array:23 [
  "pii" => "S2173572722000510"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2021.03.002"
  "estado" => "S300"
  "fechaPublicacion" => "2022-04-01"
  "aid" => "1656"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2021"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Med Intensiva. 2022;46:224"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173572722000285"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2022.02.003"
    "estado" => "S300"
    "fechaPublicacion" => "2022-04-01"
    "aid" => "1653"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2022;46:225-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Organ donor with PCR positive for SARS-CoV-2&#44; it has been always no&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "225"
          "paginaFinal" => "226"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Donante de &#243;rganos con PCR positiva para SARS-CoV-2&#44; &#191;siempre no es no&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Royo-Villanova Reparaz, B&#46; Dominguez-Gil, A&#46; Moreno Doc&#243;n, S&#46;J&#46; C&#225;novas L&#243;pez, F&#46;J&#46; Pastor P&#233;rez, A&#46;J&#46; Ort&#237;n Freire"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Royo-Villanova Reparaz"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Dominguez-Gil"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Moreno Doc&#243;n"
            ]
            3 => array:2 [
              "nombre" => "S&#46;J&#46;"
              "apellidos" => "C&#225;novas L&#243;pez"
            ]
            4 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Pastor P&#233;rez"
            ]
            5 => array:2 [
              "nombre" => "A&#46;J&#46;"
              "apellidos" => "Ort&#237;n Freire"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S021056912100070X"
        "doi" => "10.1016/j.medin.2021.03.011"
        "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/S021056912100070X?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000285?idApp=WMIE"
    "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000285/v1_202204210557/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173572722000509"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2021.04.013"
    "estado" => "S300"
    "fechaPublicacion" => "2022-04-01"
    "aid" => "1660"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2022;46:221-3"
    "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">Scientific Letter</span>"
      "titulo" => "Health care-associated infections in patients with COVID-19 pneumonia in COVID critical care areas"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "221"
          "paginaFinal" => "223"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Infecciones relacionadas con la asistencia sanitaria en pacientes con neumon&#237;a COVID-19 en &#225;reas de cuidados intensivos COVID"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2420
              "Ancho" => 2508
              "Tamanyo" => 276534
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Outcomes&#58; length of ICU stay and mortality in patients with COVID-19 pneumonia admitted to the COVID-19 intensive care units&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 vs No HAI&#59; &#42;&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 vs No HAI&#59; <span class="elsevierStyleSup">&#35;</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 vs 2 HAIs&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Marin-Corral, S&#46; Pascual-Guardia, R&#46; Mu&#241;oz-Berm&#250;dez, A&#46; Salazar-Degracia, C&#46; Climent, C&#46; Vil&#224;-Vilardell, M&#46; Acer, M&#46; Picornell, M&#46;I&#46; Restrepo, J&#46;R&#46; Masclans, F&#46; &#193;lvarez-Lerma"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Marin-Corral"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Pascual-Guardia"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Mu&#241;oz-Berm&#250;dez"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Salazar-Degracia"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Climent"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Vil&#224;-Vilardell"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Acer"
            ]
            7 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Picornell"
            ]
            8 => array:2 [
              "nombre" => "M&#46;I&#46;"
              "apellidos" => "Restrepo"
            ]
            9 => array:2 [
              "nombre" => "J&#46;R&#46;"
              "apellidos" => "Masclans"
            ]
            10 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "&#193;lvarez-Lerma"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000509?idApp=WMIE"
    "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000509/v1_202204210557/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>"
    "titulo" => "The science of truth"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "224"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Fajardo, R&#46; Adasme, A&#46; Medina, V&#46; Modesto i Alapont"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Fajardo"
            "email" => array:1 [
