4 [ 0 => "Acute respiratory distress syndrome" 1 => "Mortality" 2 => "Respiratory failure" 3 => "Acute respiratory distress syndrome rescue therapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec821700" "palabras" => array:4 [ 0 => "Síndrome de distress respiratorio agudo" 1 => "Mortalidad" 2 => "Insuficiencia respiratoria" 3 => "Terapias de rescate en síndrome de distress respiratorio agudo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionMortality in Acute Respiratory Distress Syndrome (ARDS) is decreasing, although its prognosis after hospital discharge and the prognostic accuracy of Berlin's new ARDS stratification are uncertain. MethodsWe did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a University Hospital in Buenos Aires, between January 2008 and June 2011. ARDS was defined by PaO2/FiO2 lower than 200mmHg under ventilation with at least 10cmH2O of PEEP and a FiO2 higher or equal than 0.5 and the presence of bilateral infiltrates in chest radiography, in the absence of cardiogenic acute pulmonary edema, during the first 72h of mechanical ventilation. Mortality associated risk factors, the use of rescue therapies and Berlin's stratification for moderate and severe ARDS patients were considered. ResultsNinety eight patients were included; mean age was 59±19 years old, 42.9% had mayor co-morbidities; APACHE II at admission was 22±7; SOFA at day 1 was 8±3. Prone position ventilation was applied in 20.4% and rescue measures in 12.2% (12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation). Hospital and 6 months mortality were 37.7 and 43.8% respectively. After logistic regression analysis, only age, the presence of septic shock at admission, Ppl>30cmH2O, and major co-morbidities were independently associated with hospital outcome. There was no difference between moderate and severe groups (41.2 and 36.8% respectively; p=0.25). ConclusionIn this cohort, including patients with severe hypoxemia and high percentage of mayor co-morbidities, ARDS associated mortality was lower than some previous studies. There was no increase in mortality after hospital discharge. There was no difference in mortality between moderate and severe groups according to Berlin's definition." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa mortalidad del distress respiratorio agudo está disminuyendo, aunque hay poca evidencia sobre su pronóstico después del egreso hospitalario y la adecuada estratificación pronóstica con la nueva clasificación de Berlín. MétodosSe analizó retrospectivamente la mortalidad de pacientes con SDRA admitidos en la Unidad de Cuidados Críticos de1 Hospital Universitario de la ciudad de Buenos Aires, desde el 1 de 2008 hasta el 6 de 2011. Se definió SDRA por hipoxemia con PaO2/FiO2≤200mmHg con al menos 10 cmH2O de PEEP y FiO2≥0,5 e infiltrados bilaterales en la radiografía de tórax en ausencia de edema agudo de pulmón cardiogénico en las primeras 72h de ventilación mecánica. Se registraron la mortalidad hospitalaria y a 6 meses, los factores asociados a mortalidad, la utilización de terapias de rescate, y la validez de la clasificación de Berlín para casos moderados y graves. ResultadosSe incluyeron 98 pacientes; edad 59±19 años; 42,9% con comorbilidades mayores; APACHEII 22±7; SOFA (día 1) 8±3. La VM en posición prono se aplicó en 20,4% y en 12,2% rescates especiales (12 óxido nítrico y 1 ECMO). La mortalidad hospitalaria y a 6 meses fue de 37,7 y 43,8% respectivamente. Los factores asociados a mortalidad fueron: edad, shock séptico en las primeras 72 h, presión plateau (Ppl) >30cmH2O durante las primeras 72 h y la presencia de comorbilidades preexistentes. No hubo diferencia de mortalidad entre los grupos moderado y grave (41,2 vs. 36,8%; p=0,25). ConclusionesEn este estudio que incluyó pacientes con hipoxemia más grave y alto porcentaje con comorbilidades mayores, la mortalidad fue menor que en algunos estudios previos; no hubo incremento en la mortalidad después del egreso hospitalario. La clasificación de Berlín no diferenció el pronóstico entre los casos moderados y graves." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Lopez Saubidet I, Maskin LP, Rodríguez PO, Bonelli I, Setten M, Valentini R. Mortalidad en pacientes con síndrome de distress respiratorio. Med Intensiva. 2016;40:356–363." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "This study was presented at the XXII Argentinean Congress of Intensive Care Medicine." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2283 "Ancho" => 961 "Tamanyo" => 101778 ] ] "descripcion" => array:1 [ "en" => "A total of 2466 patients were admitted to the ICU over 42 consecutive months from January 2008 to June 2011. Of these, 789 required MV, and 126 presented ARDS according to the criteria of the American-European consensus of 1994 (AECC). Among the latter subjects, 28 were excluded due to improvement in under 24h of adjusting MV with adequate PEEP and FiO2 levels. A total of 98 patients were finally included in the study. Of these, 37 died and 61 survived (overall mortality rate 37.7%). MV: mechanical ventilation; ARDS: acute respiratory distress syndrome." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1561 "Ancho" => 2633 "Tamanyo" => 124737 ] ] "descripcion" => array:1 [ "en" => "Mortality according to plateau pressure on days 1 and 7 of ARDS. Ppl: end-inspiratory plateau pressure." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "APACHE II: Acute Physiology, Age and Chronic Health Evaluation; SOFA: Sepsis-related Organ Failure Assessment.Data expressed as mean (standard deviation), or number of patients (percentage)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total population (n=98) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n=61) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deceased (n=37) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ideal body weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.1 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.2 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE II score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SOFA score (day 1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major comorbidities<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>(%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (42.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septic shock (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (67.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary injury (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (60.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (60.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (59.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary injury (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (39.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (39.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (40.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Reason for admission to ICU (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (49.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extrapulmonary sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (24.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (21.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (29.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (16.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Burns \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1387535.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Major comorbidities include: active cancer disease, solid organ transplant, hematopoietic cell transplant and other immune depression conditions." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Others include: abdominal aortic aneurysm, gastrointestinal bleeding and diffuse pulmonary hemorrhage." ] ] ] "descripcion" => array:1 [ "en" => "Patient demographic data." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "All data were recorded on day 1 of mechanical ventilation.Csr: static compliance of the respiratory system; FiO2: fraction of inspired oxygen; PaO2: partial pressure of oxygen in arterial blood; PaCO2: partial pressure of carbon dioxide in arterial blood; PEEP: positive end-expiratory pressure; Ppl: end-inspiratory plateau pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total population (n=98) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors (n=61) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deceased (n=37) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total PEEP (cmH2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 (3.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.2 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.5 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tidal volume (ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">411 (68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">407 (66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">417 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tidal volume (ml/kg/ideal body weight) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ppl (cmH2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.4 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.8 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.5 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Csr (ml/cmH2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO2/FiO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.28 (0.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.29 (0.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.26 (0.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1387536.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Mechanical ventilation and gas exchange data." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Factors independently associated to prognosis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Confidence interval \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0–1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septic shock upon admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2–18.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plateau pressure>30cmH2O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5–19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major comorbidities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6–52.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1387538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated to patient prognosis." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "FiO2: fraction of inspired oxygen; PaO2: partial pressure of oxygen in arterial blood 1; PEEP: positive end-expiratory pressure; Vt/kg: tidal volume per kg ideal body weight." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">ALIVE (2003) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">VENTILA (2004) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">KCLIP (2005) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">FINNALI (2009) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">ALIEN (2011) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Villar et al. (2007) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">CEMIC (2011) \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=401 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=198 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=828 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=68 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=255 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=99 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n=98 \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inclusion criterion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤300) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200)+PEEP≥10 and FiO2≥0.5 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC (≤200)+PEEP≥10 and FiO2≥0.5 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.4 (18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 (41–73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 (44–67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 (47–72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.6 (5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20.8(6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO2/FiO2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">119 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">114 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">155.8 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">146 (40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PEEP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.7 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5–12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.3 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.4 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vt/kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.3 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6–8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n/d \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.2 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.5 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41.10% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45.50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.70% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1387537.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the principal demographic and ventilatory variables and of mortality between the different published series and our population." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:39 [ 0 => array:3 [ "identificador" => "bib0200" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality rates for patients with acute lung injury/ARDS have decreased over time" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Zambon" 1 => "J.L. Vincent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.07-2134" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2008" "volumen" => "133" "paginaInicial" => "1120" "paginaFinal" => "1127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18263687" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0205" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Has mortality from acute respiratory distress syndrome decreased over time?: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Phua" 1 => "J.R. Badia" 2 => "N.K. Adhikari" 3 => "J.O. Friedrich" 4 => "R.A. Fowler" 5 => "J.M. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200805-722OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2009" "volumen" => "179" "paginaInicial" => "220" "paginaFinal" => "227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19011152" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0210" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Expiratory Pressure (Express) Study Group" "etal" => true "autores" => array:6 [ 0 => "A. Mercat" 1 => "J.C. Richard" 2 => "B. Vielle" 3 => "S. Jaber" 4 => "D. Osman" 5 => "J.L. Diehl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.6.646" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "646" "paginaFinal" => "655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18270353" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0215" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Lung Open Ventilation Study Investigators" "etal" => true "autores" => array:6 [ 0 => "M.O. Meade" 1 => "D.J. Cook" 2 => "G.H. Guyatt" 3 => "A.S. Slutsky" 4 => "Y.M. Arabi" 5 => "D.J. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.6.637" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "637" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18270352" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0220" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Briel" 1 => "M. Meade" 2 => "A. Mercat" 3 => "R.G. Brower" 4 => "D. Talmor" 5 => "S.D. Walter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2010.218" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2010" "volumen" => "303" "paginaInicial" => "865" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20197533" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0225" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prone positioning in severe acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the PROSEVA Study Group" "etal" => false "autores" => array:3 [ 0 => "C. Guérin" 1 => "J. Reignier" 2 => "J.C. Richard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1214103" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "368" "paginaInicial" => "2159" "paginaFinal" => "2168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688302" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0230" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "NIH NHLBI ARDS Network. Recent trends in acute lung injury mortality: 1996–2005" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.E. Erickson" 1 => "G.S. Martin" 2 => "J.L. Davis" 3 => "M.A. Matthay" 4 => "M.D. Eisner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e31819fefdf" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "1574" "paginaFinal" => "1579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19325464" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0235" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HELP Network. An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Villar" 1 => "L. Pérez-Méndez" 2 => "J. López" 3 => "J. Belda" 4 => "J. Blanco" 5 => "L. Saralegui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200610-1534OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2007" "volumen" => "176" "paginaInicial" => "795" "paginaFinal" => "804" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17585106" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0240" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory distress syndrome: the Berlin definition" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ARDS Definition Task Force" "etal" => true "autores" => array:6 [ 0 => "V.M. Ranieri" 1 => "G.D. Rubenfeld" 2 => "B.T. Thompson" 3 => "N.D. Ferguson" 4 => "E. Calguel" 5 => "E. Fan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.5669" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "2526" "paginaFinal" => "2533" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22797452" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0245" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An attempt to validate the modification of the American-European consensus definition of acute lung injury/acute respiratory distress syndrome by the Berlin definition in a university hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Hernu" 1 => "F. Wallet" 2 => "F. Thiollière" 3 => "O. Martin" 4 => "J.C. Richard" 5 => "Z. Schmitt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-013-3122-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "2161" "paginaFinal" => "2170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24114319" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0250" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Spanish Initiative for Epidemiology, Stratification & Therapies for ARDS (SIESTA) Network" "etal" => true "autores" => array:6 [ 0 => "J. Villar" 1 => "J. Blanco" 2 => "R. del Campo" 3 => "D. Andaluz-Ojeda" 4 => "F.J. Díaz-Domínguez" 5 => "A. Muriel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2014-006812" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "e006812" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25818272" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0255" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.R. Bernard" 1 => "A. Artigas" 2 => "K.L. Brigham" 3 => "J. Carlet" 4 => "K. Falke" 5 => "L. Hudson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.149.3.7509706" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1994" "volumen" => "149" "paginaInicial" => "818" "paginaFinal" => "824" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7509706" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0260" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Vincent" 1 => "R. Moreno" 2 => "J. Takala" 3 => "S. Willats" 4 => "A. Mendonca" 5 => "H. Bruining" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "1996" "volumen" => "22" "paginaInicial" => "707" "paginaFinal" => "710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8844239" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0265" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ALIEN Network" "etal" => true "autores" => array:6 [ 0 => "J. Villar" 1 => "J. Blanco" 2 => "J.M. Añón" 3 => "A. Santos-Bouza" 4 => "L. Blanch" 5 => "A. Ambros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-011-2380-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1932" "paginaFinal" => "1941" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21997128" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0270" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory failure in intensive care units. FINNALI: a prospective cohort study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "FINNALI-study group" "etal" => true "autores" => array:6 [ 0 => "R. Linko" 1 => "M. Okkonen" 2 => "V. Pettilä" 3 => "J. Pettilä" 4 => "L. Parviainen" 5 => "E. Roukonen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-009-1519-z" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "1352" "paginaFinal" => "1361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19526218" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0275" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "ALIVE Study Group" "etal" => false "autores" => array:3 [ 0 => "C. Brun-Buisson" 1 => "C. Minelli" 2 => "G. Bertolini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-003-2022-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "51" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14569423" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0280" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and outcomes of acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.D. Rubenfeld" 1 => "E. Caldwell" 2 => "E. Peabody" 3 => "J. Weaver" 4 => "D.P. Martin" 5 => "M. Neff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa050333" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "353" "paginaInicial" => "1685" "paginaFinal" => "1693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236739" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0285" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolution of mechanical ventilation in response to clinical research" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "VENTILA Group" "etal" => true "autores" => array:6 [ 0 => "A. Esteban" 1 => "N.D. Ferguson" 2 => "M.O. Meade" 3 => "F. Frutos-Vivar" 4 => "C. Apesteguia" 5 => "L. Brochard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200706-893OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2008" "volumen" => "177" "paginaInicial" => "170" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17962636" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0290" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "National Heart, Lung, and Blood Institute ARDS Clinical Trials Network" "etal" => true "autores" => array:6 [ 0 => "R.G. Brower" 1 => "P.N. Lanken" 2 => "N. MacIntyre" 3 => "M.A. Matthey" 4 => "A. Morris" 5 => "M. Ancukiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa032193" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2004" "volumen" => "351" "paginaInicial" => "327" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15269312" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0295" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transpulmonary pressure and gas exchange during decremental PEEP titration in pulmonary ARDS patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.O. Rodriguez" 1 => "I. Bonelli" 2 => "M. Setten" 3 => "S. Attie" 4 => "M. Madorno" 5 => "L.P. Maskin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.01977" "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "754" "paginaFinal" => "763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23051849" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0300" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "July 7" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled nitric oxide for acute respiratory distress syndrome (ARDS) and acute lung injury in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Afshari" 1 => "J. Brok" 2 => "A.M. Møller" 3 => "J. Wetterslev" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2010" "paginaInicial" => "CD002787" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0305" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracorporeal membrane oxygenation for 2009 Influenza A (H1N1) acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators" "etal" => true "autores" => array:6 [ 0 => "A. Davies" 1 => "D. Jones" 2 => "M. Bailey" 3 => "J. Beca" 4 => "R. Bellomo" 5 => "N. Blackwell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2009.1535" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2009" "volumen" => "302" "paginaInicial" => "1888" "paginaFinal" => "1895" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19822628" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0310" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of extracorporeal membrane oxygenation for treatment of the adult respiratory distress syndrome: review and quantitative analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.P. Chalwin" 1 => "J.L. Moran" 2 => "P.L. Graham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesth Intensive Care" "fecha" => "2008" "volumen" => "36" "paginaInicial" => "152" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18361004" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0315" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentrer randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Peek" 1 => "M. Mugford" 2 => "R. Tiruvoipati" 3 => "A. Wilson" 4 => "E. Allen" 5 => "M.M. Thalanany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61069-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "1351" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762075" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0320" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de oxigenación con membrana extracorpórea en fase tardía del síndrome de distrés respiratorio agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. López-Saubidet" 1 => "P.O. Rodríguez" 2 => "P. Maskin" 3 => "S. Attie" 4 => "I. Bonelli" 5 => "R. Valentini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2010.12.007" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "448" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21496966" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0325" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pandemic 2009 Influenza A in Argentina, a study of 337 patients on mechanical ventilation" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the Registry of the Argentinian Society of Intensive Care (SATI)" "etal" => true "autores" => array:6 [ 0 => "E. Estenssoro" 1 => "F.G. Rıos" 2 => "C. Apezteguıa" 3 => "R. Reina" 4 => "J. Neira" 5 => "D.H. Ceraso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/201001-0037OC" "Revista" => array:6 [ "tituloSerie" => "Am J Resp Crit Care Med" "fecha" => "2010" "volumen" => "182" "paginaInicial" => "41" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20203241" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0330" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The Acute Respiratory Distress Syndrome Network" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200005043421801" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "342" "paginaInicial" => "1301" "paginaFinal" => "1308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0335" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bench-to-bedside review: chest wall elastance in acute lung injury/acute respiratory distress syndrome patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Gattinoni" 1 => "D. Chiumello" 2 => "E. Carlesso" 3 => "F. Valenza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc2854" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2004" "volumen" => "8" "paginaInicial" => "350" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15469597" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0340" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tidal volume lower than 6ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.P. Terragni" 1 => "L. del Sorbo" 2 => "L. Mascia" 3 => "R. Urbino" 4 => "E.L. Martin" 5 => "A. Birocco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181b764d2" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2009" "volumen" => "111" "paginaInicial" => "826" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19741487" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0345" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower tidal volume strategy (≈3ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6ml/kg) in severe ARDS: the prospective randomized Xtravent-study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Bein" 1 => "S. Weber-Carstens" 2 => "A. Goldmann" 3 => "T. Müller" 4 => "T. Staudinger" 5 => "J. Brederlau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2787-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "847" "paginaFinal" => "856" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23306584" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0350" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of mechanical ventilation and renal replacement therapy in critically ill hematopoietic stem cell transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Gilbert" 1 => "T.S. Vasu" 2 => "M. Baram" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbmt.2012.09.010" "Revista" => array:6 [ "tituloSerie" => "Biol Blood Marrow Transplant" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "321" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23025989" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0355" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory distress syndrome in patients with malignancies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Azoulay" 1 => "V. Lemiale" 2 => "D. Mokart" 3 => "F. Pene" 4 => "A. Kouatchet" 5 => "P. Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-014-3354-0" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "1106" "paginaFinal" => "1114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24898895" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0360" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.C. Sheu" 1 => "M.N. Gong" 2 => "R. Zhai" 3 => "F. Chen" 4 => "E.K. Baiwa" 5 => "P.F. Clardy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-2933" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "559" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20507948" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0365" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How important is age in defining the prognosis of patients with community-acquired pneumonia?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.I. Sligl" 1 => "S.R. Majumdar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QCO.0b013e328343b6f8" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Infect Dis" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "142" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21252659" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0370" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome: age, plateau pressure, and PaO2/FiO2 at ARDS onset can predict mortality" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Hospitales Españoles Para el Estudio de la Lesión Pulmonar (HELP) Network" "etal" => true "autores" => array:6 [ 0 => "J. Villar" 1 => "L. Pérez-Méndez" 2 => "S. Basaldúa" 3 => "J. Blanco" 4 => "G. Aguilar" 5 => "D. Toral" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.00811" "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2011" "volumen" => "56" "paginaInicial" => "420" "paginaFinal" => "428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21255500" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0375" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.L. Groll" 1 => "D.K. Heyland" 2 => "M. Caeser" 3 => "J.G. Wright" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.phm.0000223220.91914.61" "Revista" => array:6 [ "tituloSerie" => "Am J Phys Med Rehabil" "fecha" => "2006" "volumen" => "85" "paginaInicial" => "574" "paginaFinal" => "581" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16788388" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0380" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "One-year outcomes in survivors of the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Canadian Critical Care Trials Group" "etal" => true "autores" => array:6 [ 0 => "M.S. Herridge" 1 => "A.M. Cheung" 2 => "C.M. Tansey" 3 => "A. Matte-Martyn" 4 => "N. Diaz Granados" 5 => "F. Al-Saidi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa022450" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "348" "paginaInicial" => "683" "paginaFinal" => "693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12594312" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0385" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional disability 5 years after acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Canadian Critical Care Trials Group" "etal" => true "autores" => array:6 [ 0 => "M.S. Herridge" 1 => "C.M. Tansey" 2 => "A. Matté" 3 => "G. Tomlinson" 4 => "N. Diaz-Granados" 5 => "A. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1011802" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "1293" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21470008" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0390" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.O. Hopkins" 1 => "L.K. Weaver" 2 => "D. Collingridge" 3 => "R.B. Parkinson" 4 => "K.J. Chan" 5 => "J.F. Orme Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200406-763OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2005" "volumen" => "171" "paginaInicial" => "340" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15542793" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300285/v2_201704060203/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000006/v2_201704060203/S2173572716300285/v2_201704060203/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300285?idApp=WMIE"]

