Perioperative management in thoracic surgery

array:23 ["pii" => "S2173572720300424" "issn" => "21735727" "doi" => "10.1016/j.medine.2019.10.006" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1418" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2020;44:185-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0210569119302700" "issn" => "02105691" "doi" => "10.1016/j.medin.2019.10.012" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1418" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2020;44:185-91" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 22 "formatos" => array:2 [ "HTML" => 10 "PDF" => 12 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "Artículo especial" "titulo" => "Manejo perioperatorio en cirugía torácica" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "191" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Perioperative management in thoracic surgery" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Muñoz de Cabo, F. Hermoso Alarza, A.M. Cossio Rodriguez, M.C. Martín Delgado" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Muñoz de Cabo" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Hermoso Alarza" ] 2 => array:2 [ "nombre" => "A.M." "apellidos" => "Cossio Rodriguez" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín Delgado" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572720300424" "doi" => "10.1016/j.medine.2019.10.006" "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/S2173572720300424?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302700?idApp=WMIE" "url" => "/02105691/0000004400000003/v1_202003260655/S0210569119302700/v1_202003260655/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572719301699" "issn" => "21735727" "doi" => "10.1016/j.medine.2019.05.008" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1349" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2020;44:192-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Point of view" "titulo" => "Can we justify the use of physical and mechanical restraint in pediatric patients admitted to the Intensive Care Unit?" "subtitulo" => "[[es]]¿Está justificado el uso de contenciones físicas y mecánicas en el paciente pediátrico ingresado en una unidad de cuidados intensivos?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "195" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1764 "Ancho" => 3342 "Tamanyo" => 548728 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Activities of prevention, detection, and control in the use of mechanical restraint systems in the pediatric patient." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Bosch-Alcaraz, G. Via-Clavero" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Bosch-Alcaraz" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Via-Clavero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569119301330" "doi" => "10.1016/j.medin.2019.05.003" "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/S0210569119301330?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301699?idApp=WMIE" "url" => "/21735727/0000004400000003/v1_202003270001/S2173572719301699/v1_202003270001/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357271930178X" "issn" => "21735727" "doi" => "10.1016/j.medine.2019.07.002" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1377" "copyright" => "Elsevier España, S.L.U. and SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2020;44:171-84" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "184" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Guías de práctica clínica basadas en la evidencia para el manejo de la sedoanalgesia y" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1663 "Ancho" => 1440 "Tamanyo" => 172282 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Algorithm for the management of pain in patients with ST-segment elevation myocardial infarction (STEMI). ASA: acetylsalicylic acid." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Celis-Rodríguez, J.C. Díaz Cortés, Y.R. Cárdenas Bolívar, J.A. Carrizosa González, D.-I. Pinilla, L.E. Ferrer Záccaro, C. Birchenall, J. Caballero López, B.M. Argüello, G. Castillo Abrego, G. Castorena Arellano, C. Dueñas Castell, J.M. Jáuregui Solórzano, R. Leal, J.M. Pardo Oviedo, M. Arroyo, F. Raffán-Sanabria, N. Raimondi, R. Reina, D.R. Rodríguez Lima, J.I. Silesky Jiménez, S. Ugarte Ubiergo, L.G. Gómez Escobar, D.P. Díaz Aya, C. Fowler, J.L. Nates" "autores" => array:26 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Celis-Rodríguez" ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Díaz Cortés" ] 2 => array:2 [ "nombre" => "Y.R." "apellidos" => "Cárdenas Bolívar" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Carrizosa González" ] 4 => array:2 [ "nombre" => "D.-I." "apellidos" => "Pinilla" ] 5 => array:2 [ "nombre" => "L.E." "apellidos" => "Ferrer Záccaro" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Birchenall" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Caballero López" ] 8 => array:2 [ "nombre" => "B.M." "apellidos" => "Argüello" ] 9 => array:2 [ "nombre" => "G." "apellidos" => "Castillo Abrego" ] 10 => array:2 [ "nombre" => "G." "apellidos" => "Castorena Arellano" ] 11 => array:2 [ "nombre" => "C." "apellidos" => "Dueñas Castell" ] 12 => array:2 [ "nombre" => "J.M." "apellidos" => "Jáuregui Solórzano" ] 13 => array:2 [ "nombre" => "R." "apellidos" => "Leal" ] 14 => array:2 [ "nombre" => "J.M." "apellidos" => "Pardo Oviedo" ] 15 => array:2 [ "nombre" => "M." "apellidos" => "Arroyo" ] 16 => array:2 [ "nombre" => "F." "apellidos" => "Raffán-Sanabria" ] 17 => array:2 [ "nombre" => "N." "apellidos" => "Raimondi" ] 18 => array:2 [ "nombre" => "R." "apellidos" => "Reina" ] 19 => array:2 [ "nombre" => "D.R." "apellidos" => "Rodríguez Lima" ] 20 => array:2 [ "nombre" => "J.I." "apellidos" => "Silesky Jiménez" ] 21 => array:2 [ "nombre" => "S." "apellidos" => "Ugarte Ubiergo" ] 22 => array:2 [ "nombre" => "L.G." "apellidos" => "Gómez Escobar" ] 23 => array:2 [ "nombre" => "D.P." "apellidos" => "Díaz Aya" ] 24 => array:2 [ "nombre" => "C." "apellidos" => "Fowler" ] 25 => array:2 [ "nombre" => "J.L." "apellidos" => "Nates" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569119301925" "doi" => "10.1016/j.medin.2019.07.013" "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/S0210569119301925?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271930178X?idApp=WMIE" "url" => "/21735727/0000004400000003/v1_202003270001/S217357271930178X/v1_202003270001/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Special article" "titulo" => "Perioperative management in thoracic surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "191" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Muñoz de Cabo, F. Hermoso Alarza, A.M. Cossio Rodriguez, M.C. Martín Delgado" "autores" => array:4 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Muñoz de Cabo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Hermoso Alarza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.M." "apellidos" => "Cossio Rodriguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "M.C." "apellidos" => "Martín Delgado" "email" => array:1 [ 0 => "mcmartindelgado@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Grado Medicina, Universidad Francisco de Vitoria, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo perioperatorio en cirugía torácica" ] ] "textoCompleto" => "IntroductionThe current new anesthesia induction techniques and the advances made in perioperative care and surgical procedures facilitate the performance of major interventions with fewer intraoperative and postoperative complications.Forty percent of in-hospital adverse events are associated with surgical procedures,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> which means that every year up to 7 million patients will suffer severe complications during or immediately after surgery, and 1 million will eventually die. According to studies conducted in developing countries, the mortality rate of major surgeries is between 5% and 10%.The risk of perioperative adverse events depends on the patient's condition prior to the surgery, the prevalence of comorbidities, the urgency, the magnitude, type, and duration of the surgery.Over the last few decades we have seen 2 major advances that have impacted surgical outcomes significantly: minimally invasive surgery and multimodal rehabilitation programs also known as the Fast track o Enhanced Recovery After Anesthesia (ERAS) protocol. The goal of both strategies is to reduce surgical aggressiveness, thus facilitating postoperative recovery.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Thoracic surgeryThoracic surgery is a highly complex surgery performed using different procedures: mediastinoscopy, video-assisted thoracoscopy, sympathectomy, pulmonary wedge resection, segmentectomy, lobectomy, pneumectomy, volume reduction surgery, thoracic wall surgery, tracheal surgery, and esophageal surgery. Patients treated with lung-resection surgery are often patients with major comorbidities such as chronic obstructive pulmonary disease, heart disease, and in most cases, they are cancer patients.Other factors associated with the intraoperative management of these patients like one-lung ventilation favor the intraoperative and postoperative pathophysiological disturbances, and the appearance of respiratory and cardiovascular complications that add up to the complications traditionally associated with surgery.Procedural mortality associated with thoracic surgery especially in parenchymatous resections has dropped below 5% in recent series. The Society of Thoracic Surgeons General Thoracic Surgery Database has a registry of 19903 patients and reports a 1.8% mortality rate, 5-day hospital stays on average, and lung complication rates of 18.5%.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Periprocedural managementIn surgery multimodal rehabilitation is the combination of evidence-based medicine-sustained perioperative strategies. Its main goal is to improve recovery after surgery. These strategies include the Fast track or ERAS protocols. Until now, the greater scientific evidence coming from the ERAS protocols derives from studies conducted with patients treated with oncological colorectal cancer surgery. The ERAS protocols reduced mortality, improve postoperative recovery, and reduced hospital stay.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Multidisciplinary strategy combines training the patient before surgery, reducing post-traumatic stress with new anesthesia, analgesia, and drug induction techniques, minimally invasive surgery, aggressive postoperative rehabilitation, and reviewing the classic principles of postoperative care (transducer, drainage, catheter, etc.) to avoid complications, improve the patient's early recovery, and thus, reduce hospital stay.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Although this multimodal approach has not been implemented extensively in thoracic surgery, there are initiatives that have shown good results.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> During the entire lung resection process, European studies recommend early intubation, mobilization, use of multimodal analgesia, and the early withdrawal of thoracic tubes. The European Society of Thoracic Surgeons has recently published its recommendations for the management of patients undergoing lung surgery (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0035">7</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Intraoperative managementThe concept of «minimally invasive surgery» refers to established surgical procedures performed remotely in a confined space. Video-assisted thoracic surgery (CTAV or VATS) or video-assisted thoracoscopy is the most advanced minimally invasive surgery. The benefits of this approach are less trauma, fewer complications, faster recovery time, work insertion and social inclusion, and better cosmetic results.There are very few data on VATS procedures because no large randomized studies have been conducted to compare this technique with lung resection through open surgery. A meta-analysis showed that VATS lobectomy was associated with a non-significant difference in mortality, but with significantly lower perioperative rates of morbidity, pneumonia, and atrial fibrillation.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>It has been proven that this is a safe and satisfactory procedure from the oncological standpoint even for locally advanced tumors such as lung tumor resection with thoracic wall involvement.<a class="elsevierStyleCrossRef" href="#bib0045">9</a>Admission criteria in intensive care unitsAlthough the systematic admission in intensive care units (ICU) of patients treated with thoracic surgery has been questioned, especially in low-risk patients, those treated with major thoracic surgery can require admission for 24–72h in these units.The clinical practice guidelines of the European Respiratory Society/European Society of Thoracic Surgeons<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and recent studies<a class="elsevierStyleCrossRef" href="#bib0055">11</a> provide data on criteria that may be a guide on what the best destination of these patients may be depending on the risks, benefits, and resources available. ICU admission is especially recommended in patients with comorbidities, a low cardiopulmonary reserve, extensive lung resections, and those who require support due to organ failure with life-threatening risk for the patient (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRef" href="#bib0060">12</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The use of predictive indices can also be useful when it comes to deciding where the patient should be transferred to after receiving thoracic surgery. One of these indices measures the probability of ICU admission depending on the complications experienced after major lung resection.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> It uses different variables and assigns different scores (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Patients with scores ≥4 would have a high risk of experiencing serious complications and, therefore, would be eligible for ICU admission.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Postoperative managementIntensive cardiorespiratory monitorization (electrocardiogram, blood pressure, heart rate, respiratory rate, oxygen saturation measured through pulse oximetry, and periodic controls of arterial-blood gas test) are basic elements in the management of these patients. In unstable patients or patients with complications, a more aggressive management may be necessary by increasing the level of monitorization. The use of fluids has been associated with the appearance of acute lung injury, which is why careful use is recommended in these patients during pre- and post-operative management with strict control of diuresis and renal function.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>The management of thoracic drainage is one characteristic procedures in these patients and recent studies with new pieces of equipment have questioned conventional management.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> The use of a single drainage can reduce the appearance of pain.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Portable suction units instead of the traditional wall-suction systems allow mobilization and even early walking. The routine use of thoracic X-rays does not affect the management of thoracic tubes and it should be used selectively. There is no consensus on the indication for the removal of drainage systems based on the amount of fluid produced. In most cases they can be safely removed within the first 24h. Despite randomized studies and meta-analyses, the optimal negative pressure or its superiority have not been established regarding water-seal drainage. With the use of new digital pleural units that allow a more objective and precise assessment of aerial leaks, drainage removal is safe without a prior seal test.Other relevant postoperative considerations include the aggressive management of pain and nausea. The right postoperative analgesia is one of the most important factors to reduce the occurrence of adverse events. Pain should be monitored correctly through validated scores and goals established for pain management purposes. The most common strategy here is multimodal analgesia adjusted to the particular characteristics of each patient and the use of local anesthesia techniques like thoracic epidural analgesia that, with the use of opioids and thoracic paravertebral block, have proven effective and reduced the respiratory complications associated with conventional analgesia.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Other less common techniques like intercostal nerve or interpleural block and intrathecal analgesia or cryo-analgesia are used occasionally. Periodic follow-up in analgesia or acute pain management units is recommended. Early rehabilitation directed by physical therapists and moving around the very first day reduces the number of complications and hospital stay in stable patients.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The removal of oxygen therapy when the patient reaches oxygen saturations above 90% facilitates mobilization.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Complications in the postoperative management of thoracic surgeryMedical complicationsRespiratory failureAcute respiratory failure is a common postoperative manifestation of thoracic surgery and one of the main causes of death in these patients.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Acute respiratory distress syndrome (ARDS) is one of the most serious causes of respiratory failure.After lung resection surgery there is a series of pathophysiological disorders that will lead to lung volume reduction and trigger respiratory failure. The main disorders are a reduced functional residual capacity, mucociliary and diaphragmatic dysfunction, the appearance of atelectasis, a reduced lung compliance, ventilation/perfusion disturbances, hypoxic pulmonary vasoconstriction, and lung injury.Early mobilization and respiratory physical therapy associated with the right analgesic pattern seem to reduce the risk of respiratory failure. Insufficient analgesia and the use of opioids or muscle relaxants have been associated with the appearance of respiratory complications.ArrhythmiasArrhythmias are one of the most common complications after lung resection. Atrial fibrillation (AF) is the most common of all. The rate of the appearance of AF in case of lobectomies is somewhere between 10% and 20%, and close to 40% when dealing with pneumonectomies.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>AF usually occurs within the first 48–72h. It is associated with higher morbidity, longer hospital stays, more postoperative mortality, and worse long-term survival prognosis.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>Different factors have been associated with the appearance of AF like old age, prior heart disease, chronic obstructive pulmonary disease, history of arrhythmias, type of surgery performed (right side surgery, basically right pneumonectomy), perioperative cardiac manipulation, extended surgery, and complications such as hypoxia, hypotension, hemorrhage, and hydroelectrolytic imbalance.The management of AF in patients treated with thoracic surgery is similar to any other patients with early-onset AF. The American Association of Thoracic Surgery (AATS) has developed specific guidelines for the prevention and management of AF in patients treated with thoracic surgery.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Pulmonary thromboembolic diseaseIn thoracic surgery the postoperative period is associated with a higher risk of venous thromboembolic disease due to the high rate of neoplastic disease and the patients’ old age.The systematic use of prophylaxis of thromboembolic disease has reduced the rate of this type of complications significantly over the last few years. The low prevalence reported in some series (0.18%)<a class="elsevierStyleCrossRef" href="#bib0120">24</a> can be attributed to the use of antithrombotic prophylaxis protocols including the use of anticoagulant drugs like the use of mechanical measures (intermittent compression systems and elastic stockings) based on the adequate stratification of thrombotic risk and early walking according to the international recommendation guidelines.Other medical complicationsAtelectasis is another complication these patients may have. It often affects the lung operated. COPD, poor pain control, the thoracic wall resection or abdominal distension are some of the factors associated with its appearance. Once again, moving around early and the right analgesia seem to be the basic pillars to prevent the appearance of atelectasis.The most common infection in these patients is pneumonia (25%) followed by tracheobronchitis, empyema, and surgical wound infections.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>Surgical complicationsHemothoraxThe rate of postoperative bleeding in lung resection surgery is around 3% in the case of pneumonectomy, but it is lower in minor resections.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>The most common cause of hemothorax is the bleeding of a thoracic wall vessel or bronchial artery. The hemothorax can also be due to the presence of bleeding in patients with vascularized pleuropulmonary adhesions.The early management is conservative with volemic restoration and correction of the possible clotting or platelet disturbances. The indications for the surgical treatment are deficits of 200mL/h for over 6h or deficits of 1200mL in less than 6h.ChylothoraxThis is a rare complication with an incidence rate <1% in most series. The most common cause is performing a thorough lymphadenectomy.The early management is conservative with intrathoracic drainage insertion if the patient did not already carry it, absolute diet and total parenteral nutrition. The use of somatostatin analogs like octreotide seems to improve the results of conservative treatment. Until now, there is no evidence available to recommend this or that dose. Most series use doses between 50μg s.c and 200μg s.c every 8h, although some authors recommend doses of up to 1mg s.c every 8h.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>Prolonged air leakAerial leak is one of the most common complications associated with lung resection surgery and in some series, its incidence rate is >50%. Most leaks subside within the first 24–48h after the surgery, but between 5% and 10% of the leaks cannot be solved whithin this timeframe. An aerial leak is said to be prolonged when it remains more than 5 days.In the presence of an aerial leak, the first step is to perform a differential diagnosis between the pleuropulmonary fistula and the bronchopleural fistula. In the first case, the intensity of the leak is usually mild-to-moderate. It often appears while breathing-out. In the second case, the leak is often massive and continuous and appears while breathing-in and breathing-out. Its prognosis is much worse for the patient. The definitive diagnosis will be given through fiberoptic bronchoscopy.Prolonged aerial leaks are often associated with more postoperative complications, especially of infectious.They are associated with a higher incidence rate of prolonged aerial leak: male sex, chronic obstructive pulmonary disease, smoking, presence of firm pleuropulmonary adhesions, presence of incomplete fissures, rigid lungs due to chronic infectious processes or pulmonary fibrosis, mechanical ventilation, diabetes mellitus, infectious process, low levels of proteins and serum albumin, and treatment with corticoids.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>The treatment of choice in cases of prolonged aerial leak should be conservative by connecting the drainage to the Heimlich valve for home management or surgical in cases of patient's intolerance to the valve due to an expanding pneumothorax or clinical impairment.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>Bronchopleural fistulaThis is one of the most feared complications by thoracic surgeons due to its high postoperative mortality rate (25%–71% according to the series).<a class="elsevierStyleCrossRef" href="#bib0150">30</a> It can be divided into early (first 48h) or late-onset bronchopleural fistula. Approximately half of late fistulas occur within the first month after surgery, and prognosis gets worse the closer they are to surgery.Once it has been diagnosed the initial treatment is placing an endothoracic drainage if the patient just could not stand it anymore, intravenous antibiotic therapy, oxygen therapy and, if possible, in the lateral decubitus position on the operated side.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> In early-onset fistulas <5mm in size, closure can be attempted through endoscopic treatment. In fistulas >5mm, the stump is covered with the muscle, pericardial fat or omentum. Regarding late-onset fistulas, treatment will depend on each patient's status, cardiorespiratory functional reserve, prior surgical findings, and on the surgeon's experience. When there is no evidence of infection, the treatment of choice is surgical. In the remaining cases, repair treatment will be delayed until there is evidence that the infection has been cleared.ConclusionsPatients who receive thoracic surgery are complex patients who require multimodal and multidisciplinary approaches. Critical care medicine services play an important role in the management of these patients adding value to the surgical process.<a class="elsevierStyleCrossRef" href="#bib0160">31</a> The selection of minimally invasive surgical techniques, the aggressive management of pain, early mobilization, respiratory physical therapy, and feeding avoids unnecessary invasive monitorization. Also, the early withdrawal of drain tubes, catheters or probes seems to reduce the rate of complications and the length of the hospital stay which improves the recovery of these patients.FundingNone.Conflicts of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1321534" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1219050" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1321533" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1219051" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Thoracic surgery" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Periprocedural management" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Intraoperative management" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Admission criteria in intensive care units" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Postoperative management" ] ] ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Complications in the postoperative management of thoracic surgery" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0040" "titulo" => "Medical complications" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Respiratory failure" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Arrhythmias" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Pulmonary thromboembolic disease" ] ] ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Other medical complications" ] 2 => array:3 [ "identificador" => "sec0065" "titulo" => "Surgical complications" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Hemothorax" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Chylothorax" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Prolonged air leak" ] 3 => array:2 [ "identificador" => "sec0085" "titulo" => "Bronchopleural fistula" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0090" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0095" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0100" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack455774" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-10-07" "fechaAceptado" => "2019-10-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1219050" "palabras" => array:3 [ 0 => "Perioperative medicine" 1 => "Thoracic surgery" 2 => "Intensive care medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1219051" "palabras" => array:3 [ 0 => "Medicina perioperatoria" 1 => "Cirugía torácica" 2 => "Medicina intensiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24–72h after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La cirugía torácica ha experimentado importantes avances en los últimos años relacionados con las técnicas anestésicas y quirúrgicas y la prevención y el manejo de las complicaciones relacionadas con el procedimiento. Esto ha permitido mejorar los resultados clínicos de los pacientes sometidos a este tipo de intervención. A pesar de ello, los procedimientos de cirugía torácica, especialmente los relacionados con la resección pulmonar, no están exentos de riesgo, con una morbimortalidad asociada considerable. Los protocolos Fast track o Enhanced recovery after anesthesia, la cirugía mínimamente invasiva y el manejo anestésico intraoperatorio mejoran el pronóstico y la seguridad de los procesos de cirugía torácica. Los pacientes postoperados de cirugía torácica mayor requieren una vigilancia intensiva, especialmente las primeras 24-72h del postoperatorio inmediato. El ingreso en la UCI se recomienda especialmente en los pacientes con comorbilidad, con reserva cardiopulmonar reducida, con resecciones pulmonares extensas y en los que requieren soporte por fallo de algún órgano con riesgo vital. Durante el periodo postoperatorio la monitorización intensiva cardiorrespiratoria, el manejo adecuado de los drenajes torácicos, el control agresivo del dolor (analgesia multimodal y técnicas anestésicas regionales), las náuseas y la rehabilitación multimodal son elementos claves para evitar eventos adversos. Entre las complicaciones médicas destacan la insuficiencia respiratoria, las arritmias, las infecciones respiratorias, las atelectasias y la enfermedad pulmonar tromboembólica. Las complicaciones quirúrgicas más frecuentes son el hemotórax, el quilotórax, la fístula broncopleural y la fuga aérea prolongada. El manejo multidisciplinar de estos pacientes durante todo el periodo perioperatorio es esencial para asegurar los mejores resultados quirúrgicos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Muñoz de Cabo C, Hermoso Alarza F, Cossio Rodriguez AM, Martín Delgado MC. Manejo perioperatorio en cirugía torácica. Med Intensiva. 2020;44:185–191." ] ] "multimedia" => array:3 [ 0 => 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:2 [ "leyenda" => "Adapted from Batchelor et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>." "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preparation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detailed information and recommendations to quit smoking and avoid alcohol consumption at least 4 weeks prior to the intervention \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nutritional supplements for malnourished patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anemia identification and correction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preconditioning of patients with borderline pulmonary functional reserve \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preoperative fasting: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Water up to 2h prior to the induction of anesthesia and solid food up to 6h prior to the induction of anesthesia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral overload of carbon hydrates prior to the intervention \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The routine use of sedatives to manage anxiety prior to the intervention is not recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perioperative \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibiotic prophylaxis and skin washing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of chlorhexidine solutions to prepare the skin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continuous control of temperature and prevention of hypothermia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung protective mechanical ventilation especially in cases of one lung ventilation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use of combined anesthesia techniques (regional and general) and half-life for anesthetic drugs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination of non-pharmacological and pharmacological measures for postoperative nausea and vomiting (PONV) prevention \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of epidural anesthesia for the management of pain and avoidance of opioids is recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The analgesia provided by paravertebral block is equivalent to that provided by epidural anesthesia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of conventional analgesia with paracetamol and NSAIDs is recommended except for contraindications \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dexamethasone can be administered to reduce PONV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid highly restrictive or liberal protocols of serum therapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of balanced solutions is preferred over saline serum solutions at 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="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral tolerance and serum therapy withdrawal will be initiated as soon as possible \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prevention of atrial fibrillation: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reintroduce beta-blockers as soon as possible in patients on chronic treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assess the use of preoperative diltiazem or postoperative amiodaron in high-risk patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">External pleural drainage: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not apply external aspiration as a general rule \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assess the removal of drainage systems as soon as possible even in cases with 450mL/day drains \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The use of a single drainage tube for is recommended \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid the use of an unnecessary vesical catheter and proceed with early withdrawal if used \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early mobilization within the first 24h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thromboembolic prophylaxis in patients treated with major lung surgery. In very high-risk cases assess whether to keep on administering prophylaxis for up to 4 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2265003.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Recommendations for the perioperative management of patients treated with lung surgery according to the European Society of Thoracic Surgeons." ] ] 1 => 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:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High comorbidity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reduced cardiopulmonary functional reserve \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extensive lung resections \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Support required for one or more organs \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2265001.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Criteria for ICU admission." ] ] 2 => 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" => "DLCO, diffusing capacity of lung for carbon monoxide; FEV1, maximal forced expiratory volume in the first second." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 points \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac comorbidity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 point \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age >65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 point \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative predictive FEV1 <65% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 point \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postoperative predictive DLCO <50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 point \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2265002.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Variables to predict the possibility of serious complications that may require urgent ICU admission." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and nature of in-hospital adverse events: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.N. De Vries" 1 => "M.A. Ramrattan" 2 => "S.M. Smorenburg" 3 => "D.J. Gouma" 4 => "M.A. Boermeester" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/qshc.2007.023622" "Revista" => array:6 [ "tituloSerie" => "Qual Saf Health Care" "fecha" => "2008" "volumen" => "17" "paginaInicial" => "216" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18519629" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The enhanced recover after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.K. Varandhan" 1 => "K.R. Neal" 2 => "C.H. Dejong" 3 => "K.C. Fearon" 4 => "O. Ljungqvist" 5 => "D.N. Lobo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clnu.2010.01.004" "Revista" => array:6 [ "tituloSerie" => "Clin Nutr" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "434" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20116145" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Society of Thoracic Surgeons General Thoracic Surgery Database: establishing generalizability to national lung cancer resection outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.J. LaPar" 1 => "C.M. Bhamidipati" 2 => "C.L. Lau" 3 => "D.R. Jones" 4 => "B.D. Kozower" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2012.03.054" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "216" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22608716" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based surgical care and the evolution of fast-track surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Kehlet" 1 => "D.V. Wilmore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31817f2c1a" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2008" "volumen" => "248" "paginaInicial" => "189" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650627" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fast track surgery: realidades y dificultades" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Kehlet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0009-739x(06)70955-1" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2006" "volumen" => "80" "paginaInicial" => "187" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17040666" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Experience with lung resection in a fast-track surgery program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Alarcón" 1 => "J.C. Peñalver Cuesta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.09.011" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "89" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245565" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for Enhanced Recovery After Surgery (ERAS@) Society and the European Society of Thoracic Surgeons (ESTS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Batchelor" 1 => "N. Rasburn" 2 => "E. Abdelnour-Berchtold" 3 => "A. Brunelli" 4 => "R. Cerfalio" 5 => "M. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ejcts/ezy301" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2019" "volumen" => "55" "paginaInicial" => "91" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30304509" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Video-assisted thoracic surgery vs. open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Cao" 1 => "C. Manganas" 2 => "S.C. Ang" 3 => "S. Peeceeyen" 4 => "T.D. Yan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivs472" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2013" "volumen" => "16" "paginaInicial" => "244" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23169877" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.D. Yan" 1 => "D. Black" 2 => "P.G. Bannon" 3 => "B.C. McCaughan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "2553" "paginaFinal" => "2562" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Respiratory Society and European Society of Thoracic Surgeons joint task force on fitness for radical therapy. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Brunelli" 1 => "A. Charloux" 2 => "C.T. Bolliger" 3 => "G. Rocco" 4 => "J.P. Sculier" 5 => "G. Varela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00184308" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "17" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19567600" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Who needs to be allocated in ICU after thoracic surgery? An observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Pinheiro" 1 => "I.L. Santoro" 2 => "S.M. Faresin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2016/3981506" "Revista" => array:5 [ "tituloSerie" => "Can Respir J" "fecha" => "2016" "volumen" => "2016" "paginaInicial" => "3981506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27493477" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, duration and causes of intensive care unit admission following pulmonary resection for malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.D. Melley" 1 => "E.M. Thomson" 2 => "S.P. Page" 3 => "G. Ladas" 4 => "J. Cordingley" 5 => "T.W. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-006-0269-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "1419" "paginaFinal" => "1422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16826388" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A scoring system predicting the risk for intensive care unit admission for complications after major lung resection: a multicenter analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Brunelli" 1 => "M.K. Ferguson" 2 => "G. Rocco" 3 => "P. Pieretti" 4 => "W.T. Vigneswaran" 5 => "N.J. Morgan-Hughes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2008.03.063" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2008" "volumen" => "86" "paginaInicial" => "213" "paginaFinal" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18573425" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting pulmonary complications after pneumonectomy for lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "F.J. Algar" 1 => "A. Alvarez" 2 => "A. Salvatierra" 3 => "C. Baamonde" 4 => "J.L. Aranda" 5 => "F.J. Lopez-Pujol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1010-7940(02)00719-4" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2003" "volumen" => "23" "paginaInicial" => "201" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12559343" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.G. French" 1 => "M. Dilena" 2 => "S. LaPlante" 3 => "F. Shamji" 4 => "S. Sundaresan" 5 => "J. Villeneuve" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2072-1439.2015.10.67" "Revista" => array:7 [ "tituloSerie" => "J Thorac Dis" "fecha" => "2016" "volumen" => "8" "numero" => "Suppl 1" "paginaInicial" => "S3" "paginaFinal" => "S11" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26941968" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should you place one or two chest drains in patients undergoing lobectomy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.G. Dawson" 1 => "S. Hosmane" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2010.235853" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "178" "paginaFinal" => "181" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20439304" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.P. Joshi" 1 => "F. Bonnet" 2 => "R. Shah" 3 => "R.C. Wilkinson" 4 => "F. Camu" 5 => "B. Fischer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ane.0000333274.63501.ff" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2008" "volumen" => "107" "paginaInicial" => "1026" "paginaFinal" => "1040" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18713924" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chest physiotherapy revisited: evaluation of its influence on the pulmonary morbidity after pulmonary resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Novoa" 1 => "E. Ballesteros" 2 => "M.F. Jiménez" 3 => "J.L. Aranda" 4 => "G. Varela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2010.11.028" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "130" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21227711" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early removal of chest drainage tubes and oxygen support after a lobectomy for lung cancer facilitates earlier recovery of the 6-minute walking distance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Nomori" 1 => "H. Horio" 2 => "K. Suemasu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s005950170128" "Revista" => array:6 [ "tituloSerie" => "Surg Today" "fecha" => "2001" "volumen" => "31" "paginaInicial" => "395" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11381501" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.R. Roberts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.thorsurg.2006.05.002" "Revista" => array:6 [ "tituloSerie" => "Thorac Surg Clin" "fecha" => "2006" "volumen" => "16" "paginaInicial" => "235" "paginaFinal" => "241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17004551" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Von Koring" 1 => "M. Lepantalo" 2 => "L. Lindgren" 3 => "O. Lindfors" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0003-4975(92)90325-x" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1992" "volumen" => "53" "paginaInicial" => "642" "paginaFinal" => "647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1554274" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors associated with atrial fibrillation after noncardiac thoracic surgery: analysis of 2,588 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.A. Vaporciyan" 1 => "A.M. Correa" 2 => "D.C. Rice" 3 => "J.A. Roth" 4 => "W.R. Smythe" 5 => "S.G. Swisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2003.07.011" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2004" "volumen" => "127" "paginaInicial" => "779" "paginaFinal" => "786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15001907" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. Executive summary" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Association of Thoracic Surgery" "etal" => true "autores" => array:6 [ 0 => "G. Frendl" 1 => "A.C. Sodickson" 2 => "M.K. Chung" 3 => "A.L. Waldo" 4 => "B.J. Gersh" 5 => "J.E. Tisdale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2014.06.037" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2014" "volumen" => "148" "paginaInicial" => "772" "paginaFinal" => "791" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25129583" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of venous thromboembolism in elective thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.T. Gómez-Hernández" 1 => "M. Rodríguez-Pérez" 2 => "N. Novoa-Valentín" 3 => "M. Jiménez-López" 4 => "J.L. Aranda-Alcaide" 5 => "G. Varela-Simó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2013.01.011" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "297" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23542046" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "O. Schussler" 1 => "M. Alifano" 2 => "H. Dermine" 3 => "S. Strano" 4 => "A. Casetta" 5 => "S. Sepulveda" 6 => "Postoperative pneumonia after major lung resection" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2006" "volumen" => "173" "paginaInicial" => "1161" "paginaFinal" => "1169" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of pulmonary resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Haitcock" 1 => "R. Feins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "T.Shields, J.Locicero, C.Reed, R.Feins" "titulo" => "General thoracic surgery" "paginaInicial" => "551" "paginaFinal" => "559" "edicion" => "7th ed." "serieFecha" => "2009" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Octreotide use in post-cardiac surgery chylothorax: a 12-year perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.S. Aljazairi" 1 => "T.A. Bhuiyan" 2 => "A.H. Alwadai" 3 => "R.A. Almehizia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0218492316682670" "Revista" => array:6 [ "tituloSerie" => "Asian Cardiovasc Thorac Ann" "fecha" => "2017" "volumen" => "25" "paginaInicial" => "6" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27920229" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective randomized trial compares suction versus water seal for air leaks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.J. Cerfolio" 1 => "C. Bass" 2 => "C.R. Katholi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2001" "volumen" => "71" "paginaInicial" => "1613" "paginaFinal" => "1617" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of alveolar air leaks after pulmonary resection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Singhal" 1 => "V. Ferraris" 2 => "C. Bridges" 3 => "E. Clough" 4 => "J. Mitchell" 5 => "H. Fernando" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2009.09.020" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2010" "volumen" => "89" "paginaInicial" => "1327" "paginaFinal" => "1335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20338378" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The development of bronchopleural fistula in lung cancer patients after major surgery: 31 years of experience with 19 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Uramoto" 1 => "T. Hanagiri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anticancer Res" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "619" "paginaFinal" => "624" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0160" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive medicine services. How to add value to the surgical process?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.C. Martín Delgado" 1 => "F. Gordo Vidal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "42" "paginaInicial" => "461" "paginaFinal" => "462" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack455774" "titulo" => "Acknowledgements" "texto" => "None." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004400000003/v1_202003270001/S2173572720300424/v1_202003270001/en/main.assets" "Apartado" => array:4 [ "identificador" => "80427" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Update in Perioperative Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004400000003/v1_202003270001/S2173572720300424/v1_202003270001/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300424?idApp=WMIE"]

Statistics

Special article

Perioperative management in thoracic surgery

Manejo perioperatorio en cirugía torácica

C. Muñoz de Caboa, F. Hermoso Alarzab, A.M. Cossio Rodriguezc, M.C. Martín Delgadoa,d,

Corresponding author

mcmartindelgado@gmail.com

Corresponding author.

a Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain

b Servicio de Cirugía Torácica, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain

c Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, Spain

d Grado Medicina, Universidad Francisco de Vitoria, Madrid, Spain

Read

16587

Times
was read the article

5077

Total PDF

11510

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173572720300424"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2019.10.006"
  "estado" => "S300"
  "fechaPublicacion" => "2020-04-01"
  "aid" => "1418"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Intensiva. 2020;44:185-91"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:18 [
      "pii" => "S0210569119302700"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2019.10.012"
      "estado" => "S300"
      "fechaPublicacion" => "2020-04-01"
      "aid" => "1418"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2020;44:185-91"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 22
        "formatos" => array:2 [
          "HTML" => 10
          "PDF" => 12
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Art&#237;culo especial</span>"
        "titulo" => "Manejo perioperatorio en cirug&#237;a tor&#225;cica"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "185"
            "paginaFinal" => "191"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Perioperative management in thoracic surgery"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Mu&#241;oz de Cabo, F&#46; Hermoso Alarza, A&#46;M&#46; Cossio Rodriguez, M&#46;C&#46; Mart&#237;n Delgado"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Mu&#241;oz de Cabo"
              ]
              1 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Hermoso Alarza"
              ]
              2 => array:2 [
                "nombre" => "A&#46;M&#46;"
                "apellidos" => "Cossio Rodriguez"
              ]
              3 => array:2 [
                "nombre" => "M&#46;C&#46;"
                "apellidos" => "Mart&#237;n Delgado"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572720300424"
          "doi" => "10.1016/j.medine.2019.10.006"
          "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/S2173572720300424?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302700?idApp=WMIE"
      "url" => "/02105691/0000004400000003/v1_202003260655/S0210569119302700/v1_202003260655/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572719301699"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2019.05.008"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "1349"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Intensiva. 2020;44:192-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Point of view</span>"
      "titulo" => "Can we justify the use of physical and mechanical restraint in pediatric patients admitted to the Intensive Care Unit&#63;"
      "subtitulo" => "&#91;&#91;es&#93;&#93;&#191;Est&#225; justificado el uso de contenciones f&#237;sicas y mec&#225;nicas en el paciente pedi&#225;trico ingresado en una unidad de cuidados intensivos&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "192"
          "paginaFinal" => "195"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1764
              "Ancho" => 3342
              "Tamanyo" => 548728
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Activities of prevention&#44; detection&#44; and control in the use of mechanical restraint systems in the pediatric patient&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Bosch-Alcaraz, G&#46; Via-Clavero"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Bosch-Alcaraz"
            ]
            1 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Via-Clavero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569119301330"
        "doi" => "10.1016/j.medin.2019.05.003"
        "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/S0210569119301330?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719301699?idApp=WMIE"
    "url" => "/21735727/0000004400000003/v1_202003270001/S2173572719301699/v1_202003270001/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217357271930178X"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2019.07.002"
    "estado" => "S300"
    "fechaPublicacion" => "2020-04-01"
    "aid" => "1377"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2020;44:171-84"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 4
      "formatos" => array:2 [
        "HTML" => 2
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
      "titulo" => "Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "171"
          "paginaFinal" => "184"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Gu&#237;as de pr&#225;ctica cl&#237;nica basadas en la evidencia para el manejo de la sedoanalgesia y"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1663
              "Ancho" => 1440
              "Tamanyo" => 172282
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0045"
              "detalle" => "Fig&#46; "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the management of pain in patients with ST-segment elevation myocardial infarction &#40;STEMI&#41;&#46; ASA&#58; acetylsalicylic acid&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Celis-Rodr&#237;guez, J&#46;C&#46; D&#237;az Cort&#233;s, Y&#46;R&#46; C&#225;rdenas Bol&#237;var, J&#46;A&#46; Carrizosa Gonz&#225;lez, D&#46;-I&#46; Pinilla, L&#46;E&#46; Ferrer Z&#225;ccaro, C&#46; Birchenall, J&#46; Caballero L&#243;pez, B&#46;M&#46; Arg&#252;ello, G&#46; Castillo Abrego, G&#46; Castorena Arellano, C&#46; Due&#241;as Castell, J&#46;M&#46; J&#225;uregui Sol&#243;rzano, R&#46; Leal, J&#46;M&#46; Pardo Oviedo, M&#46; Arroyo, F&#46; Raff&#225;n-Sanabria, N&#46; Raimondi, R&#46; Reina, D&#46;R&#46; Rodr&#237;guez Lima, J&#46;I&#46; Silesky Jim&#233;nez, S&#46; Ugarte Ubiergo, L&#46;G&#46; G&#243;mez Escobar, D&#46;P&#46; D&#237;az Aya, C&#46; Fowler, J&#46;L&#46; Nates"
          "autores" => array:26 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Celis-Rodr&#237;guez"
            ]
            1 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "D&#237;az Cort&#233;s"
            ]
            2 => array:2 [
              "nombre" => "Y&#46;R&#46;"
              "apellidos" => "C&#225;rdenas Bol&#237;var"
            ]
            3 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Carrizosa Gonz&#225;lez"
            ]
            4 => array:2 [
              "nombre" => "D&#46;-I&#46;"
              "apellidos" => "Pinilla"
            ]
            5 => array:2 [
              "nombre" => "L&#46;E&#46;"
              "apellidos" => "Ferrer Z&#225;ccaro"
            ]
            6 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Birchenall"
            ]
            7 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Caballero L&#243;pez"
            ]
            8 => array:2 [
              "nombre" => "B&#46;M&#46;"
              "apellidos" => "Arg&#252;ello"
            ]
            9 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Castillo Abrego"
            ]
            10 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Castorena Arellano"
            ]
            11 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Due&#241;as Castell"
            ]
            12 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "J&#225;uregui Sol&#243;rzano"
            ]
            13 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Leal"
            ]
            14 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Pardo Oviedo"
            ]
            15 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Arroyo"
            ]
            16 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Raff&#225;n-Sanabria"
            ]
            17 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Raimondi"
            ]
            18 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Reina"
            ]
            19 => array:2 [
              "nombre" => "D&#46;R&#46;"
              "apellidos" => "Rodr&#237;guez Lima"
            ]
            20 => array:2 [
              "nombre" => "J&#46;I&#46;"
              "apellidos" => "Silesky Jim&#233;nez"
            ]
            21 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Ugarte Ubiergo"
            ]
            22 => array:2 [
              "nombre" => "L&#46;G&#46;"
              "apellidos" => "G&#243;mez Escobar"
            ]
            23 => array:2 [
              "nombre" => "D&#46;P&#46;"
              "apellidos" => "D&#237;az Aya"
            ]
            24 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Fowler"
            ]
            25 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Nates"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569119301925"
        "doi" => "10.1016/j.medin.2019.07.013"
        "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/S0210569119301925?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271930178X?idApp=WMIE"
    "url" => "/21735727/0000004400000003/v1_202003270001/S217357271930178X/v1_202003270001/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>"
    "titulo" => "Perioperative management in thoracic surgery"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "185"
        "paginaFinal" => "191"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "C&#46; Mu&#241;oz de Cabo, F&#46; Hermoso Alarza, A&#46;M&#46; Cossio Rodriguez, M&#46;C&#46; Mart&#237;n Delgado"
        "autores" => array:4 [
          0 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Mu&#241;oz de Cabo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Hermoso Alarza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;M&#46;"
            "apellidos" => "Cossio Rodriguez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:4 [
            "nombre" => "M&#46;C&#46;"
            "apellidos" => "Mart&#237;n Delgado"
            "email" => array:1 [
              0 => "mcmartindelgado@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario de Torrej&#243;n&#44; Torrej&#243;n de Ardoz&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Tor&#225;cica&#44; Hospital Universitario de Torrej&#243;n&#44; Torrej&#243;n de Ardoz&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario Virgen Macarena&#44; Sevilla&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Grado Medicina&#44; Universidad Francisco de Vitoria&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Manejo perioperatorio en cirug&#237;a tor&#225;cica"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The current new anesthesia induction techniques and the advances made in perioperative care and surgical procedures facilitate the performance of major interventions with fewer intraoperative and postoperative complications&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Forty percent of in-hospital adverse events are associated with surgical procedures&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which means that every year up to 7 million patients will suffer severe complications during or immediately after surgery&#44; and 1 million will eventually die&#46; According to studies conducted in developing countries&#44; the mortality rate of major surgeries is between 5&#37; and 10&#37;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The risk of perioperative adverse events depends on the patient&#39;s condition prior to the surgery&#44; the prevalence of comorbidities&#44; the urgency&#44; the magnitude&#44; type&#44; and duration of the surgery&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Over the last few decades we have seen 2 major advances that have impacted surgical outcomes significantly&#58; minimally invasive surgery and multimodal rehabilitation programs also known as the Fast track o Enhanced Recovery After Anesthesia &#40;ERAS&#41; protocol&#46; The goal of both strategies is to reduce surgical aggressiveness&#44; thus facilitating postoperative recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Thoracic surgery</span><p id="par0025" class="elsevierStylePara elsevierViewall">Thoracic surgery is a highly complex surgery performed using different procedures&#58; mediastinoscopy&#44; video-assisted thoracoscopy&#44; sympathectomy&#44; pulmonary wedge resection&#44; segmentectomy&#44; lobectomy&#44; pneumectomy&#44; volume reduction surgery&#44; thoracic wall surgery&#44; tracheal surgery&#44; and esophageal surgery&#46; Patients treated with lung-resection surgery are often patients with major comorbidities such as chronic obstructive pulmonary disease&#44; heart disease&#44; and in most cases&#44; they are cancer patients&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Other factors associated with the intraoperative management of these patients like one-lung ventilation favor the intraoperative and postoperative pathophysiological disturbances&#44; and the appearance of respiratory and cardiovascular complications that add up to the complications traditionally associated with surgery&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Procedural mortality associated with thoracic surgery especially in parenchymatous resections has dropped below 5&#37; in recent series&#46; The Society of Thoracic Surgeons General Thoracic Surgery Database has a registry of 19<span class="elsevierStyleHsp" style=""></span>903 patients and reports a 1&#46;8&#37; mortality rate&#44; 5-day hospital stays on average&#44; and lung complication rates of 18&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Periprocedural management</span><p id="par0040" class="elsevierStylePara elsevierViewall">In surgery multimodal rehabilitation is the combination of evidence-based medicine-sustained perioperative strategies&#46; Its main goal is to improve recovery after surgery&#46; These strategies include the Fast track or ERAS protocols&#46; Until now&#44; the greater scientific evidence coming from the ERAS protocols derives from studies conducted with patients treated with oncological colorectal cancer surgery&#46; The ERAS protocols reduced mortality&#44; improve postoperative recovery&#44; and reduced hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Multidisciplinary strategy combines training the patient before surgery&#44; reducing post-traumatic stress with new anesthesia&#44; analgesia&#44; and drug induction techniques&#44; minimally invasive surgery&#44; aggressive postoperative rehabilitation&#44; and reviewing the classic principles of postoperative care &#40;transducer&#44; drainage&#44; catheter&#44; etc&#46;&#41; to avoid complications&#44; improve the patient&#39;s early recovery&#44; and thus&#44; reduce hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although this multimodal approach has not been implemented extensively in thoracic surgery&#44; there are initiatives that have shown good results&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> During the entire lung resection process&#44; European studies recommend early intubation&#44; mobilization&#44; use of multimodal analgesia&#44; and the early withdrawal of thoracic tubes&#46; The European Society of Thoracic Surgeons has recently published its recommendations for the management of patients undergoing lung surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Intraoperative management</span><p id="par0055" class="elsevierStylePara elsevierViewall">The concept of &#171;minimally invasive surgery&#187; refers to established surgical procedures performed remotely in a confined space&#46; Video-assisted thoracic surgery &#40;CTAV or VATS&#41; or video-assisted thoracoscopy is the most advanced minimally invasive surgery&#46; The benefits of this approach are less trauma&#44; fewer complications&#44; faster recovery time&#44; work insertion and social inclusion&#44; and better cosmetic results&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">There are very few data on VATS procedures because no large randomized studies have been conducted to compare this technique with lung resection through open surgery&#46; A meta-analysis showed that VATS lobectomy was associated with a non-significant difference in mortality&#44; but with significantly lower perioperative rates of morbidity&#44; pneumonia&#44; and atrial fibrillation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">It has been proven that this is a safe and satisfactory procedure from the oncological standpoint even for locally advanced tumors such as lung tumor resection with thoracic wall involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Admission criteria in intensive care units</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although the systematic admission in intensive care units &#40;ICU&#41; of patients treated with thoracic surgery has been questioned&#44; especially in low-risk patients&#44; those treated with major thoracic surgery can require admission for 24&#8211;72<span class="elsevierStyleHsp" style=""></span>h in these units&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The clinical practice guidelines of the European Respiratory Society&#47;European Society of Thoracic Surgeons<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and recent studies<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> provide data on criteria that may be a guide on what the best destination of these patients may be depending on the risks&#44; benefits&#44; and resources available&#46; ICU admission is especially recommended in patients with comorbidities&#44; a low cardiopulmonary reserve&#44; extensive lung resections&#44; and those who require support due to organ failure with life-threatening risk for the patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The use of predictive indices can also be useful when it comes to deciding where the patient should be transferred to after receiving thoracic surgery&#46; One of these indices measures the probability of ICU admission depending on the complications experienced after major lung resection&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> It uses different variables and assigns different scores &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Patients with scores &#8805;4 would have a high risk of experiencing serious complications and&#44; therefore&#44; would be eligible for ICU admission&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Postoperative management</span><p id="par0085" class="elsevierStylePara elsevierViewall">Intensive cardiorespiratory monitorization &#40;electrocardiogram&#44; blood pressure&#44; heart rate&#44; respiratory rate&#44; oxygen saturation measured through pulse oximetry&#44; and periodic controls of arterial-blood gas test&#41; are basic elements in the management of these patients&#46; In unstable patients or patients with complications&#44; a more aggressive management may be necessary by increasing the level of monitorization&#46; The use of fluids has been associated with the appearance of acute lung injury&#44; which is why careful use is recommended in these patients during pre- and post-operative management with strict control of diuresis and renal function&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The management of thoracic drainage is one characteristic procedures in these patients and recent studies with new pieces of equipment have questioned conventional management&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The use of a single drainage can reduce the appearance of pain&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Portable suction units instead of the traditional wall-suction systems allow mobilization and even early walking&#46; The routine use of thoracic X-rays does not affect the management of thoracic tubes and it should be used selectively&#46; There is no consensus on the indication for the removal of drainage systems based on the amount of fluid produced&#46; In most cases they can be safely removed within the first 24<span class="elsevierStyleHsp" style=""></span>h&#46; Despite randomized studies and meta-analyses&#44; the optimal negative pressure or its superiority have not been established regarding water-seal drainage&#46; With the use of new digital pleural units that allow a more objective and precise assessment of aerial leaks&#44; drainage removal is safe without a prior seal test&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Other relevant postoperative considerations include the aggressive management of pain and nausea&#46; The right postoperative analgesia is one of the most important factors to reduce the occurrence of adverse events&#46; Pain should be monitored correctly through validated scores and goals established for pain management purposes&#46; The most common strategy here is multimodal analgesia adjusted to the particular characteristics of each patient and the use of local anesthesia techniques like thoracic epidural analgesia that&#44; with the use of opioids and thoracic paravertebral block&#44; have proven effective and reduced the respiratory complications associated with conventional analgesia&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Other less common techniques like intercostal nerve or interpleural block and intrathecal analgesia or cryo-analgesia are used occasionally&#46; Periodic follow-up in analgesia or acute pain management units is recommended&#46; Early rehabilitation directed by physical therapists and moving around the very first day reduces the number of complications and hospital stay in stable patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The removal of oxygen therapy when the patient reaches oxygen saturations above 90&#37; facilitates mobilization&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Complications in the postoperative management of thoracic surgery</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Medical complications</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Respiratory failure</span><p id="par0100" class="elsevierStylePara elsevierViewall">Acute respiratory failure is a common postoperative manifestation of thoracic surgery and one of the main causes of death in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Acute respiratory distress syndrome &#40;ARDS&#41; is one of the most serious causes of respiratory failure&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">After lung resection surgery there is a series of pathophysiological disorders that will lead to lung volume reduction and trigger respiratory failure&#46; The main disorders are a reduced functional residual capacity&#44; mucociliary and diaphragmatic dysfunction&#44; the appearance of atelectasis&#44; a reduced lung compliance&#44; ventilation&#47;perfusion disturbances&#44; hypoxic pulmonary vasoconstriction&#44; and lung injury&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Early mobilization and respiratory physical therapy associated with the right analgesic pattern seem to reduce the risk of respiratory failure&#46; Insufficient analgesia and the use of opioids or muscle relaxants have been associated with the appearance of respiratory complications&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Arrhythmias</span><p id="par0115" class="elsevierStylePara elsevierViewall">Arrhythmias are one of the most common complications after lung resection&#46; Atrial fibrillation &#40;AF&#41; is the most common of all&#46; The rate of the appearance of AF in case of lobectomies is somewhere between 10&#37; and 20&#37;&#44; and close to 40&#37; when dealing with pneumonectomies&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">AF usually occurs within the first 48&#8211;72<span class="elsevierStyleHsp" style=""></span>h&#46; It is associated with higher morbidity&#44; longer hospital stays&#44; more postoperative mortality&#44; and worse long-term survival prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Different factors have been associated with the appearance of AF like old age&#44; prior heart disease&#44; chronic obstructive pulmonary disease&#44; history of arrhythmias&#44; type of surgery performed &#40;right side surgery&#44; basically right pneumonectomy&#41;&#44; perioperative cardiac manipulation&#44; extended surgery&#44; and complications such as hypoxia&#44; hypotension&#44; hemorrhage&#44; and hydroelectrolytic imbalance&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The management of AF in patients treated with thoracic surgery is similar to any other patients with early-onset AF&#46; The American Association of Thoracic Surgery &#40;AATS&#41; has developed specific guidelines for the prevention and management of AF in patients treated with thoracic surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Pulmonary thromboembolic disease</span><p id="par0135" class="elsevierStylePara elsevierViewall">In thoracic surgery the postoperative period is associated with a higher risk of venous thromboembolic disease due to the high rate of neoplastic disease and the patients&#8217; old age&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The systematic use of prophylaxis of thromboembolic disease has reduced the rate of this type of complications significantly over the last few years&#46; The low prevalence reported in some series &#40;0&#46;18&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> can be attributed to the use of antithrombotic prophylaxis protocols including the use of anticoagulant drugs like the use of mechanical measures &#40;intermittent compression systems and elastic stockings&#41; based on the adequate stratification of thrombotic risk and early walking according to the international recommendation guidelines&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Other medical complications</span><p id="par0145" class="elsevierStylePara elsevierViewall">Atelectasis is another complication these patients may have&#46; It often affects the lung operated&#46; COPD&#44; poor pain control&#44; the thoracic wall resection or abdominal distension are some of the factors associated with its appearance&#46; Once again&#44; moving around early and the right analgesia seem to be the basic pillars to prevent the appearance of atelectasis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The most common infection in these patients is pneumonia &#40;25&#37;&#41; followed by tracheobronchitis&#44; empyema&#44; and surgical wound infections&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical complications</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Hemothorax</span><p id="par0155" class="elsevierStylePara elsevierViewall">The rate of postoperative bleeding in lung resection surgery is around 3&#37; in the case of pneumonectomy&#44; but it is lower in minor resections&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The most common cause of hemothorax is the bleeding of a thoracic wall vessel or bronchial artery&#46; The hemothorax can also be due to the presence of bleeding in patients with vascularized pleuropulmonary adhesions&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The early management is conservative with volemic restoration and correction of the possible clotting or platelet disturbances&#46; The indications for the surgical treatment are deficits of 200<span class="elsevierStyleHsp" style=""></span>mL&#47;h for over 6<span class="elsevierStyleHsp" style=""></span>h or deficits of 1200<span class="elsevierStyleHsp" style=""></span>mL in less than 6<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Chylothorax</span><p id="par0170" class="elsevierStylePara elsevierViewall">This is a rare complication with an incidence rate &#60;1&#37; in most series&#46; The most common cause is performing a thorough lymphadenectomy&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The early management is conservative with intrathoracic drainage insertion if the patient did not already carry it&#44; absolute diet and total parenteral nutrition&#46; The use of somatostatin analogs like octreotide seems to improve the results of conservative treatment&#46; Until now&#44; there is no evidence available to recommend this or that dose&#46; Most series use doses between 50<span class="elsevierStyleHsp" style=""></span>&#956;g s&#46;c and 200<span class="elsevierStyleHsp" style=""></span>&#956;g s&#46;c every 8<span class="elsevierStyleHsp" style=""></span>h&#44; although some authors recommend doses of up to 1<span class="elsevierStyleHsp" style=""></span>mg s&#46;c every 8<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Prolonged air leak</span><p id="par0180" class="elsevierStylePara elsevierViewall">Aerial leak is one of the most common complications associated with lung resection surgery and in some series&#44; its incidence rate is &#62;50&#37;&#46; Most leaks subside within the first 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h after the surgery&#44; but between 5&#37; and 10&#37; of the leaks cannot be solved whithin this timeframe&#46; An aerial leak is said to be prolonged when it remains more than 5 days&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In the presence of an aerial leak&#44; the first step is to perform a differential diagnosis between the pleuropulmonary fistula and the bronchopleural fistula&#46; In the first case&#44; the intensity of the leak is usually mild-to-moderate&#46; It often appears while breathing-out&#46; In the second case&#44; the leak is often massive and continuous and appears while breathing-in and breathing-out&#46; Its prognosis is much worse for the patient&#46; The definitive diagnosis will be given through fiberoptic bronchoscopy&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Prolonged aerial leaks are often associated with more postoperative complications&#44; especially of infectious&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">They are associated with a higher incidence rate of prolonged aerial leak&#58; male sex&#44; chronic obstructive pulmonary disease&#44; smoking&#44; presence of firm pleuropulmonary adhesions&#44; presence of incomplete fissures&#44; rigid lungs due to chronic infectious processes or pulmonary fibrosis&#44; mechanical ventilation&#44; diabetes mellitus&#44; infectious process&#44; low levels of proteins and serum albumin&#44; and treatment with corticoids&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The treatment of choice in cases of prolonged aerial leak should be conservative by connecting the drainage to the Heimlich valve for home management or surgical in cases of patient&#39;s intolerance to the valve due to an expanding pneumothorax or clinical impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Bronchopleural fistula</span><p id="par0205" class="elsevierStylePara elsevierViewall">This is one of the most feared complications by thoracic surgeons due to its high postoperative mortality rate &#40;25&#37;&#8211;71&#37; according to the series&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> It can be divided into early &#40;first 48<span class="elsevierStyleHsp" style=""></span>h&#41; or late-onset bronchopleural fistula&#46; Approximately half of late fistulas occur within the first month after surgery&#44; and prognosis gets worse the closer they are to surgery&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Once it has been diagnosed the initial treatment is placing an endothoracic drainage if the patient just could not stand it anymore&#44; intravenous antibiotic therapy&#44; oxygen therapy and&#44; if possible&#44; in the lateral decubitus position on the operated side&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In early-onset fistulas &#60;5<span class="elsevierStyleHsp" style=""></span>mm in size&#44; closure can be attempted through endoscopic treatment&#46; In fistulas &#62;5<span class="elsevierStyleHsp" style=""></span>mm&#44; the stump is covered with the muscle&#44; pericardial fat or omentum&#46; Regarding late-onset fistulas&#44; treatment will depend on each patient&#39;s status&#44; cardiorespiratory functional reserve&#44; prior surgical findings&#44; and on the surgeon&#39;s experience&#46; When there is no evidence of infection&#44; the treatment of choice is surgical&#46; In the remaining cases&#44; repair treatment will be delayed until there is evidence that the infection has been cleared&#46;</p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">Patients who receive thoracic surgery are complex patients who require multimodal and multidisciplinary approaches&#46; Critical care medicine services play an important role in the management of these patients adding value to the surgical process&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a> The selection of minimally invasive surgical techniques&#44; the aggressive management of pain&#44; early mobilization&#44; respiratory physical therapy&#44; and feeding avoids unnecessary invasive monitorization&#46; Also&#44; the early withdrawal of drain tubes&#44; catheters or probes seems to reduce the rate of complications and the length of the hospital stay which improves the recovery of these patients&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres1321534"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1219050"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1321533"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1219051"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Thoracic surgery"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Periprocedural management"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Intraoperative management"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Admission criteria in intensive care units"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Postoperative management"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Complications in the postoperative management of thoracic surgery"
          "secciones" => array:3 [
            0 => array:3 [
              "identificador" => "sec0040"
              "titulo" => "Medical complications"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0045"
                  "titulo" => "Respiratory failure"
                ]
                1 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Arrhythmias"
                ]
                2 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Pulmonary thromboembolic disease"
                ]
              ]
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Other medical complications"
            ]
            2 => array:3 [
              "identificador" => "sec0065"
              "titulo" => "Surgical complications"
              "secciones" => array:4 [
                0 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Hemothorax"
                ]
                1 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Chylothorax"
                ]
                2 => array:2 [
                  "identificador" => "sec0080"
                  "titulo" => "Prolonged air leak"
                ]
                3 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Bronchopleural fistula"
                ]
              ]
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:2 [
          "identificador" => "xack455774"
          "titulo" => "Acknowledgements"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-10-07"
    "fechaAceptado" => "2019-10-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1219050"
          "palabras" => array:3 [
            0 => "Perioperative medicine"
            1 => "Thoracic surgery"
            2 => "Intensive care medicine"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1219051"
          "palabras" => array:3 [
            0 => "Medicina perioperatoria"
            1 => "Cirug&#237;a tor&#225;cica"
            2 => "Medicina intensiva"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure&#46; This has allowed improvements in patient clinical outcomes in surgeries of this kind&#46; Despite the above&#44; thoracic surgery&#44; especially related to pulmonary resection&#44; is not without risk&#44; and is associated to considerable morbidity and mortality&#46; Fast track or enhanced recovery after anesthesia protocols&#44; minimally invasive surgery&#44; and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery&#46; Patients in the postoperative period of major thoracic surgery require intensive surveillance&#44; especially the first 24&#8211;72<span class="elsevierStyleHsp" style=""></span>h after surgery&#46; Admission to the ICU is especially recommended in those patients with comorbidities&#44; a reduced cardiopulmonary reserve&#44; extensive lung resections&#44; and those requiring support due to life-threatening organ failure&#46; During the postoperative period&#44; intensive cardiorespiratory monitoring&#44; proper management of thoracic drainage&#44; aggressive pain control &#40;multimodal analgesia and regional anesthetic techniques&#41;&#44; nausea and multimodal rehabilitation are key elements for avoiding adverse events&#46; Medical complications include respiratory failure&#44; arrhythmias&#44; respiratory infections&#44; atelectasis and thromboembolic lung disease&#46; The most frequent surgical complications are hemothorax&#44; chylothorax&#44; bronchopleural fistula and prolonged air leakage&#46; The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a tor&#225;cica ha experimentado importantes avances en los &#250;ltimos a&#241;os relacionados con las t&#233;cnicas anest&#233;sicas y quir&#250;rgicas y la prevenci&#243;n y el manejo de las complicaciones relacionadas con el procedimiento&#46; Esto ha permitido mejorar los resultados cl&#237;nicos de los pacientes sometidos a este tipo de intervenci&#243;n&#46; A pesar de ello&#44; los procedimientos de cirug&#237;a tor&#225;cica&#44; especialmente los relacionados con la resecci&#243;n pulmonar&#44; no est&#225;n exentos de riesgo&#44; con una morbimortalidad asociada considerable&#46; Los protocolos <span class="elsevierStyleItalic">Fast track</span> o <span class="elsevierStyleItalic">Enhanced recovery after anesthesia</span>&#44; la cirug&#237;a m&#237;nimamente invasiva y el manejo anest&#233;sico intraoperatorio mejoran el pron&#243;stico y la seguridad de los procesos de cirug&#237;a tor&#225;cica&#46; Los pacientes postoperados de cirug&#237;a tor&#225;cica mayor requieren una vigilancia intensiva&#44; especialmente las primeras 24-72<span class="elsevierStyleHsp" style=""></span>h del postoperatorio inmediato&#46; El ingreso en la UCI se recomienda especialmente en los pacientes con comorbilidad&#44; con reserva cardiopulmonar reducida&#44; con resecciones pulmonares extensas y en los que requieren soporte por fallo de alg&#250;n &#243;rgano con riesgo vital&#46; Durante el periodo postoperatorio la monitorizaci&#243;n intensiva cardiorrespiratoria&#44; el manejo adecuado de los drenajes tor&#225;cicos&#44; el control agresivo del dolor &#40;analgesia multimodal y t&#233;cnicas anest&#233;sicas regionales&#41;&#44; las n&#225;useas y la rehabilitaci&#243;n multimodal son elementos claves para evitar eventos adversos&#46; Entre las complicaciones m&#233;dicas destacan la insuficiencia respiratoria&#44; las arritmias&#44; las infecciones respiratorias&#44; las atelectasias y la enfermedad pulmonar tromboemb&#243;lica&#46; Las complicaciones quir&#250;rgicas m&#225;s frecuentes son el hemot&#243;rax&#44; el quilot&#243;rax&#44; la f&#237;stula broncopleural y la fuga a&#233;rea prolongada&#46; El manejo multidisciplinar de estos pacientes durante todo el periodo perioperatorio es esencial para asegurar los mejores resultados quir&#250;rgicos&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mu&#241;oz de Cabo C&#44; Hermoso Alarza F&#44; Cossio Rodriguez AM&#44; Mart&#237;n Delgado MC&#46; Manejo perioperatorio en cirug&#237;a tor&#225;cica&#46; Med Intensiva&#46; 2020&#59;44&#58;185&#8211;191&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => 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:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adapted from Batchelor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Preparation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Detailed information and recommendations to quit smoking and avoid alcohol consumption at least 4 weeks prior to the intervention</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nutritional supplements for malnourished patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anemia identification and correction</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preconditioning of patients with borderline pulmonary functional reserve</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Preoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative fasting&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Water up to 2<span class="elsevierStyleHsp" style=""></span>h prior to the induction of anesthesia and solid food up to 6<span class="elsevierStyleHsp" style=""></span>h prior to the induction of anesthesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Oral overload of carbon hydrates prior to the intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The routine use of sedatives to manage anxiety prior to the intervention is not recommended</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Perioperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Antibiotic prophylaxis and skin washing</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Use of chlorhexidine solutions to prepare the skin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Continuous control of temperature and prevention of hypothermia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lung protective mechanical ventilation especially in cases of one lung ventilation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Use of combined anesthesia techniques &#40;regional and general&#41; and half-life for anesthetic drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Combination of non-pharmacological and pharmacological measures for postoperative nausea and vomiting &#40;PONV&#41; prevention</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The use of epidural anesthesia for the management of pain and avoidance of opioids is recommended</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The analgesia provided by paravertebral block is equivalent to that provided by epidural anesthesia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The use of conventional analgesia with paracetamol and NSAIDs is recommended except for contraindications</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dexamethasone can be administered to reduce PONV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Avoid highly restrictive or liberal protocols of serum therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The use of balanced solutions is preferred over saline serum solutions at 0&#46;9&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Oral tolerance and serum therapy withdrawal will be initiated as soon as possible</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prevention of atrial fibrillation&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Reintroduce beta-blockers as soon as possible in patients on chronic treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Assess the use of preoperative diltiazem or postoperative amiodaron in high-risk patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">External pleural drainage&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Do not apply external aspiration as a general rule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Assess the removal of drainage systems as soon as possible even in cases with 450<span class="elsevierStyleHsp" style=""></span>mL&#47;day drains&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>The use of a single drainage tube for is recommended&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Avoid the use of an unnecessary vesical catheter and proceed with early withdrawal if used</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Early mobilization within the first 24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Thromboembolic prophylaxis in patients treated with major lung surgery&#46; In very high-risk cases assess whether to keep on administering prophylaxis for up to 4 weeks</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2265003.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommendations for the perioperative management of patients treated with lung surgery according to the European Society of Thoracic Surgeons&#46;</p>"
        ]
      ]
      1 => 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:1 [
          "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High comorbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reduced cardiopulmonary functional reserve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extensive lung resections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Support required for one or more organs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2265001.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Criteria for ICU admission&#46;</p>"
        ]
      ]
      2 => 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="spar0035" class="elsevierStyleSimplePara elsevierViewall">DLCO&#44; diffusing capacity of lung for carbon monoxide&#59; FEV<span class="elsevierStyleInf">1</span>&#44; maximal forced expiratory volume in the first second&#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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiac comorbidity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#62;65 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative predictive FEV<span class="elsevierStyleInf">1</span> &#60;65&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Postoperative predictive DLCO &#60;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2265002.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Variables to predict the possibility of serious complications that may require urgent ICU admission&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence and nature of in-hospital adverse events&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;N&#46; De Vries"
                            1 => "M&#46;A&#46; Ramrattan"
                            2 => "S&#46;M&#46; Smorenburg"
                            3 => "D&#46;J&#46; Gouma"
                            4 => "M&#46;A&#46; Boermeester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/qshc.2007.023622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Qual Saf Health Care"
                        "fecha" => "2008"
                        "volumen" => "17"
                        "paginaInicial" => "216"
                        "paginaFinal" => "223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18519629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The enhanced recover after surgery &#40;ERAS&#41; pathway for patients undergoing major elective open colorectal surgery&#58; a meta-analysis of randomized trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;K&#46; Varandhan"
                            1 => "K&#46;R&#46; Neal"
                            2 => "C&#46;H&#46; Dejong"
                            3 => "K&#46;C&#46; Fearon"
                            4 => "O&#46; Ljungqvist"
                            5 => "D&#46;N&#46; Lobo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2010.01.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nutr"
                        "fecha" => "2010"
                        "volumen" => "29"
                        "paginaInicial" => "434"
                        "paginaFinal" => "440"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20116145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Society of Thoracic Surgeons General Thoracic Surgery Database&#58; establishing generalizability to national lung cancer resection outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;J&#46; LaPar"
                            1 => "C&#46;M&#46; Bhamidipati"
                            2 => "C&#46;L&#46; Lau"
                            3 => "D&#46;R&#46; Jones"
                            4 => "B&#46;D&#46; Kozower"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2012.03.054"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "94"
                        "paginaInicial" => "216"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22608716"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based surgical care and the evolution of fast-track surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Kehlet"
                            1 => "D&#46;V&#46; Wilmore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e31817f2c1a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2008"
                        "volumen" => "248"
                        "paginaInicial" => "189"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fast track surgery&#58; realidades y dificultades"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Kehlet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0009-739x(06)70955-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cir Esp"
                        "fecha" => "2006"
                        "volumen" => "80"
                        "paginaInicial" => "187"
                        "paginaFinal" => "188"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17040666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Experience with lung resection in a fast-track surgery program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Alarc&#243;n"
                            1 => "J&#46;C&#46; Pe&#241;alver Cuesta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2012.09.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "89"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23245565"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for Enhanced Recovery After Surgery &#40;ERAS&#64;&#41; Society and the European Society of Thoracic Surgeons &#40;ESTS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Batchelor"