              0 => "drauriopiotr@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Adasme"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Medina"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Modesto i Alapont"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Internal Medicine Service and Critical Patient Unit&#44; Vi&#241;a del Mar&#44; Chile"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Respiratory Therapy UC-Christus Health Network Clinical Hospital&#44; School of Kinesiology&#44; Faculty of Rehabilitation&#44; Andres Bello University&#44; Santiago&#44; Chile"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Central University Hospital of Asturias&#44; Oviedo&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Universitari i Polit&#232;cnic La Fe&#44; Val&#232;ncia&#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" => "La ciencia de la verdad"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the article &#8220;<span class="elsevierStyleItalic">High flow nasal cannula useful for severe SARS-CoV-2 pneumonia</span>&#8221;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> and we believe that what the authors claim is not supported by the data and analysis they provide&#46; The article describes the use of HFNO with an initial requirement of 100&#37; FiO<span class="elsevierStyleInf">2</span>&#46; These are therefore patients with severe ARDS&#44; which clinical practice guidelines prescribes intubation&#44; invasive mechanical ventilation &#40;IMV&#41; and even prone position&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Maintaining non-invasive support in these patients causes more mortality than performing IMV&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> This simple statement has not yet been able to be experimentally refuted&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Being a retrospective study&#44; the cause&#8211;effect relationship regarding the efficacy of a treatment &#40;HFNO&#41; vs&#46; another &#40;IMV&#41; cannot be rigorously argued if it is not demonstrated that the two cohorts &#40;with and without treatment&#41; were similar before applying the respective treatments&#46; The authors do not present a table showing the distribution of the covariates in both cohorts before the treatment was applied&#46; And therefore&#44; we do not know the confounding factors that should have been controlled for in the analysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We did find some data that makes us believe that IMV was applied to patients with a higher probability of dying&#46; Thus&#44; they indicate that &#8220;<span class="elsevierStyleItalic">patients were placed in HFNO if they had ventilatory failure&#8221;&#44;</span> but that &#8220;<span class="elsevierStyleItalic">patients that had severely altered consciousness at admission&#44; severe work of breathing &#40;exhaustion&#41;&#44; or shock were placed on invasive mechanical ventilation&#8221;&#46;</span> Survival of &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; patients who received IMV was 42&#46;2&#37;&#46; And of those &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41; who received HFNO at some point in their evolution&#44; 35 &#40;58&#37;&#41; could be weaned from HFNO and went home&#44; but in 25 &#40;42&#37;&#41; of them the treatment failed&#46; Of these&#44; 24 had to be intubated and 13 finally died &#40;21&#46;67&#37; mortality&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients where HFNO failed &#40;Tables 1 and 2&#41; were much more severe than those where it worked&#46; So&#44; since the assignment of patients to treatments was not random&#44; it is logical to deduce that the IMV had to deal with the most seriously ill&#46; This is clearly a co-intervention bias&#46; And despite this&#44; we can calculate that the IMV was quite effective&#44; in the sense of achieving the objective for which it was administered&#46; Since IMV was applied to 30<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54 patients&#44; with a total of 17<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 deaths&#44; it worked in more than 55&#46;56&#37; of the patients where it was applied&#46; HFNO only fulfilled its function in 58&#37; of the patients where it was used&#44; and who were the healthiest&#46; Using a beta-binomial Bayesian model&#44; and a non-informative a priori distribution&#44; the probability &#40;rational belief&#41; that IMV fulfills its function better than HFNO is 61&#46;8&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So&#44; to our knowledge&#44; statements such as &#8220;We show evidence of the utility of HFNO in severe covid-19 patients that required ICU admission for the treatment of severe respiratory failure&#46; We achieved a high survival and posterior discharge rate&#8221; are far from having endured a rigorous experimental rebuttal and must still remain in the degree of belief&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval and consent to participate</span><p id="par0030" class="elsevierStylePara elsevierViewall">Consent for publication&#44; availability of data and material&#58; Not applicable&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contribution</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors contributed equally to this manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no competing interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Ethics approval and consent to participate"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#8217; contribution"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Funding"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflict of interest"
        ]
        4 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">WeVent&#58; International Mechanical Ventilation Group&#46;</p>"
        "identificador" => "fn0005"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "&#193;ngel Mej&#237;a V&#44; Isaza D&#44; Fern&#225;ndez Turizo M&#46; High flow nasal cannula useful for severe SARSs-CoV-2 pneumonia&#44; Med Intens&#46; <a target="_blank" href="https://doi.org/10.1016/j.medin.2021.01.002">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medin&#46;2021&#46;01&#46;002</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome&#58; the LUNG SAFE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Laffey"
                            1 => "G&#46; Bellani"
                            2 => "T&#46; Pham"
                            3 => "E&#46; Fan"
                            4 => "F&#46; Madotto"
                            5 => "E&#46;K&#46; Bajwa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-016-4571-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1865"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27757516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive ventilation of patients with acute respiratory distress syndrome insights from the LUNG SAFE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Bellani"
                            1 => "J&#46;G&#46; Laffey"
                            2 => "T&#46; Pham"
                            3 => "F&#46; Madotto"
                            4 => "E&#46; Fan"
                            5 => "L&#46; Brochard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201606-1306OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "195"
                        "paginaInicial" => "67"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27753501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000510/v1_202204210557/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "15647"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Scientific letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000004/v1_202204210557/S2173572722000510/v1_202204210557/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000510?idApp=WMIE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Scientific letter
The science of truth
La ciencia de la verdad
A. Fajardoa,
,1
, R. Adasmeb,1, A. Medinac,1, V. Modesto i Alapontd,1
a Internal Medicine Service and Critical Patient Unit, Viña del Mar, Chile
b Respiratory Therapy UC-Christus Health Network Clinical Hospital, School of Kinesiology, Faculty of Rehabilitation, Andres Bello University, Santiago, Chile
c Central University Hospital of Asturias, Oviedo, Spain
d Hospital Universitari i Politècnic La Fe, València, Spain
Read
1963
Times
was read the article
908
Total PDF
1055
Total HTML
Share statistics
 array:23 [
  "pii" => "S2173572722000510"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2021.03.002"
  "estado" => "S300"
  "fechaPublicacion" => "2022-04-01"
  "aid" => "1656"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
  "copyrightAnyo" => "2021"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Med Intensiva. 2022;46:224"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173572722000285"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2022.02.003"
    "estado" => "S300"
    "fechaPublicacion" => "2022-04-01"
    "aid" => "1653"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2022;46:225-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Organ donor with PCR positive for SARS-CoV-2&#44; it has been always no&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "225"
          "paginaFinal" => "226"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Donante de &#243;rganos con PCR positiva para SARS-CoV-2&#44; &#191;siempre no es no&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Royo-Villanova Reparaz, B&#46; Dominguez-Gil, A&#46; Moreno Doc&#243;n, S&#46;J&#46; C&#225;novas L&#243;pez, F&#46;J&#46; Pastor P&#233;rez, A&#46;J&#46; Ort&#237;n Freire"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Royo-Villanova Reparaz"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Dominguez-Gil"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Moreno Doc&#243;n"
            ]
            3 => array:2 [
              "nombre" => "S&#46;J&#46;"
              "apellidos" => "C&#225;novas L&#243;pez"
            ]
            4 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Pastor P&#233;rez"
            ]
            5 => array:2 [
              "nombre" => "A&#46;J&#46;"
              "apellidos" => "Ort&#237;n Freire"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S021056912100070X"
        "doi" => "10.1016/j.medin.2021.03.011"
        "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/S021056912100070X?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000285?idApp=WMIE"
    "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000285/v1_202204210557/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173572722000509"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2021.04.013"
    "estado" => "S300"
    "fechaPublicacion" => "2022-04-01"
    "aid" => "1660"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2022;46:221-3"
    "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">Scientific Letter</span>"
      "titulo" => "Health care-associated infections in patients with COVID-19 pneumonia in COVID critical care areas"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "221"
          "paginaFinal" => "223"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Infecciones relacionadas con la asistencia sanitaria en pacientes con neumon&#237;a COVID-19 en &#225;reas de cuidados intensivos COVID"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2420
              "Ancho" => 2508
              "Tamanyo" => 276534
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Outcomes&#58; length of ICU stay and mortality in patients with COVID-19 pneumonia admitted to the COVID-19 intensive care units&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 vs No HAI&#59; &#42;&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 vs No HAI&#59; <span class="elsevierStyleSup">&#35;</span><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 vs 2 HAIs&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Marin-Corral, S&#46; Pascual-Guardia, R&#46; Mu&#241;oz-Berm&#250;dez, A&#46; Salazar-Degracia, C&#46; Climent, C&#46; Vil&#224;-Vilardell, M&#46; Acer, M&#46; Picornell, M&#46;I&#46; Restrepo, J&#46;R&#46; Masclans, F&#46; &#193;lvarez-Lerma"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Marin-Corral"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Pascual-Guardia"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Mu&#241;oz-Berm&#250;dez"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Salazar-Degracia"
            ]
            4 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Climent"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Vil&#224;-Vilardell"
            ]
            6 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Acer"
            ]
            7 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Picornell"
            ]
            8 => array:2 [
              "nombre" => "M&#46;I&#46;"
              "apellidos" => "Restrepo"
            ]
            9 => array:2 [
              "nombre" => "J&#46;R&#46;"
              "apellidos" => "Masclans"
            ]
            10 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "&#193;lvarez-Lerma"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000509?idApp=WMIE"
    "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000509/v1_202204210557/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>"
    "titulo" => "The science of truth"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "224"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Fajardo, R&#46; Adasme, A&#46; Medina, V&#46; Modesto i Alapont"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Fajardo"
            "email" => array:1 [
              0 => "drauriopiotr@gmail.com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Adasme"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Medina"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Modesto i Alapont"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Internal Medicine Service and Critical Patient Unit&#44; Vi&#241;a del Mar&#44; Chile"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Respiratory Therapy UC-Christus Health Network Clinical Hospital&#44; School of Kinesiology&#44; Faculty of Rehabilitation&#44; Andres Bello University&#44; Santiago&#44; Chile"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Central University Hospital of Asturias&#44; Oviedo&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Hospital Universitari i Polit&#232;cnic La Fe&#44; Val&#232;ncia&#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" => "La ciencia de la verdad"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the article &#8220;<span class="elsevierStyleItalic">High flow nasal cannula useful for severe SARS-CoV-2 pneumonia</span>&#8221;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> and we believe that what the authors claim is not supported by the data and analysis they provide&#46; The article describes the use of HFNO with an initial requirement of 100&#37; FiO<span class="elsevierStyleInf">2</span>&#46; These are therefore patients with severe ARDS&#44; which clinical practice guidelines prescribes intubation&#44; invasive mechanical ventilation &#40;IMV&#41; and even prone position&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Maintaining non-invasive support in these patients causes more mortality than performing IMV&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> This simple statement has not yet been able to be experimentally refuted&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Being a retrospective study&#44; the cause&#8211;effect relationship regarding the efficacy of a treatment &#40;HFNO&#41; vs&#46; another &#40;IMV&#41; cannot be rigorously argued if it is not demonstrated that the two cohorts &#40;with and without treatment&#41; were similar before applying the respective treatments&#46; The authors do not present a table showing the distribution of the covariates in both cohorts before the treatment was applied&#46; And therefore&#44; we do not know the confounding factors that should have been controlled for in the analysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We did find some data that makes us believe that IMV was applied to patients with a higher probability of dying&#46; Thus&#44; they indicate that &#8220;<span class="elsevierStyleItalic">patients were placed in HFNO if they had ventilatory failure&#8221;&#44;</span> but that &#8220;<span class="elsevierStyleItalic">patients that had severely altered consciousness at admission&#44; severe work of breathing &#40;exhaustion&#41;&#44; or shock were placed on invasive mechanical ventilation&#8221;&#46;</span> Survival of &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; patients who received IMV was 42&#46;2&#37;&#46; And of those &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41; who received HFNO at some point in their evolution&#44; 35 &#40;58&#37;&#41; could be weaned from HFNO and went home&#44; but in 25 &#40;42&#37;&#41; of them the treatment failed&#46; Of these&#44; 24 had to be intubated and 13 finally died &#40;21&#46;67&#37; mortality&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients where HFNO failed &#40;Tables 1 and 2&#41; were much more severe than those where it worked&#46; So&#44; since the assignment of patients to treatments was not random&#44; it is logical to deduce that the IMV had to deal with the most seriously ill&#46; This is clearly a co-intervention bias&#46; And despite this&#44; we can calculate that the IMV was quite effective&#44; in the sense of achieving the objective for which it was administered&#46; Since IMV was applied to 30<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54 patients&#44; with a total of 17<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 deaths&#44; it worked in more than 55&#46;56&#37; of the patients where it was applied&#46; HFNO only fulfilled its function in 58&#37; of the patients where it was used&#44; and who were the healthiest&#46; Using a beta-binomial Bayesian model&#44; and a non-informative a priori distribution&#44; the probability &#40;rational belief&#41; that IMV fulfills its function better than HFNO is 61&#46;8&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So&#44; to our knowledge&#44; statements such as &#8220;We show evidence of the utility of HFNO in severe covid-19 patients that required ICU admission for the treatment of severe respiratory failure&#46; We achieved a high survival and posterior discharge rate&#8221; are far from having endured a rigorous experimental rebuttal and must still remain in the degree of belief&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval and consent to participate</span><p id="par0030" class="elsevierStylePara elsevierViewall">Consent for publication&#44; availability of data and material&#58; Not applicable&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contribution</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors contributed equally to this manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no competing interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:5 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Ethics approval and consent to participate"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Authors&#8217; contribution"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Funding"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflict of interest"
        ]
        4 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">WeVent&#58; International Mechanical Ventilation Group&#46;</p>"
        "identificador" => "fn0005"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:3 [
            0 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "&#193;ngel Mej&#237;a V&#44; Isaza D&#44; Fern&#225;ndez Turizo M&#46; High flow nasal cannula useful for severe SARSs-CoV-2 pneumonia&#44; Med Intens&#46; <a target="_blank" href="https://doi.org/10.1016/j.medin.2021.01.002">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medin&#46;2021&#46;01&#46;002</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome&#58; the LUNG SAFE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Laffey"
                            1 => "G&#46; Bellani"
                            2 => "T&#46; Pham"
                            3 => "E&#46; Fan"
                            4 => "F&#46; Madotto"
                            5 => "E&#46;K&#46; Bajwa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-016-4571-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1865"
                        "paginaFinal" => "1876"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27757516"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive ventilation of patients with acute respiratory distress syndrome insights from the LUNG SAFE study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Bellani"
                            1 => "J&#46;G&#46; Laffey"
                            2 => "T&#46; Pham"
                            3 => "F&#46; Madotto"
                            4 => "E&#46; Fan"
                            5 => "L&#46; Brochard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201606-1306OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "195"
                        "paginaInicial" => "67"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27753501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004600000004/v1_202204210557/S2173572722000510/v1_202204210557/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "15647"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Scientific letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000004/v1_202204210557/S2173572722000510/v1_202204210557/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722000510?idApp=WMIE"
]
Article information
ISSN: 21735727
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 5 8
2024 October 42 44 86
2024 September 36 31 67
2024 August 45 44 89
2024 July 33 28 61
2024 June 26 40 66
2024 May 43 30 73
2024 April 33 31 64
2024 March 37 31 68
2024 February 38 37 75
2024 January 49 37 86
2023 December 73 34 107
2023 November 40 38 78
2023 October 56 33 89
2023 September 32 36 68
2023 August 25 18 43
2023 July 31 26 57
2023 June 26 16 42
2023 May 29 28 57
2023 April 17 14 31
2023 March 40 25 65
2023 February 28 27 55
2023 January 29 25 54
2022 December 42 27 69
2022 November 42 35 77
2022 October 44 44 88
2022 September 36 28 64
2022 August 43 44 87
2022 July 36 52 88
2022 May 1 0 1
Show all

Follow this link to access the full text of the article

Idiomas
Medicina Intensiva (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?