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Hospital Universitario Arnau de Vilanova de Lleida&#41; desde enero de 1997 a diciembre de 2010&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica fue informado de la realizaci&#243;n del trabajo y dadas las caracter&#237;sticas del estudio&#44; no consider&#243; necesario la obtenci&#243;n del consentimiento informado&#46; Se garantiz&#243; el anonimato de los pacientes durante todo el periodo del estudio&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogieron datos demogr&#225;ficos&#44; diagn&#243;stico al ingreso&#44; presencia de comorbilidades definidas como la coexistencia de un estado patol&#243;gico presente previo al ingreso a UCI &#40;respiratorio&#44; cardiovascular&#44; gastrointestinal y neoplasias&#41;&#44; motivo de ingreso&#44; realizaci&#243;n de procedimientos de uso com&#250;n en UCI &#40;intubaci&#243;n&#44; ventilaci&#243;n mec&#225;nica&#44; cateterizaci&#243;n arterial o venosa central&#44; administraci&#243;n de f&#225;rmacos vasoactivos&#44; sedaci&#243;n&#44; etc&#46;&#41;&#44; traslado a UCIP de un hospital terciario&#44; estancia &#40;en horas&#41; y mortalidad hospitalaria &#40;tanto en centro propio como en el hospital donde se traslad&#243;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se calcul&#243; el &#237;ndice PIM en la primera hora del ingreso seg&#250;n la ecuaci&#243;n descrita por Shann<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes se clasificaron en 6 grupos diagn&#243;sticos&#58; TRAUMA &#40;patolog&#237;a traum&#225;tica grave&#41;&#44; RESPIR &#40;patolog&#237;a respiratoria aguda o cr&#243;nica descompensada&#41;&#44; NEURO &#40;patolog&#237;a del sistema nervioso central no traum&#225;tica&#41;&#44; SEPSIS &#40;patolog&#237;a infecciosa grave de cualquier etiolog&#237;a&#41; y OTROS &#40;patolog&#237;as no incluidas en grupos previos&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los criterios que marcaban la decisi&#243;n de traslado a UCIP de referencia eran la necesidad de soporte ventilatorio invasivo&#44; previsi&#243;n de estancia prolongada&#44; necesidad de soporte pedi&#225;trico especializado no disponible en nuestro centro&#44; patolog&#237;a cr&#243;nica controlada en centro de referencia y edad inferior a 1 a&#241;o o peso inferior a 5 kg&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los pacientes se clasificaron seg&#250;n la evoluci&#243;n y destino en 4 grupos&#58; el subgrupo que realiza su proceso asistencial en el hospital de origen &#40;UCIA-VIVOS&#41;&#44; el subgrupo que fallece en el hospital de origen &#40;UCIA-MUERTOS&#41;&#44; el que se traslada y completa su asistencia en el hospital de referencia &#40;UCIP-VIVOS&#41; y por &#250;ltimo el que fallece en el hospital de referencia &#40;UCIP-MUERTOS&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las variables continuas se muestran como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o como porcentaje&#46; Para la comparaci&#243;n de las variables categ&#243;ricas se utiliz&#243; el test de chi cuadrado &#40;&#967;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#41; y el test no param&#233;trico de Kruskal-Wallis para las variables continuas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La capacidad discriminativa de las probabilidades individuales&#44; obtenidas con el PIM&#44; se midi&#243; mediante la construcci&#243;n de la curva ROC &#40;<span class="elsevierStyleItalic">receiver operating characteristic</span>&#41; y el c&#225;lculo del &#225;rea bajo la curva &#40;ABC&#41; con su intervalo de confianza &#40;IC&#41;&#46; Se consider&#243; como aceptable un ABC superior a 0&#44;7&#46; Para comparar la mortalidad observada frente la esperada se calcul&#243; la raz&#243;n de mortalidad estandarizada &#40;RME&#41; con su intervalo de confianza del 95&#37;&#46; La RME que es el cociente entre la mortalidad observada en la muestra y la mortalidad esperada seg&#250;n el &#237;ndice PIM&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se utiliz&#243; el programa estad&#237;stico SPSS &#40;versi&#243;n 16&#46;0&#41;&#46; Se consider&#243; la diferencia como significativa con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio&#44; ingresaron 134 pacientes menores de 14 a&#241;os lo que representa un 2&#44;7&#37; de los pacientes atendidos con una media de 10 ingresos al a&#241;o observ&#225;ndose un incremento en los 2 &#250;ltimos a&#241;os &#40;ver <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se excluyeron 3 pacientes por no disponer los datos de evoluci&#243;n en hospital de referencia y otro por historia cl&#237;nica incompleta&#46; En total el grupo de estudio lo forman 130 pacientes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se describen las caracter&#237;sticas cl&#237;nico-demogr&#225;ficas de los pacientes&#46; La edad media fue de 6&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 a&#241;os&#44; siendo un tercio de los pacientes menores de 2 a&#241;os&#44; con una distribuci&#243;n homog&#233;nea en los grupos de edad &#40;grupos de edad seleccionados seg&#250;n los cuartiles de nuestra serie&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">El ingreso se realiz&#243; prioritariamente en los turnos de tarde y noche y los diagn&#243;sticos m&#225;s frecuentes fueron el traumatismo y la sepsis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se trasladaron a una UCIP pedi&#225;trica 84 pacientes &#40;64&#44;6&#37;&#41;&#46; Fallecieron 17 pacientes &#40;13&#37;&#41;&#44; un 15&#44;2&#37; de los tratados en la UCIA y un 11&#44;9&#37; de los trasladados a una UCIP&#46; Observamos diferencias significativas en edad&#44; comorbilidad y estancia media entre los 4 grupos &#40;ver <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En general&#44; los pacientes que fallecieron &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41; ten&#237;an menos edad que los que sobrevivieron &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>113&#41; &#40;3&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs&#46; 6&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Con respecto a los pacientes trasladados a UCIP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>84&#41;&#44; los ni&#241;os que permanecieron ingresados en la UCIA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41;&#44; fueron m&#225;s mayores &#40;7&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs&#46; 5&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; y con menos comorbilidad previa &#40;11&#44;9 vs&#46; 6&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;328&#41; aunque sin llegar a ser una diferencia significativa&#46; La estancia media de los pacientes no trasladados fue de 41&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38 horas&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Encontramos tambi&#233;n diferencias en la necesidad de procedimientos invasivos&#44; siendo menos frecuentes en los que permanecieron en la UCIA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> se recogen los valores de las principales variables fisiol&#243;gicas y de laboratorio y se incluye el valor del &#237;ndice PIM&#46; Los pacientes que fallecieron presentaron una puntuaci&#243;n significativamente superior que los pacientes supervivientes tanto en la UCIA como en la UCIP&#46; Al analizar las variables que componen el &#237;ndice PIM existieron diferencias significativas entre los vivos y muertos en todas las variables excepto en el ingreso no programado &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; La curva ROC obtenida mostr&#243; una excelente capacidad discriminativa del PIM con respecto a la mortalidad con un ABC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;91 &#40;IC del 95&#37;&#44; 0&#44;85-0&#44;98&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; La mortalidad esperada por el &#237;ndice PIM fue del 16&#37; y la observada del 17&#37; y se obtuvo una RME de 1&#44;04 &#40;1&#44;02-1&#44;08&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Las recomendaciones actuales van dirigidas al cuidado y tratamiento de los pacientes cr&#237;ticos pedi&#225;tricos en las UCIP pero la centralizaci&#243;n y regionalizaci&#243;n de estas unidades exige que las UCIA de ciertas &#225;reas geogr&#225;ficas deban estar preparadas para la atenci&#243;n del paciente cr&#237;tico pedi&#225;trico de forma ocasional&#46; En nuestro caso&#44; la distancia a la UCIP de referencia est&#225; situada a m&#225;s de 150 km lo que obliga a la atenci&#243;n y estabilizaci&#243;n del ni&#241;o cr&#237;tico con estrategias de actuaci&#243;n diferentes a las del paciente adulto<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Diversos estudios ponen de manifiesto que un porcentaje significativo de pacientes pedi&#225;tricos son atendidos en las UCIA durante todo su proceso asistencial como muestra el estudio italiano y su traslado a UCIP viene condicionado a la necesidad de tratamiento especializado<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; En nuestro caso&#44; no todos los pacientes pedi&#225;tricos fueron trasladados a la UCIP de referencia&#44; algunos pacientes requieren una observaci&#243;n estrecha&#44; con un nivel de cuidados que no se pueden ofrecer en una planta convencional pero asumible para una UCI general sin necesidad de someter al paciente y su familia a un transporte innecesario<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Para el tratamiento de estos pacientes es fundamental garantizar el conocimiento&#44; competencias y habilidades de los profesionales sanitarios implicados disponiendo de protocolos de actuaci&#243;n actualizados&#44; programas de formaci&#243;n continuada y soporte del hospital de referencia ante aparici&#243;n de complicaciones<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Estudios como los de Fraser et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> y Henderson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> compararon el riesgo ajustado a mortalidad de los ni&#241;os atendidos en UCIP con aquellos atendidos en UCIA y observaron que los pacientes con alto riesgo de muerte medido con los &#237;ndices PIM y PRISM presentaron una supervivencia m&#225;s alta en las UCIP&#46; En cambio&#44; no hubo diferencias en los pacientes de bajo riesgo&#46; Debemos destacar que&#44; al igual que en nuestro estudio&#44; los pacientes pedi&#225;tricos atendidos en las UCIA eran m&#225;s mayores y con menor gravedad&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Una de las principales caracter&#237;sticas de nuestros ingresos es que ninguno de ellos fue programado&#44; su atenci&#243;n se realiz&#243; principalmente fuera de la jornada ordinaria laboral y precisaron de la realizaci&#243;n de m&#250;ltiples procedimientos tanto para su atenci&#243;n inicial como para su traslado&#46; Todo ello dificulta la especializaci&#243;n de un personal reducido y obliga a generalizar el aprendizaje para poder ofrecer los cuidados adecuados de forma continuada en el tiempo&#46; Para ello es fundamental la colaboraci&#243;n con el servicio de pediatr&#237;a que aporta una formaci&#243;n espec&#237;fica en el manejo asistencial del ni&#241;o enfermo y que debemos complementar con una formaci&#243;n en competencias y habilidades del personal de la UCIA<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio&#44; 2 tercios de los pacientes fueron trasladados a la UCIP de referencia&#46; Los pacientes que fallecieron en UCIA presentaron una estancia media de 2 horas&#44; sin tiempo a que llegue la unidad de transporte medicalizado y por tanto no pudo intentarse su traslado al centro de referencia&#46; Debemos destacar el alto porcentaje de procedimientos invasivos que se realizaron previos al traslado a UCIP atribuible a la necesidad de estabilizaci&#243;n del paciente antes de someterlo&#44; en nuestro caso&#44; a un viaje no inferior a 2 horas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; El transporte del ni&#241;o cr&#237;tico conlleva un riesgo elevado y debemos asegurar una calidad de cuidados durante el mismo&#46; Para ello es fundamental una buena coordinaci&#243;n entre el hospital emisor&#44; Servicio de Emergencias M&#233;dicas &#40;SEM&#41; y hospital receptor valorando el momento m&#225;s adecuado&#46; Un traslado precipitado o por personal no entrenado puede comportar la aparici&#243;n de problemas de riesgo vital durante el trayecto<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Los &#237;ndices pron&#243;sticos han sido dise&#241;ados para predecir la mortalidad de los pacientes cr&#237;ticos pero tambi&#233;n permiten evaluar la calidad de los cuidados y permiten estratificar a los pacientes seg&#250;n su gravedad<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46; En el ni&#241;o cr&#237;tico los &#237;ndices pron&#243;sticos m&#225;s utilizados son el PRISM y PIM&#44; ambos han demostrado su capacidad predictora de mortalidad<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a>&#46; Aunque tradicionalmente el &#237;ndice PRISM ha sido el m&#225;s utilizado en las UCIP su principal limitaci&#243;n es que se elabora a partir de las variables de las primeras 24 horas y que puede verse influenciado por la calidad de cuidados recibidos<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Por este motivo&#44; en nuestro estudio&#44; hemos aplicado el &#237;ndice PIM que obtiene sus variables a partir de la primera hora del ingreso en UCI y permite medirlo en todos los pacientes atendidos incluso en aquellos ingresados por pocas horas&#46; Tiene la ventaja de ser un modelo muy sencillo de recoger y estima la mortalidad de forma precoz sin influenciarse por la calidad del tratamiento instaurado tras su ingreso&#46; La capacidad predictiva del PIM al aplicarlo en nuestro grupo de estudio obtuvo valores superponibles a la descrita en el trabajo original&#46; Prieto et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> demostr&#243; una buena discriminaci&#243;n y calibraci&#243;n del PIM y PIM2&#44; en cambio&#44; el PRISM sobreestim&#243; ligeramente la mortalidad observada&#46; En nuestra serie el PIM consigue una discriminaci&#243;n buena y la comparaci&#243;n entre la mortalidad observada y la esperada es adecuada&#46; Otros estudios tambi&#233;n obtuvieron una buena capacidad predictora del PIM<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;28</span></a> y cuando se compara entre UCIP y UCIA&#44; algunos estudios demuestran mejor capacidad predictiva del &#237;ndice PIM en las unidades de adultos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Una justificaci&#243;n a este hecho ser&#237;a que en la UCIA la recogida de datos se realiza de forma precoz en la atenci&#243;n del ni&#241;o y en la UCIP puede verse influido por un traslado previo o por el manejo del equipo asistencial en Urgencias&#44; como apunta el estudio de Tahori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La escala PIM&#44; adem&#225;s de predecir la mortalidad&#44; resulta &#250;til para la estratificaci&#243;n de los pacientes seg&#250;n su gravedad&#46; La evidencia sugiere que los pacientes pedi&#225;tricos cr&#237;ticos con alto riesgo de muerte son mejor atendidos en las UCIP&#46; El &#237;ndice PIM nos puede ayudar en la identificaci&#243;n de estos pacientes para optimizar su tratamiento y priorizar su traslado a un centro terciario&#46; Los pacientes con un bajo riesgo de muerte podr&#237;an ser tratados en la UCIA evitando un traslado innecesario y paralelamente reduciendo la demanda de los recursos de una UCIP<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene varias limitaciones&#46; La primera limitaci&#243;n viene condicionada por el an&#225;lisis retrospectivo de los datos&#44; el tama&#241;o limitado de la muestra y haberse realizado en una sola UCI con sus caracter&#237;sticas socio-demogr&#225;ficas espec&#237;ficas&#46; Otra limitaci&#243;n se debe al periodo prolongado del estudio que puede implicar variaciones en los cuidados y t&#233;cnicas realizadas pero el &#237;ndice PIM al calcularse con variables del momento del ingreso no se ve influenciado por posibles cambios en la pr&#225;ctica cl&#237;nica&#46; No se utiliz&#243; la nueva versi&#243;n PIM2 ya que su creaci&#243;n y validaci&#243;n fue posterior al inicio del estudio<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; En este estudio no se recogen los ni&#241;os que fueron atendidos en otras &#225;reas fuera de UCI y de los cuales no tenemos registro &#40;por ejemplo&#44; nuestro personal ha colaborado en la atenci&#243;n de ni&#241;os en Urgencias o en planta de Pediatr&#237;a&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que algunas unidades de intensivos de adultos siguen y seguir&#225;n atendiendo pacientes pedi&#225;tricos aunque sea de forma espor&#225;dica&#46; Estos ni&#241;os necesitaran de t&#233;cnicas y procedimientos derivados de su condici&#243;n de pacientes cr&#237;ticos&#46; La necesidad de atender al ni&#241;o cr&#237;tico pone en evidencia que debemos poseer unos conocimientos&#44; habilidades y actitudes que permitan darle una asistencia adecuada<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Debemos asegurar una formaci&#243;n continuada en todo nuestro personal&#44; desde el auxiliar&#44; enfermer&#237;a&#44; residentes y adjuntos&#46; Es imprescindible una colaboraci&#243;n estrecha con el personal de pediatr&#237;a experto en la atenci&#243;n del paciente pedi&#225;trico y de sus caracter&#237;sticas fisiopatol&#243;gicas<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La principal funci&#243;n de la UCIA ser&#225; tratar de estabilizar al ni&#241;o para su traslado a una UCIP&#44; si no se consigue esta estabilizaci&#243;n&#44; el ni&#241;o morir&#225; sin poder trasladarse &#40;debemos asegurar que ha tenido la mejor atenci&#243;n posible&#41;&#46; Si se consigue la estabilizaci&#243;n del ni&#241;o&#44; la decisi&#243;n de traslado deber&#225; tomarse con toda la informaci&#243;n disponible que incluye el nivel de gravedad&#44; la necesidad de tratamiento especializado&#44; y la colaboraci&#243;n del servicio de Pediatr&#237;a del centro emisor y UCIP del centro receptor&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Concluimos que el &#237;ndice PIM puede ser una herramienta &#250;til para estratificar la gravedad de los ni&#241;os atendidos y puede ayudarnos a detectar los casos que deben ser tratados en los centros especializados y priorizar su traslado y diferenciarlos de aquellos que van a requerir un nivel de cuidados menor&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-10-16"
    "fechaAceptado" => "2012-03-03"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Medicina Intensiva"
            1 => "Pediatr&#237;a"
            2 => "Procedimientos"
            3 => "Paediatric Index Mortality"
            4 => "Traslado"
            5 => "Entrenamiento en Cuidados Intensivos Pedi&#225;tricos"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec72254"
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            0 => "Intensive Care"
            1 => "Pediatric"
            2 => "Procedures"
            3 => "Pediatric Index Mortality"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar las caracter&#237;sticas de los pacientes menores de 14 a&#241;os atendidos en una UCI de adultos &#40;UCIA&#41;&#44; determinar los procedimientos y t&#233;cnicas que precisan y evaluar el uso del Paediatric Index of Mortality &#40;PIM&#41; para estratificar la gravedad&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos polivalente de un hospital de segundo nivel&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron 130 pacientes con edad entre 1 mes y 14 a&#241;os &#40;edad media 6&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 a&#241;os&#41; atendidos en UCIA desde enero de 1997 a diciembre de 2010&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">cl&#237;nico-demogr&#225;ficas&#44; diagn&#243;stico&#44; procedimientos&#44; puntuaci&#243;n PIM&#44; estancia&#44; traslado a UCI pedi&#225;trica &#40;UCIP&#41; y mortalidad&#46; Clasificaci&#243;n seg&#250;n el destino &#40;UCIA&#44; UCIP&#41; y el resultado &#40;VIVO&#44; MUERTO&#41;&#46; PIM y valoraci&#243;n de la curva de rendimiento diagn&#243;stico &#40;ROC&#41; para la mortalidad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Edad media de 6&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 a&#241;os&#46; Los diagn&#243;sticos m&#225;s frecuentes fueron&#58; traumatismo &#40;26&#44;9&#37;&#41; y sepsis &#40;22&#44;3&#37;&#41;&#46; Los principales procedimientos fueron&#58; ventilaci&#243;n mec&#225;nica &#40;58&#44;5&#37;&#41;&#44; v&#237;a venosa central &#40;74&#44;6&#37;&#41; y f&#225;rmacos vasoactivos &#40;20&#37;&#41;&#46; Traslado a UCIP en un 64&#44;6&#37; y mortalidad global de 13&#37;&#46; Los pacientes que permanecieron en la UCIA eran de mayor edad &#40;8&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs&#46; 5&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 a&#241;os&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; con poca comorbilidad y estancia corta &#40;44&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38 horas&#41;&#46; &#205;ndice PIM significativamente m&#225;s alto en fallecidos &#40;UCIA 60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#44; UCIP 38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#41; que en supervivientes &#40;UCIA 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44; UCIP 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Curva ROC con excelente capacidad discriminativa con &#225;rea bajo la curva<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;91&#44; &#40;intervalo de confianza del 95&#37;&#44; 0&#44;85-0&#44;98&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El &#237;ndice PIM permite estratificar la gravedad e identificar los pacientes con mayor riesgo de muerte&#46; La atenci&#243;n ocasional del ni&#241;o cr&#237;tico obliga a que exista una adecuaci&#243;n tanto en material como en la formaci&#243;n del personal de las UCIA para proporcionar una adecuada asistencia&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">An analysis is made of the characteristics of patients younger than 14 years treated in an adult ICU &#40;AICU&#41;&#44; to determine the procedures and techniques required by such patients&#44; and to evaluate the use of the Pediatric Index of Mortality &#40;PIM&#41; in stratifying severity&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was carried out&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">An AICU of a second level hospital&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">We studied 130 patients aged from 1 month to 14 years &#40;average age 6&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 years&#41; treated in the AICU from January 1997 to December 2010&#46;</p> <span class="elsevierStyleSectionTitle">Variables of interest</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical-demographic parameters&#44; diagnosis&#44; clinical procedures&#44; PIM score&#44; length of stay&#44; transfer to pediatric ICU &#40;PICU&#41;&#44; and mortality&#46; Classification by destination &#40;AICU&#44; PICU&#41; and outcome &#40;alive&#44; dead&#41;&#46; PIM and assessment of the diagnostic performance curve &#40;ROC&#41; for mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The average age of the patients was 6&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 years&#46; Most common diagnoses&#58; trauma &#40;26&#46;9&#37;&#41; and sepsis &#40;22&#46;3&#37;&#41;&#46; Main procedures&#58; mechanical ventilation &#40;58&#46;5&#37;&#41;&#44; central venous line &#40;74&#46;6&#37;&#41; and vasoactive drugs &#40;20&#37;&#41;&#46; A total of 64&#46;6&#37; were transferred to PICU&#44; and the overall mortality was 13&#37;&#46; Patients who stayed in the AICU were older &#40;8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 vs 5&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 years&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; had low morbidity&#44; and their stay was short &#40;44&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38<span class="elsevierStyleHsp" style=""></span>hours&#41;&#46; The PIM score was significantly higher in the patients who died &#40;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20 AICU&#44; 38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30 PICU&#41; than in those who survived &#40;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 AICU&#44; 9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 PICU&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; ROC curve with AUC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;91 &#40;95&#37;CI&#58; 0&#46;85 to 0&#46;98&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The PIM score can stratify severity and identify patients at an increased risk of death&#46; Critical child care in the AICU requires the presence of adequate materials and the continuous learning of procedures adapted to pediatric patients in order to ensure adequate care&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
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        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A&#41; N&#250;mero de ingresos durante el periodo de estudio&#46; B&#41; Distribuci&#243;n de los pacientes seg&#250;n grupos de edad&#46; C&#41; Porcentaje de ingresos seg&#250;n los turnos de trabajo&#46; D&#41; Distribuci&#243;n seg&#250;n grupo diagn&#243;stico&#46;</p>"
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      1 => array:7 [
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        "mostrarFloat" => true
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        "figura" => array:1 [
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Curva ROC de discriminaci&#243;n de la mortalidad para el &#237;ndice PIM&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">a&#58; a&#241;os&#59; m&#58; meses&#59; MUERTOS&#58; pacientes fallecidos&#59; NEURO&#58; pacientes neurol&#243;gicos&#59; OTROS&#58; otros diagn&#243;sticos&#59; RESPIR&#58; pacientes respiratorios&#59; SEPSIS&#58; pacientes con diagn&#243;stico de sepsis&#59; TRAUMA&#58; pacientes traum&#225;ticos&#59; UCIA&#58; pacientes atendidos en UCI de adultos sin traslado a UCI pedi&#225;trica&#59; UCIP&#58; pacientes trasladados a UCI pedi&#225;trica&#59; VIVOS&#58; pacientes supervivientes&#46;</p>"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">EB&#58; exceso de base&#46; PIM&#58; &#237;ndice pedi&#225;trico de mortalidad&#59; FC&#58; frecuencia cardiaca&#59; FR&#58; frecuencia respiratoria&#59; MUERTOS&#58; pacientes fallecidos&#59; TAM&#58; tensi&#243;n arterial media&#59; UCIP&#58; pacientes trasladados a UCI pedi&#225;trica&#59; UCIA&#58; pacientes atendidos en UCI de adultos sin traslado a UCI pedi&#225;trica&#59; VIVOS&#58; pacientes supervivientes&#46;<span class="elsevierStyleSup">a</span>Comparaci&#243;n entre los diferentes grupos con p determinada por test de Kruskal-Wallis&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">UCIP MUERTOS n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">p<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">GLASGOW&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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TAM &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FC &#40;x&#8242;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">130<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>40&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;474&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FR &#40;x&#8242;&#41;&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
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;395&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">FiO2 &#40;&#37;&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PaO2 &#40;mmHg&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>38&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>60&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>90&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;448&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">PCO2 &#40;mmHg&#41;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">50<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CO3H2 &#40;mEq&#47;L&#41;&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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;335&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">pH&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
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                  \t\t\t\t">7&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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