                            1 => "N&#46; Rasburn"
                            2 => "E&#46; Abdelnour-Berchtold"
                            3 => "A&#46; Brunelli"
                            4 => "R&#46; Cerfalio"
                            5 => "M&#46; Gonzalez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ejcts/ezy301"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2019"
                        "volumen" => "55"
                        "paginaInicial" => "91"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30304509"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Video-assisted thoracic surgery vs&#46; open thoracotomy for non-small cell lung cancer&#58; a meta-analysis of propensity score-matched patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Cao"
                            1 => "C&#46; Manganas"
                            2 => "S&#46;C&#46; Ang"
                            3 => "S&#46; Peeceeyen"
                            4 => "T&#46;D&#46; Yan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivs472"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "244"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23169877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;D&#46; Yan"
                            1 => "D&#46; Black"
                            2 => "P&#46;G&#46; Bannon"
                            3 => "B&#46;C&#46; McCaughan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2009"
                        "volumen" => "27"
                        "paginaInicial" => "2553"
                        "paginaFinal" => "2562"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Respiratory Society and European Society of Thoracic Surgeons joint task force on fitness for radical therapy&#46; ERS&#47;ESTS clinical guidelines on fitness for radical therapy in lung cancer patients &#40;surgery and chemo-radiotherapy&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Brunelli"
                            1 => "A&#46; Charloux"
                            2 => "C&#46;T&#46; Bolliger"
                            3 => "G&#46; Rocco"
                            4 => "J&#46;P&#46; Sculier"
                            5 => "G&#46; Varela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00184308"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "17"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19567600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Who needs to be allocated in ICU after thoracic surgery&#63; An observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Pinheiro"
                            1 => "I&#46;L&#46; Santoro"
                            2 => "S&#46;M&#46; Faresin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2016/3981506"
                      "Revista" => array:5 [
                        "tituloSerie" => "Can Respir J"
                        "fecha" => "2016"
                        "volumen" => "2016"
                        "paginaInicial" => "3981506"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27493477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence&#44; duration and causes of intensive care unit admission following pulmonary resection for malignancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;D&#46; Melley"
                            1 => "E&#46;M&#46; Thomson"
                            2 => "S&#46;P&#46; Page"
                            3 => "G&#46; Ladas"
                            4 => "J&#46; Cordingley"
                            5 => "T&#46;W&#46; Evans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-006-0269-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1419"
                        "paginaFinal" => "1422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16826388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A scoring system predicting the risk for intensive care unit admission for complications after major lung resection&#58; a multicenter analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Brunelli"
                            1 => "M&#46;K&#46; Ferguson"
                            2 => "G&#46; Rocco"
                            3 => "P&#46; Pieretti"
                            4 => "W&#46;T&#46; Vigneswaran"
                            5 => "N&#46;J&#46; Morgan-Hughes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2008.03.063"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2008"
                        "volumen" => "86"
                        "paginaInicial" => "213"
                        "paginaFinal" => "218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18573425"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting pulmonary complications after pneumonectomy for lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Algar"
                            1 => "A&#46; Alvarez"
                            2 => "A&#46; Salvatierra"
                            3 => "C&#46; Baamonde"
                            4 => "J&#46;L&#46; Aranda"
                            5 => "F&#46;J&#46; Lopez-Pujol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1010-7940(02)00719-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2003"
                        "volumen" => "23"
                        "paginaInicial" => "201"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12559343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimizing postoperative care protocols in thoracic surgery&#58; best evidence and new technology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;G&#46; French"
                            1 => "M&#46; Dilena"
                            2 => "S&#46; LaPlante"
                            3 => "F&#46; Shamji"
                            4 => "S&#46; Sundaresan"
                            5 => "J&#46; Villeneuve"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2072-1439.2015.10.67"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2016"
                        "volumen" => "8"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "S3"
                        "paginaFinal" => "S11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26941968"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should you place one or two chest drains in patients undergoing lobectomy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;G&#46; Dawson"
                            1 => "S&#46; Hosmane"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1510/icvts.2010.235853"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "178"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20439304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;P&#46; Joshi"
                            1 => "F&#46; Bonnet"
                            2 => "R&#46; Shah"
                            3 => "R&#46;C&#46; Wilkinson"
                            4 => "F&#46; Camu"
                            5 => "B&#46; Fischer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/01.ane.0000333274.63501.ff"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2008"
                        "volumen" => "107"
                        "paginaInicial" => "1026"
                        "paginaFinal" => "1040"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18713924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chest physiotherapy revisited&#58; evaluation of its influence on the pulmonary morbidity after pulmonary resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Novoa"
                            1 => "E&#46; Ballesteros"
                            2 => "M&#46;F&#46; Jim&#233;nez"
                            3 => "J&#46;L&#46; Aranda"
                            4 => "G&#46; Varela"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2010.11.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2011"
                        "volumen" => "40"
                        "paginaInicial" => "130"
                        "paginaFinal" => "134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21227711"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early removal of chest drainage tubes and oxygen support after a lobectomy for lung cancer facilitates earlier recovery of the 6-minute walking distance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Nomori"
                            1 => "H&#46; Horio"
                            2 => "K&#46; Suemasu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s005950170128"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Today"
                        "fecha" => "2001"
                        "volumen" => "31"
                        "paginaInicial" => "395"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11381501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;R&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.thorsurg.2006.05.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorac Surg Clin"
                        "fecha" => "2006"
                        "volumen" => "16"
                        "paginaInicial" => "235"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17004551"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac arrhythmias and myocardial ischemia after thoracotomy for lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Von Koring"
                            1 => "M&#46; Lepantalo"
                            2 => "L&#46; Lindgren"
                            3 => "O&#46; Lindfors"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(92)90325-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "1992"
                        "volumen" => "53"
                        "paginaInicial" => "642"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1554274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors associated with atrial fibrillation after noncardiac thoracic surgery&#58; analysis of 2&#44;588 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;A&#46; Vaporciyan"
                            1 => "A&#46;M&#46; Correa"
                            2 => "D&#46;C&#46; Rice"
                            3 => "J&#46;A&#46; Roth"
                            4 => "W&#46;R&#46; Smythe"
                            5 => "S&#46;G&#46; Swisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2003.07.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2004"
                        "volumen" => "127"
                        "paginaInicial" => "779"
                        "paginaFinal" => "786"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15001907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures&#46; Executive summary"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "American Association of Thoracic Surgery"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Frendl"
                            1 => "A&#46;C&#46; Sodickson"
                            2 => "M&#46;K&#46; Chung"
                            3 => "A&#46;L&#46; Waldo"
                            4 => "B&#46;J&#46; Gersh"
                            5 => "J&#46;E&#46; Tisdale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2014.06.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2014"
                        "volumen" => "148"
                        "paginaInicial" => "772"
                        "paginaFinal" => "791"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25129583"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of venous thromboembolism in elective thoracic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;T&#46; G&#243;mez-Hern&#225;ndez"
                            1 => "M&#46; Rodr&#237;guez-P&#233;rez"
                            2 => "N&#46; Novoa-Valent&#237;n"
                            3 => "M&#46; Jim&#233;nez-L&#243;pez"
                            4 => "J&#46;L&#46; Aranda-Alcaide"
                            5 => "G&#46; Varela-Sim&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2013.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "297"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23542046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:7 [
                            0 => "O&#46; Schussler"
                            1 => "M&#46; Alifano"
                            2 => "H&#46; Dermine"
                            3 => "S&#46; Strano"
                            4 => "A&#46; Casetta"
                            5 => "S&#46; Sepulveda"
                            6 => "Postoperative pneumonia after major lung resection"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2006"
                        "volumen" => "173"
                        "paginaInicial" => "1161"
                        "paginaFinal" => "1169"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of pulmonary resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Haitcock"
                            1 => "R&#46; Feins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "T&#46;Shields, J&#46;Locicero, C&#46;Reed, R&#46;Feins"
                        "titulo" => "General thoracic surgery"
                        "paginaInicial" => "551"
                        "paginaFinal" => "559"
                        "edicion" => "7th ed&#46;"
                        "serieFecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Octreotide use in post-cardiac surgery chylothorax&#58; a 12-year perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;S&#46; Aljazairi"
                            1 => "T&#46;A&#46; Bhuiyan"
                            2 => "A&#46;H&#46; Alwadai"
                            3 => "R&#46;A&#46; Almehizia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0218492316682670"
                      "Revista" => array:6 [
                        "tituloSerie" => "Asian Cardiovasc Thorac Ann"
                        "fecha" => "2017"
                        "volumen" => "25"
                        "paginaInicial" => "6"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27920229"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective randomized trial compares suction versus water seal for air leaks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;J&#46; Cerfolio"
                            1 => "C&#46; Bass"
                            2 => "C&#46;R&#46; Katholi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2001"
                        "volumen" => "71"
                        "paginaInicial" => "1613"
                        "paginaFinal" => "1617"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of alveolar air leaks after pulmonary resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Singhal"
                            1 => "V&#46; Ferraris"
                            2 => "C&#46; Bridges"
                            3 => "E&#46; Clough"
                            4 => "J&#46; Mitchell"
                            5 => "H&#46; Fernando"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2009.09.020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2010"
                        "volumen" => "89"
                        "paginaInicial" => "1327"
                        "paginaFinal" => "1335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20338378"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The development of bronchopleural fistula in lung cancer patients after major surgery&#58; 31 years of experience with 19 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Uramoto"
                            1 => "T&#46; Hanagiri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Anticancer Res"
                        "fecha" => "2011"
                        "volumen" => "31"
                        "paginaInicial" => "619"
                        "paginaFinal" => "624"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive medicine services&#46; How to add value to the surgical process&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;C&#46; Mart&#237;n Delgado"
                            1 => "F&#46; Gordo Vidal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2018"
                        "volumen" => "42"
                        "paginaInicial" => "461"
                        "paginaFinal" => "462"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack455774"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0230" class="elsevierStylePara elsevierViewall">None&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004400000003/v1_202003270001/S2173572720300424/v1_202003270001/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "80427"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Update in Perioperative Intensive Medicine"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004400000003/v1_202003270001/S2173572720300424/v1_202003270001/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300424?idApp=WMIE"
]

Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2019.10.006

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	13	22
2024 October	191	90	281
2024 September	189	67	256
2024 August	185	88	273
2024 July	184	73	257
2024 June	219	222	441
2024 May	229	107	336
2024 April	182	83	265
2024 March	228	76	304
2024 February	207	113	320
2024 January	240	119	359
2023 December	244	101	345
2023 November	268	128	396
2023 October	298	123	421
2023 September	368	187	555
2023 August	243	78	321
2023 July	254	89	343
2023 June	280	111	391
2023 May	312	125	437
2023 April	324	102	426
2023 March	446	109	555
2023 February	328	83	411
2023 January	294	96	390
2022 December	355	111	466
2022 November	306	124	430
2022 October	309	134	443
2022 September	274	121	395
2022 August	235	126	361
2022 July	195	81	276
2022 June	171	76	247
2022 May	216	85	301
2022 April	211	92	303
2022 March	222	142	364
2022 February	166	86	252
2022 January	163	104	267
2021 December	144	117	261
2021 November	180	100	280
2021 October	270	152	422
2021 September	224	99	323
2021 August	138	83	221
2021 July	124	56	180
2021 June	144	69	213
2021 May	147	80	227
2021 April	380	223	603
2021 March	308	98	406
2021 February	201	58	259
2021 January	209	56	265
2020 December	179	49	228
2020 November	100	42	142
2020 October	47	28	75
2020 September	1	1	2
2020 July	28	14	42
2020 June	37	31	68
2020 May	44	25	69
2020 April	60	31	91

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter