array:24 [
  "pii" => "S2173572723000176"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2023.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2023-05-01"
  "aid" => "1847"
  "copyright" => "Elsevier España, S.L.U. and SEMICYUC"
  "copyrightAnyo" => "2023"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Intensiva. 2023;47:301-2"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569123000098"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2023.01.004"
      "estado" => "S300"
      "fechaPublicacion" => "2023-05-01"
      "aid" => "1847"
      "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Intensiva. 2023;47:301-2"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
        "titulo" => "Suero salino&#44; soluciones balanceadas y Thomas Bayes"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "301"
            "paginaFinal" => "302"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Saline&#44; balanced solutions and Thomas Bayes"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alejandro Gonz&#225;lez-Castro, Vicente Modesto i Alapont, Raquel Ferrero-Franco"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Alejandro"
                "apellidos" => "Gonz&#225;lez-Castro"
              ]
              1 => array:2 [
                "nombre" => "Vicente"
                "apellidos" => "Modesto i Alapont"
              ]
              2 => array:2 [
                "nombre" => "Raquel"
                "apellidos" => "Ferrero-Franco"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572723000176"
          "doi" => "10.1016/j.medine.2023.03.003"
          "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/S2173572723000176?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569123000098?idApp=WMIE"
      "url" => "/02105691/0000004700000005/v1_202304261231/S0210569123000098/v1_202304261231/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173572722002351"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2022.09.009"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1826"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and SEMICYUC"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Intensiva. 2023;47:302-3"
    "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">Letter to the Editor</span>"
      "titulo" => "Reply&#58; Pulmonary aspergillosis in the Intensive Care Unit&#46; An underdiagnosed disease&#63; Active search protocol for pulmonary aspergillosis associated with COVID-19 pneumonia"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "302"
          "paginaFinal" => "303"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Respuesta&#58; Aspergilosis pulmonar en la unidad de cuidados intensivos&#58; &#191;una enfermedad infradiagnosticada&#63; Protocolo b&#250;squeda activa aspergillosis pulmonar asociado a neumon&#237;a COVID-19"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; L&#243;pez-Olivencia, J&#46; Higuera-Lucas, M&#46;C&#46; Soriano-Cuesta, R&#46; De Pablo"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "L&#243;pez-Olivencia"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Higuera-Lucas"
            ]
            2 => array:2 [
              "nombre" => "M&#46;C&#46;"
              "apellidos" => "Soriano-Cuesta"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "De Pablo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569122002881"
        "doi" => "10.1016/j.medin.2022.08.007"
        "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/S0210569122002881?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722002351?idApp=WMIE"
    "url" => "/21735727/0000004700000005/v1_202304261213/S2173572722002351/v1_202304261213/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "S2173572722002272"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2022.08.006"
    "estado" => "S300"
    "fechaPublicacion" => "2023-05-01"
    "aid" => "1820"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Intensiva. 2023;47:298-300"
    "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" => "Are ICU nurses able to achieve their ventilation goals when bagging a patient&#63; A pilot study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "298"
          "paginaFinal" => "300"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Son las enfermeras de la UCI capaces de alcanzar sus objetivos de ventilaci&#243;n cuando ventilan manualmente a un paciente&#63; Un estudio piloto"
        ]
      ]
      "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" => 1162
              "Ancho" => 2091
              "Tamanyo" => 122245
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of ventilation performance between the blinded-test and the guided-test&#46; Ventilation performance was defined by a tidal volume &#40;V<span class="elsevierStyleInf">T</span>&#41; and ventilation rate &#40;V<span class="elsevierStyleInf">R</span>&#41; within the target range&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Rodriguez-Ruiz, S&#46; Marcos-Alonso, M&#46; Campelo-Izquierdo, A&#46; Estany-Gestal, A&#46; Rodr&#237;guez-N&#250;&#241;ez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Rodriguez-Ruiz"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Marcos-Alonso"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Campelo-Izquierdo"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Estany-Gestal"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Rodr&#237;guez-N&#250;&#241;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572722002272?idApp=WMIE"
    "url" => "/21735727/0000004700000005/v1_202304261213/S2173572722002272/v1_202304261213/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Saline&#44; balanced solutions and Thomas Bayes"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "301"
        "paginaFinal" => "302"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alejandro Gonz&#225;lez-Castro, Vicente Modesto i Alapont, Raquel Ferrero-Franco"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Alejandro"
            "apellidos" => "Gonz&#225;lez-Castro"
            "email" => array:1 [
              0 => "e409@humv.es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Vicente"
            "apellidos" => "Modesto i Alapont"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Raquel"
            "apellidos" => "Ferrero-Franco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "UCI Pedi&#225;trica&#44; Hospital Universitario La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "DUE Servicio C&#225;ntabro de Salud&#44; Santander&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Suero salino&#44; soluciones balanceadas y Thomas Bayes"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since the publication of the study &#8220;<span class="elsevierStyleItalic">SMART&#58; Is saline on the tightrope&#63;</span>&#8221;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; several authors have worked with the hypothesis that the infusion of balanced solutions in critical patients improves the outcomes in terms of renal function and mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; No studies have evidenced benefit from the use of saline solution&#59; in the best of cases&#44; performance has been reported to be equivalent<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A recent systematic review has been made of randomized clinical trials comparing balanced crystalloids with saline solution in adult critical patients&#44; with 90-day mortality as the primary endpoint&#46; The frequency statistics analysis revealed no significant differences&#46; However&#44; Bayesian analysis showed the posterior probability that balanced crystalloids reduce mortality to be 89&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physicians naturally use the Bayes theorem in decision-making referring to patient diagnosis&#44; prognosis and treatment&#46; Based on an effect&#44; we decide on the cause of the effect and intuitively assign a probability to the cause we are considering&#46; Different information sources added in sequence &#8211; development of hyperchloremia&#44; acidosis&#44; renal failure &#8211; define in an increasingly precise way the probability of a certain cause&#44; and always on an intuitive basis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; However&#44; when considering research methodology&#44; priority is given to the simplicity of being able to decide whether a treatment&#44; a diagnostic method or a procedure is effective or not&#44; based on a pre-established <span class="elsevierStyleItalic">p</span> &#60; 0&#46;05&#46; The problem is that the p-value&#44; which is no more than a tool used to quantify such uncertainty&#44; is too often overvalued and misinterpreted&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-12-05"
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0105"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">RL&#58; Ringer lactate&#59; BS&#58; balanced solution&#59; ABS&#58; acetate balanced solution&#59; SS 0&#46;9&#37;&#58; 0&#46;9&#37; saline solution</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "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">Author&#44; year&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">Name of study&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">Country&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">Patients randomized to SS 0&#46;9&#37;&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">Patients randomized to BS&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">Type of balanced solution&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">Follow-up&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semler&#44; 2018&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SMART&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1169&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1167&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RL or ABS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 days&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pagano&#44; 2020&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">&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italy&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Golla&#44; 2020&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">&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">India&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RL&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 days&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zampieri&#44; 2021&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BaSICS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brazil&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1017&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1987&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ABS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 days&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Finfer&#44; 2022&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PLUS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Australia and New Zealand&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1026&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1068&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ABS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Principal characteristics of randomized controlled studies comparing 0&#46;9&#37; saline solution versus balanced solutions in critical patients after 2018&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:4 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SMART&#58; Is saline on the tightrope&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Gonz&#225;lez-Castro"
                            1 => "M&#46; Ortiz-Lasa"
                            2 => "J&#46; Bada da Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2017.12.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva &#40;Engl Ed&#41;"
                        "fecha" => "2018"
                        "volumen" => "42"
                        "paginaInicial" => "394"
                        "paginaFinal" => "395"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29397228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isotonic saline&#44; balanced fluids&#44; and chloride toxicity in ICU&#58; Lessons from the PLUS trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Muller"
                            1 => "O&#46; Joannes-Boyau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.accpm.2022.101078"
                      "Revista" => array:3 [
                        "tituloSerie" => "Anaesth Crit Care Pain Med"
                        "fecha" => "2022"
                        "volumen" => "41"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Balanced crystalloids versus saline in critically ill adults &#8212; A systematic review with metaanalysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;E&#46; Hammond"
                            1 => "F&#46;G&#46; Zampieri"
                            2 => "G&#46;L&#46;D&#46; di Tanna"
                            3 => "T&#46; Garside"
                            4 => "D&#46; Adigbli"
                            5 => "A&#46;B&#46; Cavalcanti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/EVIDoa2100010"
                      "Revista" => array:2 [
                        "tituloSerie" => "NEJM Evid"
                        "fecha" => "2022"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A brief look into Bayesian statistics in cardiology data analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Armero"
                            1 => "P&#46; Rodr&#237;guez"
                            2 => "J&#46;M&#46; de la Torre Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "REC Interv Cardiol"
                        "fecha" => "2022"
                        "volumen" => "4"
                        "paginaInicial" => "207"
                        "paginaFinal" => "215"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004700000005/v1_202304261213/S2173572723000176/v1_202304261213/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "64604"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Letters to the Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004700000005/v1_202304261213/S2173572723000176/v1_202304261213/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572723000176?idApp=WMIE"
]
Share
Journal Information
Vol. 47. Issue 5.
Pages 301-302 (May 2023)
Vol. 47. Issue 5.
Pages 301-302 (May 2023)
Letter to the Editor
Full text access
Saline, balanced solutions and Thomas Bayes
Suero salino, soluciones balanceadas y Thomas Bayes
Visits
1125
Alejandro González-Castroa,
Corresponding author
e409@humv.es

Corresponding author.
, Vicente Modesto i Alapontb, Raquel Ferrero-Francoc
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b UCI Pediátrica, Hospital Universitario La Fe, Valencia, Spain
c DUE Servicio Cántabro de Salud, Santander, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editor:

Since the publication of the study “SMART: Is saline on the tightrope?1, several authors have worked with the hypothesis that the infusion of balanced solutions in critical patients improves the outcomes in terms of renal function and mortality (Table 1). No studies have evidenced benefit from the use of saline solution; in the best of cases, performance has been reported to be equivalent2.

Table 1.

Principal characteristics of randomized controlled studies comparing 0.9% saline solution versus balanced solutions in critical patients after 2018.

Author, year  Name of study  Country  Patients randomized to SS 0.9%  Patients randomized to BS  Type of balanced solution  Follow-up 
Semler, 2018  SMART  USA  1169  1167  RL or ABS  30 days 
Pagano, 2020    Italy  49  35  RL  – 
Golla, 2020    India  80  80  RL  30 days 
Zampieri, 2021  BaSICS  Brazil  1017  1987  ABS  90 days 
Finfer, 2022  PLUS  Australia and New Zealand  1026  1068  ABS  90 days 

RL: Ringer lactate; BS: balanced solution; ABS: acetate balanced solution; SS 0.9%: 0.9% saline solution

A recent systematic review has been made of randomized clinical trials comparing balanced crystalloids with saline solution in adult critical patients, with 90-day mortality as the primary endpoint. The frequency statistics analysis revealed no significant differences. However, Bayesian analysis showed the posterior probability that balanced crystalloids reduce mortality to be 89.5%3.

Physicians naturally use the Bayes theorem in decision-making referring to patient diagnosis, prognosis and treatment. Based on an effect, we decide on the cause of the effect and intuitively assign a probability to the cause we are considering. Different information sources added in sequence – development of hyperchloremia, acidosis, renal failure – define in an increasingly precise way the probability of a certain cause, and always on an intuitive basis4. However, when considering research methodology, priority is given to the simplicity of being able to decide whether a treatment, a diagnostic method or a procedure is effective or not, based on a pre-established p < 0.05. The problem is that the p-value, which is no more than a tool used to quantify such uncertainty, is too often overvalued and misinterpreted.

References
[1]
A. González-Castro, M. Ortiz-Lasa, J. Bada da Silva.
SMART: Is saline on the tightrope?.
Med Intensiva (Engl Ed), 42 (2018), pp. 394-395
[2]
L. Muller, O. Joannes-Boyau.
Isotonic saline, balanced fluids, and chloride toxicity in ICU: Lessons from the PLUS trial.
Anaesth Crit Care Pain Med, 41 (2022),
[3]
N.E. Hammond, F.G. Zampieri, G.L.D. di Tanna, T. Garside, D. Adigbli, A.B. Cavalcanti, et al.
Balanced crystalloids versus saline in critically ill adults — A systematic review with metaanalysis.
[4]
C. Armero, P. Rodríguez, J.M. de la Torre Hernández.
A brief look into Bayesian statistics in cardiology data analysis.
REC Interv Cardiol, 4 (2022), pp. 207-215
Copyright © 2023. Elsevier España, S.L.U. and SEMICYUC
Idiomas
Medicina Intensiva (English Edition)
Article options
Tools
es en

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

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