Statistics

Original

Mortality in patients with respiratory distress syndrome

Mortalidad en pacientes con síndrome de distress respiratorio

I. Lopez Saubidet

Corresponding author

ilopezsaubidet@gmail.com

Corresponding author.

, L.P. Maskin, P.O. Rodríguez, I. Bonelli, M. Setten, R. Valentini

Terapia Intensiva, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Buenos Aires, Argentina

Read

10167

Times
was read the article

3599

Total PDF

6568

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173572716300285"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2015.10.004"
  "estado" => "S300"
  "fechaPublicacion" => "2016-08-01"
  "aid" => "858"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Intensiva. 2016;40:356-63"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3090
    "formatos" => array:3 [
      "EPUB" => 178
      "HTML" => 2109
      "PDF" => 803
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569115002429"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2015.10.007"
      "estado" => "S300"
      "fechaPublicacion" => "2016-08-01"
      "aid" => "858"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2016;40:356-63"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8822
        "formatos" => array:3 [
          "EPUB" => 214
          "HTML" => 6540
          "PDF" => 2068
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Mortalidad en pacientes con s&#237;ndrome de <span class="elsevierStyleItalic">distress</span> respiratorio"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "356"
            "paginaFinal" => "363"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Mortality in patients with respiratory distress syndrome"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2283
                "Ancho" => 960
                "Tamanyo" => 96086
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Dos mil cuatrocientos sesenta y seis pacientes ingresaron en la Unidad de Cuidados Criticos en 42 meses consecutivos entre enero de 2008 y junio de 2011&#44; 789 requirieron ventilaci&#243;n mec&#225;nica&#44; 126 pacientes presentaron s&#237;ndrome de <span class="elsevierStyleItalic">distress</span> respiratorio agudo seg&#250;n criterios del consenso americano-europeo de 1994 &#40;AECC&#41;&#46; De estos &#250;ltimos 28 fueron excluidos por presentar mejor&#237;a en menos de 24 h al ajustar la ventilaci&#243;n mec&#225;nica con niveles adecuados de presi&#243;n positiva de fin de espiraci&#243;n &#40;PEEP&#41; y FiO<span class="elsevierStyleInf">2</span>&#46; Finalmente 98 pacientes fueron incluidos al estudio de los cuales 37 fallecieron y 61 sobrevivieron &#40;mortalidad global del 37&#44;7&#37;&#41;&#46; VM&#58; ventilaci&#243;n mec&#225;nica&#59; SDRA&#58; s&#237;ndrome de <span class="elsevierStyleItalic">distress</span> repiratorio agudo&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "I&#46; Lopez Saubidet, L&#46;P&#46; Maskin, P&#46;O&#46; Rodr&#237;guez, I&#46; Bonelli, M&#46; Setten, R&#46; Valentini"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Lopez Saubidet"
              ]
              1 => array:2 [
                "nombre" => "L&#46;P&#46;"
                "apellidos" => "Maskin"
              ]
              2 => array:2 [
                "nombre" => "P&#46;O&#46;"
                "apellidos" => "Rodr&#237;guez"
              ]
              3 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Bonelli"
              ]
              4 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Setten"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Valentini"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572716300285"
          "doi" => "10.1016/j.medine.2015.10.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300285?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002429?idApp=WMIE"
      "url" => "/02105691/0000004000000006/v1_201607300234/S0210569115002429/v1_201607300234/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S2173572716300303"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2015.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-08-01"
    "aid" => "865"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:364-70"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1972
      "formatos" => array:3 [
        "EPUB" => 176
        "HTML" => 1190
        "PDF" => 606
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Design and application of model for training ultrasound-guided vascular cannulation in pediatric patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "364"
          "paginaFinal" => "370"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Dise&#241;o y aplicaci&#243;n de un modelo de entrenamiento para la canalizaci&#243;n vascular ecoguiada en pacientes pedi&#225;tricos"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1128
              "Ancho" => 1801
              "Tamanyo" => 217246
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Components of the training model&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "O&#46; P&#233;rez-Quevedo, J&#46;M&#46; L&#243;pez-&#193;lvarez, J&#46;M&#46; Limi&#241;ana-Ca&#241;al, J&#46;F&#46; Loro-Ferrer"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "O&#46;"
              "apellidos" => "P&#233;rez-Quevedo"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "L&#243;pez-&#193;lvarez"
            ]
            2 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Limi&#241;ana-Ca&#241;al"
            ]
            3 => array:2 [
              "nombre" => "J&#46;F&#46;"
              "apellidos" => "Loro-Ferrer"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300303?idApp=WMIE"
    "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300303/v2_201704060203/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173572716300273"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2015.07.004"
    "estado" => "S300"
    "fechaPublicacion" => "2016-08-01"
    "aid" => "831"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:348-55"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2645
      "formatos" => array:3 [
        "EPUB" => 179
        "HTML" => 1651
        "PDF" => 815
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Predicting short-term mortality in patients with acute exacerbation of chronic heart failure&#58; The EAHFE-3D scale"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "348"
          "paginaFinal" => "355"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Predicci&#243;n de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca cr&#243;nica agudizada&#58; escala EAHFE-3D"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 981
              "Ancho" => 1333
              "Tamanyo" => 92237
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">EAHFE-3D score&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Jacob, &#210;&#46; Mir&#243;, P&#46; Herrero, F&#46;J&#46; Mart&#237;n-S&#225;nchez, V&#46; Gil, J&#46; Tost, A&#46; Aguirre, R&#46; Escoda, A&#46; Alqu&#233;zar, J&#46;A&#46; Andueza, P&#46; Llorens"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Jacob"
            ]
            1 => array:2 [
              "nombre" => "&#210;&#46;"
              "apellidos" => "Mir&#243;"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Herrero"
            ]
            3 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Mart&#237;n-S&#225;nchez"
            ]
            4 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Gil"
            ]
            5 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Tost"
            ]
            6 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Aguirre"
            ]
            7 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Escoda"
            ]
            8 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Alqu&#233;zar"
            ]
            9 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Andueza"
            ]
            10 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Llorens"
            ]
            11 => array:1 [
              "colaborador" => "on behalf of ICA-SEMES Group"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569115001734"
        "doi" => "10.1016/j.medin.2015.07.013"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115001734?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300273?idApp=WMIE"
    "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300273/v2_201704060203/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
    "titulo" => "Mortality in patients with respiratory distress syndrome"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "356"
        "paginaFinal" => "363"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "I&#46; Lopez Saubidet, L&#46;P&#46; Maskin, P&#46;O&#46; Rodr&#237;guez, I&#46; Bonelli, M&#46; Setten, R&#46; Valentini"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "I&#46;"
            "apellidos" => "Lopez Saubidet"
            "email" => array:1 [
              0 => "ilopezsaubidet&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "L&#46;P&#46;"
            "apellidos" => "Maskin"
          ]
          2 => array:2 [
            "nombre" => "P&#46;O&#46;"
            "apellidos" => "Rodr&#237;guez"
          ]
          3 => array:2 [
            "nombre" => "I&#46;"
            "apellidos" => "Bonelli"
          ]
          4 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "Setten"
          ]
          5 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "Valentini"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Terapia Intensiva&#44; Centro de Educaci&#243;n M&#233;dica e Investigaciones Cl&#237;nicas Norberto Quirno&#44; CEMIC&#44; Buenos Aires&#44; Argentina"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Mortalidad en pacientes con s&#237;ndrome de <span class="elsevierStyleItalic">distress</span> respiratorio"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2283
            "Ancho" => 961
            "Tamanyo" => 101778
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 2466 patients were admitted to the ICU over 42 consecutive months from January 2008 to June 2011&#46; Of these&#44; 789 required MV&#44; and 126 presented ARDS according to the criteria of the American-European consensus of 1994 &#40;AECC&#41;&#46; Among the latter subjects&#44; 28 were excluded due to improvement in under 24<span class="elsevierStyleHsp" style=""></span>h of adjusting MV with adequate PEEP and FiO<span class="elsevierStyleInf">2</span> levels&#46; A total of 98 patients were finally included in the study&#46; Of these&#44; 37 died and 61 survived &#40;overall mortality rate 37&#46;7&#37;&#41;&#46; MV&#58; mechanical ventilation&#59; ARDS&#58; acute respiratory distress syndrome&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite improved knowledge of the physiopathology of acute respiratory distress syndrome &#40;ARDS&#41; and technological advances&#44; controversy remains as to whether there has been a resulting decrease in patient mortality&#46; In this regard&#44; recent epidemiological studies describe a high in-hospital mortality rate despite the introduction of protective mechanical ventilation &#40;MV&#41; strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; in patients with important hypoxemia&#44; the use of higher positive end-expiratory pressure &#40;PEEP&#41; levels could reduce mortality associated to refractory hypoxemia&#44; the need for recue therapeutic measures&#44; and the days on MV&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#8211;5</span></a> Likewise&#44; and as indicated by a recent trial&#44; MV in the prone position appears to result in significantly improved survival&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">6</span></a> However&#44; randomized clinical trials tend to exclude seriously ill patients and individuals with a poorer prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a> It therefore would be very interesting to obtain prognostic information from studies conducted outside the specific context of clinical trials&#44; and involving protective MV strategies with low tidal volumes &#40;Vt&#41; and higher PEEP levels&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A recently proposed definition of ARDS has included a minimum PEEP level for considering oxygen alteration&#44; and has classified severity according to the PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> Since its publication&#44; some authors have questioned the clinical usefulness of this stratification&#44; since the PEEP value at the time of diagnosis does not appear to have prognostic relevance&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a> at least not without adapting PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> to standardized PEEP and FiO<span class="elsevierStyleInf">2</span> levels&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The present study describes mortality among the patients with ARDS in our Intensive Care Unit &#40;ICU&#41;&#44; including only those individuals with moderate to severe ARDS and persistent hypoxemia after 24<span class="elsevierStyleHsp" style=""></span>h of MV&#44; with adjusted PEEP and FiO<span class="elsevierStyleInf">2</span> levels&#46; Likewise&#44; it defines the conditions associated to mortality&#44; and determines whether the Berlin classification allows prognostic stratification of our patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">A review was made of the case histories of all the patients admitted to our ICU between January 2008 and June 2011&#46; We initially selected patients over 18 years of age with a diagnosis of ARDS according to the criteria of the American-European consensus of 1994 &#40;AECC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> We only considered patients presenting hypoxemia with PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmHg on MV with PEEP levels &#8805;10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and with FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;5 within the first 72<span class="elsevierStyleHsp" style=""></span>h of MV&#44; and with chest X-rays revealing bilateral infiltrates in four quadrants in the absence of cardiogenic acute lung edema&#46; The decision to include only patients with hypoxemia under concrete PEEP and FiO<span class="elsevierStyleInf">2</span> levels was based on a previous study in which a PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio of &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg with at least 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O of PEEP clearly differentiated patient prognosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data acquisition</span><p id="par0025" class="elsevierStylePara elsevierViewall">The data were collected retrospectively from the case histories of the patients admitted to the ICU of our University Hospital over a period of 42 consecutive months&#46; We recorded demographic and etiological data&#44; the APACHE II score upon admission&#44; major comorbidities &#40;active cancer disease&#44; solid organ transplants&#44; hematopoietic cell transplants and other immune depression states&#41;&#44; gas exchange &#40;pH&#44; pCO<span class="elsevierStyleInf">2</span>&#44; pO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41;&#44; MV parameters &#40;peak pressure&#44; plateau pressure &#91;Ppl&#93;&#44; total PEEP&#44; working pressure &#91;Ppl minus total PEEP&#93;&#44; exhaled Vt&#44; Vt per kg ideal body weight &#91;Vt&#47;kg&#93;&#44; static compliance of the respiratory system&#41; and the SOFA score for assessing organ dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a> In our Unit&#44; all patients are measured upon admission with a metric tape&#44; recording height and ideal body weight both in the case history and in the daily monitoring table for patients on MV&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data referred to MV and organ dysfunction were recorded on days 1&#44; 3&#44; 7 and 10 of MV&#46; In-hospital mortality and mortality after 6 months were documented&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Refractory hypoxemia and hypercapnia were defined as the persistence of PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg with FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;9 during at least 1<span class="elsevierStyleHsp" style=""></span>h&#44; and pH<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7&#46;20 with PaCO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; respectively&#44; after optimizing MV with recruitment maneuvers&#44; reducing Vt to 4&#8211;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg ideal body weight&#44; elevating the respiratory frequency &#40;RF&#41; &#40;limited by the generation of auto-PEEP or intrinsic PEEP&#41; and adopting patient pronation for 12<span class="elsevierStyleHsp" style=""></span>h in the selected individuals&#46; All these data were collected from the abovementioned MV monitoring table&#44; used in all patients subjected to MV in our Unit&#46; This table is updated every 8<span class="elsevierStyleHsp" style=""></span>h from the start of MV until patient extubation or death&#46; Mechanical ventilation in the prone position was used in patients presenting PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mmHg with at least 15<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O of PEEP&#44; and following recruitment maneuvering&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">All patients were ventilated in flow assisted&#47;controlled mode with a constant flow curve&#46; Sedoanalgesia was administered in the form of a continuous infusion of midazolam or propofol plus fentanyl&#44; and occasionally using muscle relaxants according to the criterion of the attending physician&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Due to the retrospective nature of the study&#44; the fact that the data were obtained from the normal patient records&#44; and the observation of patient confidentiality&#44; the hospital Ethics Committee approved conduction of the study without requiring the obtainment of informed consent&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Continuous variables were reported as the mean and standard deviation &#40;SD&#41; or median with the interquartile range&#44; as applicable&#46; Continuous variables and proportions were compared using the Student <span class="elsevierStyleItalic">t</span>-test and chi-squared test&#44; respectively&#46; A logistic regression model was developed&#44; entering those variables that proved significant in the univariate analysis between survivors and deceased individuals&#44; and considering mortality as final outcome or endpoint&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A forward stepwise model was developed&#46; Statistical significance was considered for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in all cases&#46;</p></span></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the study period a total of 2466 patients were admitted to the ICU and 789 required MV&#46; Of these&#44; 98 &#40;12&#46;4&#37;&#41; met the inclusion criteria and were finally included in the analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Follow-up during 6 months proved possible in 52 of 61 patients discharged alive &#40;85&#46;2&#37;&#41;&#46; The demographic and physiological data are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean age was 59 years&#59; 57&#37; were males&#59; the APACHE II score upon admission was 22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7 points&#59; and the SOFA score on day 1 was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 points&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The most frequent comorbidity was active&#44; advanced-stage solid organ cancer&#44; present in 24 patients &#40;24&#46;5&#37;&#41;&#46; Fourteen patients &#40;14&#46;3&#37;&#41; suffered other immune depressive conditions &#40;5 solid organ transplants&#44; 4 cases of acute leukemia with hematopoietic cell transplantation&#44; 2 with immunosuppressive treatment due to systemic lupus erythematosus&#44; one with immunosuppressive treatment due to Wegener&#39;s disease&#44; one with chronic corticosteroid use&#44; one with CHILD class C cirrhosis due to hepatitis B infection&#41;&#46; The main diagnoses upon admission were pneumonia &#40;51&#37;&#41;&#44; extrapulmonary sepsis &#40;24&#46;5&#37;&#41;&#44; polytraumatism &#40;11&#46;2&#37;&#41; and chest surgery &#40;7&#46;1&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The PEEP and Vt&#47;kg levels used in the first 48<span class="elsevierStyleHsp" style=""></span>h of MV were 13&#46;3 &#40;&#177;2&#46;9&#41;<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and 6&#46;8 &#40;&#177;1&#41;<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#44; respectively&#46; The Ppl value was 27&#46;4 &#40;&#177;4&#41;<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio on day 1 of MV was 145 &#40;&#177;40&#41;<span class="elsevierStyleHsp" style=""></span>mmHg&#46; In 12 cases &#40;12&#46;2&#37;&#41; rescue treatment measures were adopted due to refractory hypoxemia or hypercapnia&#58; nitric oxide &#40;NO&#41; in 12 patients&#44; with extracorporeal membrane oxygenation &#40;ECMO&#41; in one of them&#46; Ventilation in the prone position was carried out in 20 patients &#40;20&#46;4&#37;&#41;&#46; Although this was not a randomized or prospective study&#44; and no comparative analysis therefore could be made&#44; the mortality rate among the global patients who received alternative treatments was 31&#37;&#44; which is lower than the global mortality rate for our series&#44; despite the fact that these were patients with greater ventilatory and oxygenation problems&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The in-hospital and 6 months mortality rate was 37&#46;7&#37; &#40;37 of 98 patients&#41; and 43&#46;8&#37; &#40;39 of 89 patients&#41;&#44; respectively&#46; The duration of in-ICU and in-hospital stay was 21 &#40;range 14&#8211;39&#41; and 34 &#40;range 21&#8211;52&#41; days&#44; respectively&#46; Mortality was higher among the patients with comorbidities &#40;60&#46;5&#37; vs 23&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46; All the patients with acute leukemia and hematopoietic cell transplantation died&#46; The mortality rates in the patients with PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#62;100<span class="elsevierStyleHsp" style=""></span>mmHg or &#8804;100<span class="elsevierStyleHsp" style=""></span>mmHg showed no significant differences &#40;41&#46;2&#37; vs 36&#46;8&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25&#41;&#46; In 27 patients&#44; Ppl was &#62;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O for at least 24<span class="elsevierStyleHsp" style=""></span>h during the first 48<span class="elsevierStyleHsp" style=""></span>h&#46; The mortality rate in this group was 63&#37; versus 28&#37; in the cases with Ppl<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; On grouping the patients into tertiles according to increasing Ppl ranges &#40;&#8804;25&#44; &#62;25&#8211;&#8804;30 and &#62;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#41;&#44; the mortality rate was seen to increase progressively &#40;22&#46;9&#37;&#44; 41&#46;9&#37; and 55&#37;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;046&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The working pressure was 14&#46;6 &#40;&#177;3&#46;7&#41;<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O in the patients who survived and 16&#46;2 cmH<span class="elsevierStyleInf">2</span>O &#40;&#177;3&#46;6&#41; in those who died &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Other factors associated to increased mortality were the presence of septic shock &#40;67&#46;5&#37; vs 25&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41; and the SOFA score of day 1 &#40;8&#46;9 &#91;&#177;3&#46;1&#93; vs 7&#46;4 &#91;&#177;2&#46;7&#93; points&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The logistic regression model for predicting in-hospital mortality included patient age&#44; the SOFA score&#44; working pressure &#40;day 1&#41;&#44; pH &#40;day 1&#41;&#44; Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O for at least 24<span class="elsevierStyleHsp" style=""></span>h during the first 48<span class="elsevierStyleHsp" style=""></span>h&#44; the presence of major comorbidities and septic shock&#46; Only age&#44; the presence of septic shock&#44; Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and major comorbidities were found to be independently associated to increased mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">In this study of patients with ARDS we found the mortality rate to be lower than reported in previous studies&#44; even on considering the more seriously ill cases<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">8&#44;14&#8211;18</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; The factors associated to mortality were the presence of major comorbidities&#44; age&#44; septic shock and MV with Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46; In contrast to the proposal of the Berlin classification of ARDS&#44; where the prognosis is stratified according to impairment of the PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio&#44; we observed no significant differences in mortality between patients with moderate ARDS &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mmHg and &#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and severe ARDS &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mmHg&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">There is controversy as to whether the introduction of protective MV has resulted in effectively decreased mortality in ARDS&#46; A recent systematic review including studies carried out in the protective ventilation era recorded no significant differences in mortality between the years 1994 and 2006&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a> However&#44; two of the studies involving high PEEP levels &#40;LOVS and Express&#41; were not included in this analysis&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#44;4</span></a> Although these two studies revealed no improvement in survival&#44; a metaanalysis that included both these trials and the ALVEOLI study<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">19</span></a> detected an improved prognosis in the subgroup of patients with greater oxygenation problems and exposed to high PEEP levels&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our population&#44; the criterion for selecting PEEP initially included the level needed to obtain a Ppl of up to 28&#8211;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;as used in the Express trial&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a> and in the group of patients with more intense hypoxemia&#44; PEEP was selected on the basis of the transpulmonary pressure &#40;Ptp&#41; with the aim of reaching and end-expiratory Ptp of between 0 and 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">20</span></a> These selection methods surely resulted in the application of higher PEEP levels&#44; which in addition to the strict selection of low Vt values&#44; may have contributed to the decrease in mortality observed in a group of patients with mild ARDS&#46; In this group the application of high PEEP levels may be deleterious&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">A previous study&#44; involving stratification according to FiO<span class="elsevierStyleInf">2</span> and PEEP in the group of patients with PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmHg and at least 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O of PEEP &#40;i&#46;e&#46;&#44; similar to the criteria used in selecting our own patients&#41;&#44; reported higher mortality<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">8</span></a> &#8211; though statistical significance cannot be inferred&#44; due in part to the size of the populations in the two studies&#46; Of the different factors that could account for this difference&#44; mention must be made of the utilization of PEEP levels lower than those used in our study &#40;11&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;09 vs 13&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;9<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#41;&#44; and the lesser use of rescue measures in refractory cases&#46; In our population&#44; special rescue therapies were applied in 12&#37; of the patients&#44; particularly ON inhalation&#44; and ECMO in a single case&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Controversy remains regarding the role of rescue therapies in the management of ARDS&#46; As an example&#44; no improvement in patient survival has been demonstrated with the use of NO&#44; though in this case the clinical trials were carried out before the introduction of protective MV strategies&#44; and generally involved patients without severely impaired oxygenation&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> On the other hand&#44; the utilization of ECMO has gained renewed impulse in recent years thanks to technological developments and the results of a clinical trial demonstrating benefit in terms of survival among selected patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">22&#8211;25</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Another ventilation strategy that may have contributed to the improved survival observed could be the use of ventilation in the prone position&#44; which was more widely employed than in some previous studies&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> reaching 20&#46;4&#37; of the population&#46; To date&#44; only some trials had evaluated the effect of ventilation in the prone position&#44; with no observation of increased benefits&#46; However&#44; a recent study has recorded significant improvement in survival with ventilation in the prone position introduced early and with longer sessions&#44; together with protective MV measures&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Another aspect to be considered in the ventilation strategy is the general recommendation to maintain Ppl levels of &#60;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> It has been questioned whether this recommendation applies to all patients&#44; taking into account that the true pressure that distends the lungs is Ptp&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">28</span></a> Nevertheless&#44; a Ppl of &#62;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O was independently associated to increased mortality&#46; In this sense&#44; some studies have demonstrated the presence of alveolar overdistension and the release of inflammatory mediators with Ppl levels even &#62;25<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">20&#44;29</span></a> The subgroup of patients in which Ppl levels of &#62;30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O were allowed surely represents the cases most refractory to treatment despite the selection of high PEEP levels&#44; strict reduction of Vt&#44; and the application of recruitment maneuvering&#46; The observation of increased mortality in the patients with Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O could warrant the earlier introduction of alternative therapies which through the extracorporeal removal of CO<span class="elsevierStyleInf">2</span> could allow even further lowering of the applied Vt to below 4<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">30</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The difference in mortality between the different cohorts could also be explained by other factors such as the patient screening criteria used&#44; the clinical characteristics&#44; the severity of ARDS&#44; and comorbidities&#46; The previous clinical characteristics of the patients are important in relation to the prognosis&#44; particularly the presence of major comorbidities such as cancer or immune depression&#46; In our study all the patients with hematopoietic cell transplantation and neutropenia who developed severe ARDS died&#46; The mortality rate in patients with immune impairment or active malignancy remains high&#44; since the cause giving rise to ARDS is usually difficult to revert&#46; Furthermore&#44; it is not uncommon for these patients to present several subsequent complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">31&#44;32</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Another factor associated to increased mortality was the concomitant presence of septic shock and its association to multiorgan failure&#44; which could explain the poorer prognosis in comparison with other etiologies of ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">18&#44;33</span></a> Lastly&#44; older age was also associated to poorer survival&#46; Although the usefulness of age as a prognostic marker in certain diseases has been questioned&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a> in the case of ARDS the association has been previously established by a number of studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">18&#44;35</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">A new definition of ARDS has recently been proposed&#58; the Berlin definition&#44; based on the PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio in patients ventilated with at least 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O of PEEP&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> Likewise&#44; a prognostic stratification based on the PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio has been proposed&#46; In our series&#44; in the same way as in some recent studies published after the Berlin classification&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;11</span></a> we observed no significant differences in mortality between the groups of patients with PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> above or below 100<span class="elsevierStyleHsp" style=""></span>mmHg&#46; The application of ventilation in the prone position in patients with greater gas exchange alterations&#44; and the option of using special rescue measures&#44; possibly may have contributed to reduce mortality in the more serious cases&#46; On the other hand&#44; the mortality associated to ARDS depends not only on the degree of lung injury but also on the patient basal conditions and the presence of other organ dysfunctions&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Although there were some missing data in the registry of mortality after 6 months in our study &#40;9 patients were lost&#41;&#44; only two of the patients discharged from hospital died in the course of the follow-up period&#44; and both of them had pre-existing comorbidities&#46; The epidemiological studies in general only report in-hospital mortality and&#47;or mortality after 90 days&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#8211;18</span></a> In series involving longer follow-up&#44; pulmonary&#44; cognitive&#44; neuromuscular and psychological defects have been recorded as long as 5 years after the ARDS episode&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">36&#8211;39</span></a> In an epidemiological study with 109 survivors&#44; the mortality rate after 12 months was reported as 11&#37;&#44; with most of the fatalities occurring in the first few months&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">37</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; Firstly&#44; its retrospective nature increases the risk of missing data&#46; Nevertheless&#44; we were able to compile full information on most of the patients&#44; even after discharge&#46; Secondly&#44; as this was a single-center study&#44; its external validity may be questioned&#46; Likewise&#44; other conditions that could have an impact upon survival&#44; such as ventilator-associated pneumonia &#40;VAP&#41; or pneumothorax&#44; were not contemplated&#46; Lastly&#44; although we evaluated mortality over the long term&#44; no analysis was made of morbidity&#44; chronic MV dependency or other disabilities&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">If the introduction of protective MV is found to result in an improved patient prognosis beyond the context of controlled studies&#44; multicenter epidemiological studies involving large patient samples would be needed for confirmation purposes&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; our findings suggest that mortality associated to severe ARDS is less than reported in earlier years&#44; and is independently correlated to patient age&#44; septic shock&#44; MV with Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; and the existence of previous comorbidities&#46; Mechanical ventilation using low Vt and high PEEP levels&#44; together with ventilation in the prone position and the adoption of rescue measures in patients with refractory hypoxemia or hypercapnia may have contributed to this potential benefit in terms of survival&#46; In those patients discharged from hospital&#44; we observed no increase in mortality upon assessment after 6 months&#46; Lastly&#44; the Berlin classification did not allow stratification of the prognosis between cases of severe ARDS and moderate ARDS&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have received no financial support for the conduction of this study&#44; and declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres825211"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec821701"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres825212"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec821700"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Data acquisition"
              "secciones" => array:1 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Statistical analysis"
                ]
              ]
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-08-13"
    "fechaAceptado" => "2015-10-23"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec821701"
          "palabras" => array:4 [
            0 => "Acute respiratory distress syndrome"
            1 => "Mortality"
            2 => "Respiratory failure"
            3 => "Acute respiratory distress syndrome rescue therapy"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec821700"
          "palabras" => array:4 [
            0 => "S&#237;ndrome de distress respiratorio agudo"
            1 => "Mortalidad"
            2 => "Insuficiencia respiratoria"
            3 => "Terapias de rescate en s&#237;ndrome de distress respiratorio agudo"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mortality in Acute Respiratory Distress Syndrome &#40;ARDS&#41; is decreasing&#44; although its prognosis after hospital discharge and the prognostic accuracy of Berlin&#39;s new ARDS stratification are uncertain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We did a restrospective analysis of hospital and 6 month mortality of patients with ARDS admitted to the Intensive Care Unit of a University Hospital in Buenos Aires&#44; between January 2008 and June 2011&#46; ARDS was defined by PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> lower than 200<span class="elsevierStyleHsp" style=""></span>mmHg under ventilation with at least 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O of PEEP and a FiO<span class="elsevierStyleInf">2</span> higher or equal than 0&#46;5 and the presence of bilateral infiltrates in chest radiography&#44; in the absence of cardiogenic acute pulmonary edema&#44; during the first 72<span class="elsevierStyleHsp" style=""></span>h of mechanical ventilation&#46; Mortality associated risk factors&#44; the use of rescue therapies and Berlin&#39;s stratification for moderate and severe ARDS patients were considered&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ninety eight patients were included&#59; mean age was 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 years old&#44; 42&#46;9&#37; had mayor co-morbidities&#59; APACHE II at admission was 22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#59; SOFA at day 1 was 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46; Prone position ventilation was applied in 20&#46;4&#37; and rescue measures in 12&#46;2&#37; &#40;12 patients with nitric oxide and 1 with extracorporeal membrane oxygenation&#41;&#46; Hospital and 6 months mortality were 37&#46;7 and 43&#46;8&#37; respectively&#46; After logistic regression analysis&#44; only age&#44; the presence of septic shock at admission&#44; Ppl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; and major co-morbidities were independently associated with hospital outcome&#46; There was no difference between moderate and severe groups &#40;41&#46;2 and 36&#46;8&#37; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;25&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this cohort&#44; including patients with severe hypoxemia and high percentage of mayor co-morbidities&#44; ARDS associated mortality was lower than some previous studies&#46; There was no increase in mortality after hospital discharge&#46; There was no difference in mortality between moderate and severe groups according to Berlin&#39;s definition&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La mortalidad del <span class="elsevierStyleItalic">distress</span> respiratorio agudo est&#225; disminuyendo&#44; aunque hay poca evidencia sobre su pron&#243;stico despu&#233;s del egreso hospitalario y la adecuada estratificaci&#243;n pron&#243;stica con la nueva clasificaci&#243;n de Berl&#237;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analiz&#243; retrospectivamente la mortalidad de pacientes con SDRA admitidos en la Unidad de Cuidados Cr&#237;ticos de1 Hospital Universitario de la ciudad de Buenos Aires&#44; desde el 1 de 2008 hasta el 6 de 2011&#46; Se defini&#243; SDRA por hipoxemia con PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#8804;200<span class="elsevierStyleHsp" style=""></span>mmHg con al menos 10 cmH<span class="elsevierStyleInf">2</span>O de PEEP y FiO<span class="elsevierStyleInf">2</span>&#8805;0&#44;5 e infiltrados bilaterales en la radiograf&#237;a de t&#243;rax en ausencia de edema agudo de pulm&#243;n cardiog&#233;nico en las primeras 72h de ventilaci&#243;n mec&#225;nica&#46; Se registraron la mortalidad hospitalaria y a 6 meses&#44; los factores asociados a mortalidad&#44; la utilizaci&#243;n de terapias de rescate&#44; y la validez de la clasificaci&#243;n de Berl&#237;n para casos moderados y graves&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 98 pacientes&#59; edad 59&#177;19 a&#241;os&#59; 42&#44;9&#37; con comorbilidades mayores&#59; APACHEII 22&#177;7&#59; SOFA &#40;d&#237;a 1&#41; 8&#177;3&#46; La VM en posici&#243;n prono se aplic&#243; en 20&#44;4&#37; y en 12&#44;2&#37; rescates especiales &#40;12 &#243;xido n&#237;trico y 1 ECMO&#41;&#46; La mortalidad hospitalaria y a 6 meses fue de 37&#44;7 y 43&#44;8&#37; respectivamente&#46; Los factores asociados a mortalidad fueron&#58; edad&#44; shock s&#233;ptico en las primeras 72 h&#44; presi&#243;n plateau &#40;Ppl&#41; &#62;30cmH<span class="elsevierStyleInf">2</span>O durante las primeras 72 h y la presencia de comorbilidades preexistentes&#46; No hubo diferencia de mortalidad entre los grupos moderado y grave &#40;41&#44;2 vs&#46; 36&#44;8&#37;&#59; p&#61;0&#44;25&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En este estudio que incluy&#243; pacientes con hipoxemia m&#225;s grave y alto porcentaje con comorbilidades mayores&#44; la mortalidad fue menor que en algunos estudios previos&#59; no hubo incremento en la mortalidad despu&#233;s del egreso hospitalario&#46; La clasificaci&#243;n de Berl&#237;n no diferenci&#243; el pron&#243;stico entre los casos moderados y graves&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Lopez Saubidet I&#44; Maskin LP&#44; Rodr&#237;guez PO&#44; Bonelli I&#44; Setten M&#44; Valentini R&#46; Mortalidad en pacientes con s&#237;ndrome de <span class="elsevierStyleItalic">distress</span> respiratorio&#46; Med Intensiva&#46; 2016&#59;40&#58;356&#8211;363&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">This study was presented at the XXII Argentinean Congress of Intensive Care Medicine&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2283
            "Ancho" => 961
            "Tamanyo" => 101778
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 2466 patients were admitted to the ICU over 42 consecutive months from January 2008 to June 2011&#46; Of these&#44; 789 required MV&#44; and 126 presented ARDS according to the criteria of the American-European consensus of 1994 &#40;AECC&#41;&#46; Among the latter subjects&#44; 28 were excluded due to improvement in under 24<span class="elsevierStyleHsp" style=""></span>h of adjusting MV with adequate PEEP and FiO<span class="elsevierStyleInf">2</span> levels&#46; A total of 98 patients were finally included in the study&#46; Of these&#44; 37 died and 61 survived &#40;overall mortality rate 37&#46;7&#37;&#41;&#46; MV&#58; mechanical ventilation&#59; ARDS&#58; acute respiratory distress syndrome&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1561
            "Ancho" => 2633
            "Tamanyo" => 124737
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Mortality according to plateau pressure on days 1 and 7 of ARDS&#46; Ppl&#58; end-inspiratory plateau pressure&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#58; Acute Physiology&#44; Age and Chronic Health Evaluation&#59; SOFA&#58; Sepsis-related Organ Failure Assessment&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Data expressed as mean &#40;standard deviation&#41;&#44; or number of patients &#40;percentage&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deceased &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ideal body weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;1 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;2 &#40;8&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">APACHE II score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SOFA score &#40;day 1&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Major comorbidities</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;42&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Septic shock &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;67&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Primary injury &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;60&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;60&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;59&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Secondary injury &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;39&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;40&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Reason for admission to ICU &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;49&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extrapulmonary sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;24&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;29&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chest surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Burns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1387535.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Major comorbidities include&#58; active cancer disease&#44; solid organ transplant&#44; hematopoietic cell transplant and other immune depression conditions&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Others include&#58; abdominal aortic aneurysm&#44; gastrointestinal bleeding and diffuse pulmonary hemorrhage&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient demographic data&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">All data were recorded on day 1 of mechanical ventilation&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Csr&#58; static compliance of the respiratory system&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fraction of inspired oxygen&#59; PaO<span class="elsevierStyleInf">2</span>&#58; partial pressure of oxygen in arterial blood&#59; PaCO<span class="elsevierStyleInf">2</span>&#58; partial pressure of carbon dioxide in arterial blood&#59; PEEP&#58; positive end-expiratory pressure&#59; Ppl&#58; end-inspiratory plateau pressure&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total population &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survivors &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Deceased &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total PEEP &#40;cmH<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;2 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;5 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tidal volume &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">411 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">407 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">417 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tidal volume &#40;ml&#47;kg&#47;ideal body weight&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ppl &#40;cmH<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;4 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;8 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;5 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Csr &#40;ml&#47;cmH<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">142 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;28 &#40;0&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;29 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;26 &#40;0&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaCO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1387536.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mechanical ventilation and gas exchange data&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Factors independently associated to prognosis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Odds ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Confidence interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&#8211;1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Septic shock upon admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&#8211;18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plateau pressure<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5&#8211;19&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Major comorbidities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&#8211;52&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1387538.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Factors associated to patient prognosis&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#58; fraction of inspired oxygen&#59; PaO<span class="elsevierStyleInf">2</span>&#58; partial pressure of oxygen in arterial blood 1&#59; PEEP&#58; positive end-expiratory pressure&#59; Vt&#47;kg&#58; tidal volume per kg ideal body weight&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">ALIVE &#40;2003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">VENTILA &#40;2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">KCLIP &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">FINNALI &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">ALIEN &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Villar et al&#46; &#40;2007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">CEMIC &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>828&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inclusion criterion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;300&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PEEP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 and FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AECC &#40;&#8804;200&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PEEP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 and FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#46;4 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58 &#40;41&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;44&#8211;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;47&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE <span class="elsevierStyleSmallCaps">II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;6 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;8&#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">155&#46;8 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PEEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;7 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#8211;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;3 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;4 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vt&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;3 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#8211;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n&#47;d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;2 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;5 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1387537.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Comparison of the principal demographic and ventilatory variables and of mortality between the different published series and our population&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:39 [
            0 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality rates for patients with acute lung injury&#47;ARDS have decreased over time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Zambon"
                            1 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.07-2134"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2008"
                        "volumen" => "133"
                        "paginaInicial" => "1120"
                        "paginaFinal" => "1127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18263687"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Has mortality from acute respiratory distress syndrome decreased over time&#63;&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Phua"
                            1 => "J&#46;R&#46; Badia"
                            2 => "N&#46;K&#46; Adhikari"
                            3 => "J&#46;O&#46; Friedrich"
                            4 => "R&#46;A&#46; Fowler"
                            5 => "J&#46;M&#46; Singh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200805-722OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "179"
                        "paginaInicial" => "220"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19011152"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Expiratory Pressure &#40;Express&#41; Study Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Mercat"
                            1 => "J&#46;C&#46; Richard"
                            2 => "B&#46; Vielle"
                            3 => "S&#46; Jaber"
                            4 => "D&#46; Osman"
                            5 => "J&#46;L&#46; Diehl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.299.6.646"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2008"
                        "volumen" => "299"
                        "paginaInicial" => "646"
                        "paginaFinal" => "655"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18270353"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilation strategy using low tidal volumes&#44; recruitment maneuvers&#44; and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Lung Open Ventilation Study Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;O&#46; Meade"
                            1 => "D&#46;J&#46; Cook"
                            2 => "G&#46;H&#46; Guyatt"
                            3 => "A&#46;S&#46; Slutsky"
                            4 => "Y&#46;M&#46; Arabi"
                            5 => "D&#46;J&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.299.6.637"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2008"
                        "volumen" => "299"
                        "paginaInicial" => "637"
                        "paginaFinal" => "645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18270352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Briel"
                            1 => "M&#46; Meade"
                            2 => "A&#46; Mercat"
                            3 => "R&#46;G&#46; Brower"
                            4 => "D&#46; Talmor"
                            5 => "S&#46;D&#46; Walter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2010.218"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2010"
                        "volumen" => "303"
                        "paginaInicial" => "865"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20197533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in severe acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "for the PROSEVA Study Group"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Gu&#233;rin"
                            1 => "J&#46; Reignier"
                            2 => "J&#46;C&#46; Richard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1214103"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "2159"
                        "paginaFinal" => "2168"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "NIH NHLBI ARDS Network&#46; Recent trends in acute lung injury mortality&#58; 1996&#8211;2005"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;E&#46; Erickson"
                            1 => "G&#46;S&#46; Martin"
                            2 => "J&#46;L&#46; Davis"
                            3 => "M&#46;A&#46; Matthay"
                            4 => "M&#46;D&#46; Eisner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31819fefdf"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "1574"
                        "paginaFinal" => "1579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19325464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "HELP Network&#46; An early PEEP&#47;FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "L&#46; P&#233;rez-M&#233;ndez"
                            2 => "J&#46; L&#243;pez"
                            3 => "J&#46; Belda"
                            4 => "J&#46; Blanco"
                            5 => "L&#46; Saralegui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200610-1534OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "176"
                        "paginaInicial" => "795"
                        "paginaFinal" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17585106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute respiratory distress syndrome&#58; the Berlin definition"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ARDS Definition Task Force"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;M&#46; Ranieri"
                            1 => "G&#46;D&#46; Rubenfeld"
                            2 => "B&#46;T&#46; Thompson"
                            3 => "N&#46;D&#46; Ferguson"
                            4 => "E&#46; Calguel"
                            5 => "E&#46; Fan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.5669"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "2526"
                        "paginaFinal" => "2533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22797452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An attempt to validate the modification of the American-European consensus definition of acute lung injury&#47;acute respiratory distress syndrome by the Berlin definition in a university hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Hernu"
                            1 => "F&#46; Wallet"
                            2 => "F&#46; Thiolli&#232;re"
                            3 => "O&#46; Martin"
                            4 => "J&#46;C&#46; Richard"
                            5 => "Z&#46; Schmitt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-3122-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "2161"
                        "paginaFinal" => "2170"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24114319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> for stratification of patients with moderate and severe acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Spanish Initiative for Epidemiology&#44; Stratification &#38; Therapies for ARDS &#40;SIESTA&#41; Network"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "J&#46; Blanco"
                            2 => "R&#46; del Campo"
                            3 => "D&#46; Andaluz-Ojeda"
                            4 => "F&#46;J&#46; D&#237;az-Dom&#237;nguez"
                            5 => "A&#46; Muriel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2014-006812"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2015"
                        "volumen" => "5"
                        "paginaInicial" => "e006812"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25818272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American-European Consensus Conference on ARDS&#46; Definitions&#44; mechanisms&#44; relevant outcomes&#44; and clinical trial coordination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;R&#46; Bernard"
                            1 => "A&#46; Artigas"
                            2 => "K&#46;L&#46; Brigham"
                            3 => "J&#46; Carlet"
                            4 => "K&#46; Falke"
                            5 => "L&#46; Hudson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.149.3.7509706"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "149"
                        "paginaInicial" => "818"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7509706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The SOFA &#40;Sepsis-related Organ Failure Assessment&#41; score to describe organ dysfunction&#47;failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Vincent"
                            1 => "R&#46; Moreno"
                            2 => "J&#46; Takala"
                            3 => "S&#46; Willats"
                            4 => "A&#46; Mendonca"
                            5 => "H&#46; Bruining"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1996"
                        "volumen" => "22"
                        "paginaInicial" => "707"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8844239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ALIEN study&#58; incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ALIEN Network"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "J&#46; Blanco"
                            2 => "J&#46;M&#46; A&#241;&#243;n"
                            3 => "A&#46; Santos-Bouza"
                            4 => "L&#46; Blanch"
                            5 => "A&#46; Ambros"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-011-2380-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1932"
                        "paginaFinal" => "1941"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21997128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute respiratory failure in intensive care units&#46; FINNALI&#58; a prospective cohort study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "FINNALI-study group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Linko"
                            1 => "M&#46; Okkonen"
                            2 => "V&#46; Pettil&#228;"
                            3 => "J&#46; Pettil&#228;"
                            4 => "L&#46; Parviainen"
                            5 => "E&#46; Roukonen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-009-1519-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "35"
                        "paginaInicial" => "1352"
                        "paginaFinal" => "1361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19526218"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology and outcome of acute lung injury in European intensive care units&#46; Results from the ALIVE study"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "ALIVE Study Group"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Brun-Buisson"
                            1 => "C&#46; Minelli"
                            2 => "G&#46; Bertolini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-2022-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "51"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14569423"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and outcomes of acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;D&#46; Rubenfeld"
                            1 => "E&#46; Caldwell"
                            2 => "E&#46; Peabody"
                            3 => "J&#46; Weaver"
                            4 => "D&#46;P&#46; Martin"
                            5 => "M&#46; Neff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa050333"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2005"
                        "volumen" => "353"
                        "paginaInicial" => "1685"
                        "paginaFinal" => "1693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16236739"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of mechanical ventilation in response to clinical research"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "VENTILA Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Esteban"
                            1 => "N&#46;D&#46; Ferguson"
                            2 => "M&#46;O&#46; Meade"
                            3 => "F&#46; Frutos-Vivar"
                            4 => "C&#46; Apesteguia"
                            5 => "L&#46; Brochard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200706-893OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "177"
                        "paginaInicial" => "170"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17962636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "National Heart&#44; Lung&#44; and Blood Institute ARDS Clinical Trials Network"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;G&#46; Brower"
                            1 => "P&#46;N&#46; Lanken"
                            2 => "N&#46; MacIntyre"
                            3 => "M&#46;A&#46; Matthey"
                            4 => "A&#46; Morris"
                            5 => "M&#46; Ancukiewicz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa032193"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "351"
                        "paginaInicial" => "327"
                        "paginaFinal" => "336"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15269312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transpulmonary pressure and gas exchange during decremental PEEP titration in pulmonary ARDS patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;O&#46; Rodriguez"
                            1 => "I&#46; Bonelli"
                            2 => "M&#46; Setten"
                            3 => "S&#46; Attie"
                            4 => "M&#46; Madorno"
                            5 => "L&#46;P&#46; Maskin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.01977"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2013"
                        "volumen" => "58"
                        "paginaInicial" => "754"
                        "paginaFinal" => "763"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23051849"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "July 7"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inhaled nitric oxide for acute respiratory distress syndrome &#40;ARDS&#41; and acute lung injury in children and adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Afshari"
                            1 => "J&#46; Brok"
                            2 => "A&#46;M&#46; M&#248;ller"
                            3 => "J&#46; Wetterslev"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2010"
                        "paginaInicial" => "CD002787"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracorporeal membrane oxygenation for 2009 Influenza A &#40;H1N1&#41; acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Australia and New Zealand Extracorporeal Membrane Oxygenation &#40;ANZ ECMO&#41; Influenza Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Davies"
                            1 => "D&#46; Jones"
                            2 => "M&#46; Bailey"
                            3 => "J&#46; Beca"
                            4 => "R&#46; Bellomo"
                            5 => "N&#46; Blackwell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2009.1535"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2009"
                        "volumen" => "302"
                        "paginaInicial" => "1888"
                        "paginaFinal" => "1895"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19822628"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of extracorporeal membrane oxygenation for treatment of the adult respiratory distress syndrome&#58; review and quantitative analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Chalwin"
                            1 => "J&#46;L&#46; Moran"
                            2 => "P&#46;L&#46; Graham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesth Intensive Care"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "152"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18361004"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CESAR trial collaboration&#46; Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure &#40;CESAR&#41;&#58; a multicentrer randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Peek"
                            1 => "M&#46; Mugford"
                            2 => "R&#46; Tiruvoipati"
                            3 => "A&#46; Wilson"
                            4 => "E&#46; Allen"
                            5 => "M&#46;M&#46; Thalanany"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(09)61069-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2009"
                        "volumen" => "374"
                        "paginaInicial" => "1351"
                        "paginaFinal" => "1363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilizaci&#243;n de oxigenaci&#243;n con membrana extracorp&#243;rea en fase tard&#237;a del s&#237;ndrome de distr&#233;s respiratorio agudo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; L&#243;pez-Saubidet"
                            1 => "P&#46;O&#46; Rodr&#237;guez"
                            2 => "P&#46; Maskin"
                            3 => "S&#46; Attie"
                            4 => "I&#46; Bonelli"
                            5 => "R&#46; Valentini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2010.12.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2011"
                        "volumen" => "35"
                        "paginaInicial" => "448"
                        "paginaFinal" => "450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21496966"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pandemic 2009 Influenza A in Argentina&#44; a study of 337 patients on mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "for the Registry of the Argentinian Society of Intensive Care &#40;SATI&#41;"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Estenssoro"
                            1 => "F&#46;G&#46; R&#305;os"
                            2 => "C&#46; Apeztegu&#305;a"
                            3 => "R&#46; Reina"
                            4 => "J&#46; Neira"
                            5 => "D&#46;H&#46; Ceraso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/201001-0037OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Resp Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "182"
                        "paginaInicial" => "41"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20203241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The Acute Respiratory Distress Syndrome Network"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200005043421801"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "342"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bench-to-bedside review&#58; chest wall elastance in acute lung injury&#47;acute respiratory distress syndrome patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Gattinoni"
                            1 => "D&#46; Chiumello"
                            2 => "E&#46; Carlesso"
                            3 => "F&#46; Valenza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc2854"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2004"
                        "volumen" => "8"
                        "paginaInicial" => "350"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15469597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tidal volume lower than 6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg enhances lung protection&#58; role of extracorporeal carbon dioxide removal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;P&#46; Terragni"
                            1 => "L&#46; del Sorbo"
                            2 => "L&#46; Mascia"
                            3 => "R&#46; Urbino"
                            4 => "E&#46;L&#46; Martin"
                            5 => "A&#46; Birocco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e3181b764d2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2009"
                        "volumen" => "111"
                        "paginaInicial" => "826"
                        "paginaFinal" => "835"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19741487"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower tidal volume strategy &#40;&#8776;3<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#41; combined with extracorporeal CO2 removal versus &#8216;conventional&#8217; protective ventilation &#40;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#41; in severe ARDS&#58; the prospective randomized Xtravent-study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Bein"
                            1 => "S&#46; Weber-Carstens"
                            2 => "A&#46; Goldmann"
                            3 => "T&#46; M&#252;ller"
                            4 => "T&#46; Staudinger"
                            5 => "J&#46; Brederlau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2787-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "847"
                        "paginaFinal" => "856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23306584"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of mechanical ventilation and renal replacement therapy in critically ill hematopoietic stem cell transplant recipients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Gilbert"
                            1 => "T&#46;S&#46; Vasu"
                            2 => "M&#46; Baram"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bbmt.2012.09.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Blood Marrow Transplant"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "321"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23025989"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute respiratory distress syndrome in patients with malignancies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Azoulay"
                            1 => "V&#46; Lemiale"
                            2 => "D&#46; Mokart"
                            3 => "F&#46; Pene"
                            4 => "A&#46; Kouatchet"
                            5 => "P&#46; Perez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-014-3354-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "1106"
                        "paginaFinal" => "1114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24898895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;C&#46; Sheu"
                            1 => "M&#46;N&#46; Gong"
                            2 => "R&#46; Zhai"
                            3 => "F&#46; Chen"
                            4 => "E&#46;K&#46; Baiwa"
                            5 => "P&#46;F&#46; Clardy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-2933"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "138"
                        "paginaInicial" => "559"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20507948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How important is age in defining the prognosis of patients with community-acquired pneumonia&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;I&#46; Sligl"
                            1 => "S&#46;R&#46; Majumdar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QCO.0b013e328343b6f8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Infect Dis"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "142"
                        "paginaFinal" => "147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21252659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome&#58; age&#44; plateau pressure&#44; and PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> at ARDS onset can predict mortality"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Hospitales Espa&#241;oles Para el Estudio de la Lesi&#243;n Pulmonar &#40;HELP&#41; Network"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "L&#46; P&#233;rez-M&#233;ndez"
                            2 => "S&#46; Basald&#250;a"
                            3 => "J&#46; Blanco"
                            4 => "G&#46; Aguilar"
                            5 => "D&#46; Toral"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.00811"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "420"
                        "paginaFinal" => "428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21255500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of long-term physical function in acute respiratory distress syndrome &#40;ARDS&#41; patients&#58; comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;L&#46; Groll"
                            1 => "D&#46;K&#46; Heyland"
                            2 => "M&#46; Caeser"
                            3 => "J&#46;G&#46; Wright"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.phm.0000223220.91914.61"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Phys Med Rehabil"
                        "fecha" => "2006"
                        "volumen" => "85"
                        "paginaInicial" => "574"
                        "paginaFinal" => "581"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16788388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "One-year outcomes in survivors of the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Canadian Critical Care Trials Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Herridge"
                            1 => "A&#46;M&#46; Cheung"
                            2 => "C&#46;M&#46; Tansey"
                            3 => "A&#46; Matte-Martyn"
                            4 => "N&#46; Diaz Granados"
                            5 => "F&#46; Al-Saidi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa022450"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2003"
                        "volumen" => "348"
                        "paginaInicial" => "683"
                        "paginaFinal" => "693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12594312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional disability 5 years after acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Canadian Critical Care Trials Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Herridge"
                            1 => "C&#46;M&#46; Tansey"
                            2 => "A&#46; Matt&#233;"
                            3 => "G&#46; Tomlinson"
                            4 => "N&#46; Diaz-Granados"
                            5 => "A&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1011802"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "364"
                        "paginaInicial" => "1293"
                        "paginaFinal" => "1304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21470008"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two-year cognitive&#44; emotional&#44; and quality-of-life outcomes in acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;O&#46; Hopkins"
                            1 => "L&#46;K&#46; Weaver"
                            2 => "D&#46; Collingridge"
                            3 => "R&#46;B&#46; Parkinson"
                            4 => "K&#46;J&#46; Chan"
                            5 => "J&#46;F&#46; Orme Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200406-763OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "340"
                        "paginaFinal" => "347"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15542793"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004000000006/v2_201704060203/S2173572716300285/v2_201704060203/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000006/v2_201704060203/S2173572716300285/v2_201704060203/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300285?idApp=WMIE"
]

Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2015.10.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	23	6	29
2024 October	81	45	126
2024 September	77	37	114
2024 August	86	48	134
2024 July	72	28	100
2024 June	66	45	111
2024 May	65	37	102
2024 April	92	51	143
2024 March	65	41	106
2024 February	54	53	107
2024 January	43	35	78
2023 December	43	35	78
2023 November	63	36	99
2023 October	84	34	118
2023 September	67	42	109
2023 August	67	26	93
2023 July	61	25	86
2023 June	79	16	95
2023 May	47	32	79
2023 April	66	20	86
2023 March	103	32	135
2023 February	56	32	88
2023 January	58	27	85
2022 December	84	42	126
2022 November	87	42	129
2022 October	72	28	100
2022 September	62	36	98
2022 August	117	52	169
2022 July	64	38	102
2022 June	83	37	120
2022 May	69	54	123
2022 April	92	44	136
2022 March	90	83	173
2022 February	58	58	116
2022 January	67	66	133
2021 December	87	66	153
2021 November	72	79	151
2021 October	107	134	241
2021 September	83	72	155
2021 August	56	74	130
2021 July	56	52	108
2021 June	68	51	119
2021 May	94	80	174
2021 April	230	170	400
2021 March	147	72	219
2021 February	120	66	186
2021 January	114	68	182
2020 December	88	51	139
2020 November	98	40	138
2020 October	98	38	136
2020 September	73	42	115
2020 August	67	40	107
2020 July	76	67	143
2020 June	66	41	107
2020 May	70	50	120
2020 April	70	27	97
2020 March	33	41	74
2020 February	75	46	121
2020 January	44	31	75
2019 December	59	32	91
2019 November	45	22	67
2019 October	74	29	103
2019 September	52	30	82
2019 August	52	34	86
2019 July	48	21	69
2019 June	38	18	56
2019 May	74	41	115
2019 April	27	20	47
2019 March	31	29	60
2019 February	37	37	74
2019 January	36	28	64
2018 December	63	47	110
2018 November	104	106	210
2018 October	133	26	159
2018 September	67	9	76
2018 August	31	7	38
2018 July	38	6	44
2018 June	58	7	65
2018 May	67	7	74
2018 April	98	7	105
2018 March	158	7	165
2018 February	119	6	125
2018 January	66	10	76
2017 December	127	4	131
2017 November	28	13	41
2017 October	29	10	39
2017 September	29	8	37
2017 August	23	8	31
2017 July	25	4	29
2017 June	23	8	31
2017 May	21	16	37
2017 April	17	14	31
2017 March	11	13	24
2017 February	19	13	32
2017 January	13	11	24
2016 December	18	26	44
2016 November	49	0	49
2016 October	2	1	3
2016 September	2	1	3
2016 August	2	2	4

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter