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en lo referente a la manera de ir disminuyendo el soporte ventilatorio con la SIMV y la presi&#243;n de soporte&#44; y en los criterios de extubaci&#243;n&#44; hace que en esta revisi&#243;n no haya sido posible identificar una t&#233;cnica superior entre los 3 modos comparados&#44; pero lo que s&#237; parece confirmarse es que la SIMV puede prolongar la desconexi&#243;n m&#225;s que el tubo en T o la reducci&#243;n gradual de la presi&#243;n de soporte &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; se han descrito nuevas aplicaciones de t&#233;cnicas habituales y nuevos m&#233;todos de ventilaci&#243;n que pudieran tener alg&#250;n papel en la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica en los enfermos con desconexi&#243;n dif&#237;cil o prolongada&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Modos alternativos y nuevos modos para la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ventilaci&#243;n no invasiva</span><p id="par0020" class="elsevierStylePara elsevierViewall">En un intento de disminuir las complicaciones asociadas a la ventilaci&#243;n mec&#225;nica prolongada&#44; algunos autores han explorado el papel de la ventilaci&#243;n no invasiva en la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#46; En esencia&#44; el proceso consiste en que los enfermos que fracasan una prueba de respiraci&#243;n espont&#225;nea son extubados e inmediatamente conectados a ventilaci&#243;n no invasiva&#46; Desde la primera experiencia descrita por Udwadia et al&#46; en 1992<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> se han publicado varios ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;33</span></a> evaluando esta t&#233;cnica como modo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#46; Las limitaciones de estos estudios para su aplicabilidad y generalizaci&#243;n son varias&#46; En primer lugar&#44; el peque&#241;o tama&#241;o muestral de casi todos los estudios&#46; En segundo lugar&#44; muchos de los estudios publicados incluyen mayoritariamente<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;25</span></a> o exclusivamente<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;24&#44;26&#44;31&#8211;33</span></a> pacientes con una enfermedad pulmonar cr&#243;nica&#44; poblaci&#243;n donde est&#225; especialmente indicada la ventilaci&#243;n no invasiva por su capacidad para disminuir la fatiga respiratoria&#44; aumentar el volumen corriente y disminuir la presi&#243;n positiva al final de la inspiraci&#243;n &#40;PEEP&#41; intr&#237;nseca&#46; Si otras causas de insuficiencia respiratoria se podr&#237;an beneficiar de la desconexi&#243;n con ventilaci&#243;n no invasiva estar&#237;a pendiente de determinar&#46; En tercer lugar&#44; hubo una gran heterogeneidad en las estrategias utilizadas para la desconexi&#243;n tanto en el grupo de desconexi&#243;n invasiva como en el grupo de desconexi&#243;n no invasiva&#46; Los pacientes asignados a desconexi&#243;n invasiva fueron desconectados preferentemente con presi&#243;n de soporte pero con diferentes estrategias en la reducci&#243;n gradual de la misma&#58; 2 observaciones diarias con una prueba de respiraci&#243;n espont&#225;nea opcional<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; disminuci&#243;n de 2 cmH<span class="elsevierStyleInf">2</span>O cada 4 h seg&#250;n tolerancia cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; disminuci&#243;n de 2-4 cmH<span class="elsevierStyleInf">2</span>O diarios<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; disminuci&#243;n gradual de la presi&#243;n de soporte hasta una presi&#243;n de soporte de 7 cmH<span class="elsevierStyleInf">2</span>O<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; En la mayor&#237;a de los estudios se intercalaron o alternaron pruebas de respiraci&#243;n espont&#225;nea con tubo en T de diferente duraci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;26&#44;31&#44;33</span></a>&#46; Igualmente&#44; en los enfermos asignados a desconexi&#243;n con ventilaci&#243;n no invasiva&#44; la aplicaci&#243;n de la misma y los criterios para la desconexi&#243;n total de la ventilaci&#243;n no invasiva fueron heterog&#233;neos&#46; Tras la extubaci&#243;n&#44; la aplicaci&#243;n de la ventilaci&#243;n no invasiva fue continua en 5 estudios<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;23&#8211;25&#44;32</span></a>&#44; en un estudio intermitente<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#44; en otro estudio durante al menos 2 h<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> y&#44; en otro&#44; dependiendo de la tolerancia durante 20-22 h con periodos de descanso para la comida<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; El nivel de soporte y la duraci&#243;n de los periodos de ventilaci&#243;n fueron gradualmente reducidos pero tambi&#233;n con diferentes protocolos&#58; disminuci&#243;n de la presi&#243;n de soporte 2 cmH<span class="elsevierStyleInf">2</span>O cada 4 h<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> o disminuci&#243;n 2-4 cmH<span class="elsevierStyleInf">2</span>O diarios<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> seg&#250;n la tolerancia de los enfermos hasta una presi&#243;n inspiratoria de 8 cmH<span class="elsevierStyleInf">2</span>O y una espiratoria de 4 cmH<span class="elsevierStyleInf">2</span>O<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> o un presi&#243;n inspiratoria menor de 10 cmH<span class="elsevierStyleInf">2</span>O<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> o hasta que la diferencia entre presi&#243;n inspiratoria y espiratoria fuese menor de 5 cmH<span class="elsevierStyleInf">2</span>O<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46; Por &#250;ltimo&#44; los resultados reportados &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#41; en el grupo control de algunos de los estudios no reflejan la pr&#225;ctica cl&#237;nica habitual<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46; Teniendo en cuenta estas limitaciones&#44; la conclusi&#243;n de los estudios es que la ventilaci&#243;n no invasiva puede ser una t&#233;cnica prometedora para la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#44; pero se necesitar&#237;an m&#225;s estudios para evaluar completamente los beneficios cl&#237;nicos y los riesgos asociados al fracaso de la extubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Compensaci&#243;n autom&#225;tica del tubo</span><p id="par0025" class="elsevierStylePara elsevierViewall">El tubo endotraqueal impone una resistencia inspiratoria durante la prueba de respiraci&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Para su compensaci&#243;n se ha propuesto el uso de niveles bajos de presi&#243;n de soporte &#40;5-8 cmH<span class="elsevierStyleInf">2</span>O&#41;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46; Desafortunadamente&#44; no es f&#225;cil determinar o predecir el nivel exacto de presi&#243;n de soporte requerido para compensar la carga inspiratoria impuesta en un paciente individual&#46; Con el mismo nivel de soporte&#44; se puede producir un fracaso de la prueba de respiraci&#243;n espont&#225;nea por una insuficiente compensaci&#243;n del trabajo impuesto o una sobrecompensaci&#243;n que puede permitir a un paciente pasar con &#233;xito una prueba de respiraci&#243;n espont&#225;nea pero no permite calibrar con exactitud si el paciente es verdaderamente capaz de respirar sin apoyo&#46; Todo ello depende del tama&#241;o del tubo endotraqueal y del flujo inspiratorio &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">La compensaci&#243;n autom&#225;tica del tubo &#40;ATC&#41;&#44; disponible en los ventiladores Evita 4&#44; Evita XL &#40;Draeger Medical&#41; y 840 Puritan Bennett &#40;Covidien&#41;&#44; es un modo donde el ventilador realiza de manera continua la medida de la ca&#237;da de presi&#243;n que ocurre a trav&#233;s del tubo endotraqueal programando&#44; a continuaci&#243;n&#44; el nivel de presi&#243;n de soporte que compensa esa ca&#237;da de presi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;40</span></a>&#46; Los estudios que han comparado ATC con presi&#243;n de soporte sugieren que la ATC es m&#225;s efectiva en la compensaci&#243;n del trabajo respiratorio&#44; m&#225;s comoda y con menos asincron&#237;as paciente-ventilador<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;41</span></a>&#46; Para su programaci&#243;n es necesario introducir el tama&#241;o del tubo endotraqueal y el porcentaje de compensaci&#243;n deseado &#40;generalmente 100&#37;&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La ATC ha sido evaluada&#44; como m&#233;todo para la prueba de respiraci&#243;n espont&#225;nea&#44; en varios ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#8211;45</span></a> con resultados muy favorables en la tasa de &#233;xito en la primera prueba de respiraci&#243;n espont&#225;nea pero con tasas de reintubaci&#243;n similares a los del grupo control &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 4</a>&#41;&#46; Por otra parte&#44; otro estudio<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> ha evaluado el tiempo de desconexi&#243;n comparando la reducci&#243;n gradual de la presi&#243;n de soporte con ATC frente a la reducci&#243;n gradual de la presi&#243;n de soporte en solitario&#46; Este trabajo incluye a 41 pacientes que requieren ventilaci&#243;n mec&#225;nica por insuficiencia respiratoria aguda secundaria a envenenamiento por mordedura de serpiente&#46; En el grupo de presi&#243;n de soporte con ATC la mediana de tiempo de desconexi&#243;n fue de 8 h &#40;rango intercuart&#237;lico 7-12&#41; vs&#46; 12 h &#40;rango intercuart&#237;lico 7-17&#41; en el grupo de presi&#243;n de soporte &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;12&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A pesar de los buenos resultados observados en los estudios publicados hasta el momento&#44; ser&#237;an necesarios estudios con un mayor n&#250;mero de enfermos y&#44; sobre todo&#44; con enfermos con dificultad para pasar la primera prueba de respiraci&#243;n espont&#225;nea para poder recomendar la ATC como el m&#233;todo de elecci&#243;n para la realizaci&#243;n de la prueba de respiraci&#243;n espont&#225;nea<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48</span></a>&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Weaning autom&#225;tico con sistemas de circuito cerrado</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ventilaci&#243;n minuto mandatoria</span><p id="par0045" class="elsevierStylePara elsevierViewall">Este modo de ventilaci&#243;n&#44; descrito por Hewlett et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a>&#44; fue el primero en el cual el ventilador modificaba el soporte basado en la respuesta del paciente o el primer modo de control computarizado de la ventilaci&#243;n&#46; Actualmente&#44; este modo de ventilaci&#243;n se encuentra disponible en los ventiladores Evita 4&#44; Evita XL &#40;Draeger Medical&#41;&#44; CPU-1 Intensive Care ventilator &#40;Ohmeda Medical&#41;&#44; Sechrist IV-100B &#40;Sechrist Industries Inc&#41; y Hamilton Veolar ventilator &#40;Hamilton Medical&#41;&#46; En esta modalidad&#44; se programa el volumen tidal y una frecuencia mandatoria definiendo&#44; por lo tanto&#44; un objetivo de ventilaci&#243;n minuto&#46; El ventilador adapta la frecuencia mandatoria al objetivo de ventilaci&#243;n minuto teniendo en cuenta la frecuencia respiratoria espont&#225;nea del paciente&#46; La diferencia con la SIMV es que mientras en esta modalidad la frecuencia mandatoria es fija en la MMV la frecuencia mandatoria es variable&#46; Si la respiraci&#243;n espont&#225;nea de un paciente&#44; que se realiza con una presi&#243;n de soporte previamente fijada&#44; alcanza o sobrepasa el objetivo prefijado&#44; el ventilador no da ninguna respiraci&#243;n mandatoria&#46; Por el contrario&#44; si la ventilaci&#243;n minuto del paciente cae por debajo del nivel pedeterminado el ventilador ofrece las respiraciones necesarias para alcanzar el objetivo&#46; Una de las principales limitaciones es que el ventilador hace los ajustes solo de acuerdo a la ventilaci&#243;n minuto determinada&#46; Esto es&#44; no diferencia un volumen tidal de 500<span class="elsevierStyleHsp" style=""></span>ml con una frecuencia respiratoria de 12 respiraciones por min &#40;patr&#243;n ventilatorio normal&#41; de un volumen tidal de 200<span class="elsevierStyleHsp" style=""></span>ml con una frecuencia respiratoria de 30 respiraciones por min &#40;patr&#243;n de respiraci&#243;n r&#225;pida y superficial&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Hay muy pocos trabajos&#44; la mayor&#237;a de ellos realizados en la poblaci&#243;n de neonatos&#44; que hayan evaluado la MMV como m&#233;todo alternativo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#46; En adultos solo hay un ensayo cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a>&#46; En este estudio&#44; se asignaron de forma aleatoria a 22 pacientes a desconexi&#243;n con MMV y a 18 pacientes a desconexi&#243;n con IMV&#46; La MMV disminuy&#243; significativamente el tiempo de desconexi&#243;n &#40;5 h vs&#46; 33 h&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; sin aumento en la tasa de fracaso de extubaci&#243;n a las 4 h de la extubaci&#243;n &#40;89 vs&#46; 86&#37;&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ventilaci&#243;n adaptativa de soporte</span><p id="par0055" class="elsevierStylePara elsevierViewall">Esta modalidad fue descrita inicialmente&#44; como ventilaci&#243;n adaptativa pulmonar&#44; por Laubscher en 1994<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">51&#44;52</span></a>&#46; Se trata de un modo asistido&#44; controlado por presi&#243;n&#44; con un sistema autom&#225;tico de regulaci&#243;n de los par&#225;metros ventilatorios en respuesta a cambios en la mec&#225;nica del sistema respiratorio y del patr&#243;n de ventilaci&#243;n espont&#225;nea&#46; Se encuentra disponible en los respiradores Galileo&#44; Raphael&#44; Hamilton S1&#44; Hamilton C2&#44; Hamilton G5 &#40;Hamilton Medical&#41;&#46; El principio b&#225;sico de su funcionamiento se basa en la f&#243;rmula de Otis<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46; Mediante esta ecuaci&#243;n se calcula la frecuencia respiratoria ideal&#44; que es la que se asocia con un menor gasto energ&#233;tico&#44; para lo que se tiene en cuenta el espacio muerto&#44; la ventilaci&#243;n minuto y la constante de tiempo espiratoria&#46; Inicialmente se introduce en el ventilador los datos de peso del paciente&#44; el porcentaje deseado de ventilaci&#243;n minuto &#40;100&#37; es igual a 100<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min&#41;&#44; la fracci&#243;n inspirada de ox&#237;geno&#44; la presi&#243;n al final de la espiraci&#243;n &#40;PEEP&#41; y la presi&#243;n m&#225;xima inspiratoria &#40;Pimax&#41;&#46; A continuaci&#243;n&#44; el sistema determina la constante de tiempo espiratoria mediante el an&#225;lisis de la curva de flujo-volumen espiratoria&#46; Posteriormente&#44; el algoritmo autom&#225;tico ajusta la presi&#243;n inspiratoria&#44; la relaci&#243;n de tiempo inspiratorio&#47;espiratorio y la frecuencia respiratoria para mantener el objetivo de ventilaci&#243;n minuto &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; dentro de un rango establecido para evitar la respiraci&#243;n r&#225;pida y superficial o un volumen de inflaci&#243;n excesivo&#46; Para la determinaci&#243;n de la frecuencia respiratoria &#243;ptima&#44; el ventilador asume un espacio muerto&#44; seg&#250;n el nomograma de Radford<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a>&#44; de 2&#44;2<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46; En los pacientes en fase de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#44; el algoritmo de la ASV ir&#225; reduciendo progresivamente y autom&#225;ticamente la presi&#243;n inspiratoria&#46; La desconexi&#243;n es completa cuando todas las respiraciones sean espont&#225;neas y el enfermo mantenga un adecuado interecambio gaseoso durante unas horas con una presi&#243;n inspiratoria menor de 8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Los estudios que han evaluado la ASV como m&#233;todo de desconexi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">56&#8211;60</span></a> sugieren que podr&#237;a simplificar el manejo ventilatorio y reducir el tiempo hasta la extubaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 5</a>&#41;&#46; Las limitaciones de estos estudios son que se han realizado en grupos peque&#241;os de enfermos predominantemente postoperatorios con una duraci&#243;n corta de la ventilaci&#243;n mec&#225;nica&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sistemas de <span class="elsevierStyleItalic">weaning</span> automatizados</span><p id="par0065" class="elsevierStylePara elsevierViewall">A diferencia de los 2 m&#233;todos previamente descritos los sistemas de <span class="elsevierStyleItalic">weaning</span> automatizados disponibles no son nuevos modos de ventilaci&#243;n sino estrategias autom&#225;ticas de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica basadas en un modo de ventilaci&#243;n ya existente como es la presi&#243;n de soporte&#46; Actualmente disponemos de 2 sistemas de weaning automatizados&#58; SmartCare<span class="elsevierStyleSup">&#174;</span><a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a> disponible en el ventilador Evita XL &#40;Draeger Medical&#41; y el sistema mandatory rate ventilation &#40;MRV&#41; disponible en el ventilador Taema Horus &#40;Air Liquid&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El sistema SmartCare<span class="elsevierStyleSup">&#174;</span> aplica continuamente un protocolo de desconexi&#243;n con cambios en la presi&#243;n de soporte basados en mediciones de la frecuencia respiratoria&#44; del volumen tidal y de la presi&#243;n parcial de CO<span class="elsevierStyleInf">2</span> al final de la espiraci&#243;n &#40;etCO<span class="elsevierStyleInf">2</span>&#41;&#46; Para iniciar el funcionamiento del sistema&#44; el m&#233;dico introduce informaci&#243;n del paciente &#40;peso&#44; antecedentes de enfermedad pulmonar cr&#243;nica y&#47;o enfermedad neurol&#243;gica&#41;&#44; tipo de v&#237;a a&#233;rea artificial &#40;tubo endotraqueal o traqueostom&#237;a&#41; y tipo de humidificaci&#243;n &#40;intercambiador de calor-humedad o humidificados de calor activo&#41;&#46; Tras ello se inicia el proceso de desconexi&#243;n&#44; inicialmente el sistema se adapta para mantener al paciente en un estado de confort respiratorio &#40;ventilaci&#243;n normal&#41; para lo cual adapta la presi&#243;n de soporte&#44; aumentando o disminuyendo entre 2 y 4 cmH<span class="elsevierStyleInf">2</span>O&#44; seg&#250;n los datos de frecuencia respiratoria &#40;l&#237;mites normales 15-30<span class="elsevierStyleHsp" style=""></span>rpm&#44; en enfermos con patolog&#237;a neurol&#243;gica aumenta el l&#237;mite superior a 34<span class="elsevierStyleHsp" style=""></span>rpm&#41;&#44; volumen tidal &#40;l&#237;mites normales<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>ml&#41; y etCO<span class="elsevierStyleInf">2</span> &#40;l&#237;mites normales<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>55<span class="elsevierStyleHsp" style=""></span>mmHg&#44; en enfemos con enfermedad pulmonar obstructiva cr&#243;nica sube el l&#237;mite a 65<span class="elsevierStyleHsp" style=""></span>mmHg&#41; cuyo promedio se calcula cada 2-5 min&#46; Una vez que el paciente se encuentra en la situaci&#243;n de ventilaci&#243;n normal&#44; el sistema reduce o aumenta la presi&#243;n de soporte&#44; dependiendo de las necesidades del enfermo&#44; cada 15&#44; 30 o 60 min dependiendo del nivel previo de presi&#243;n de soporte hasta llegar a una presi&#243;n de soporte variable dependiendo del tipo de v&#237;a a&#233;rea artificial y del tipo de humidificaci&#243;n &#40;5 cmH<span class="elsevierStyleInf">2</span>O para humidificador de calor activo y traqueotom&#237;a&#44; 7 cmH<span class="elsevierStyleInf">2</span>O para humificador de calor activo y tubo endotraqueal&#44; 9 cmH<span class="elsevierStyleInf">2</span>O para humificador de calor-humedad y traqueotom&#237;a&#44; 12 cmH<span class="elsevierStyleInf">2</span>O para humificador de calor-humedad y tubo endotraqueal&#41;&#46; Una vez que se llega a este nivel de soporte se considera que el enfermo inicia una prueba de respiraci&#243;n espont&#225;nea cuya duraci&#243;n es determinada por el patr&#243;n respiratorio y el nivel de presi&#243;n de soporte al que inici&#243; el proceso de desconexi&#243;n&#46; Si durante ese tiempo el enfermo presenta un patr&#243;n respiratorio diferente a la ventilaci&#243;n normal o a la hiperventilaci&#243;n el sistema considera que ha fracasado la prueba de respiraci&#243;n espont&#225;nea y aumenta la presi&#243;n de soporte hasta obtener un patr&#243;n de ventilaci&#243;n normal&#46; En caso de estabilidad del patr&#243;n respiratorio&#44; el respirador mostrar&#225; un mensaje indicando que el enfermo est&#225; preparado para ser extubado&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este sistema&#44; que no se recomienda en enfermos con patolog&#237;a neurol&#243;gica que afecte al control de la respiraci&#243;n&#44; en enfermos sobre-sedados&#44; en pacientes con broncoespasmo grave&#44; en enfermos con delirio&#47;agitaci&#243;n y en enfermos con polineuropatia&#47;miopatia grave&#44; ha sido evaluado en varios ensayos cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">62&#8211;65</span></a> con diferentes resultados &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 6</a>&#41; debido a la evaluaci&#243;n de diferentes desenlaces y a diferencias en el protocolo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica en el grupo de desconexi&#243;n no-autom&#225;tica&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Por su parte&#44; el sistema MRV va disminuyendo progresivamente la presi&#243;n de soporte bas&#225;ndose en un objetivo de frecuencia respiratoria&#46; Esta frecuencia respiratoria representa la frecuencia respiratoria que se espera realice el enfermo&#46; En cada ciclo&#44; el ventilador compara la frecuencia respiratoria deseada con el promedio de frecuencia respiratoria realizado en los 4 ciclos previos&#46; Si el promedio es mayor que el objetivo de frecuencia respiratoria&#44; la presi&#243;n de soporte aumenta autom&#225;ticamente 1 cmH<span class="elsevierStyleInf">2</span>O&#46; Si el promedio de frecuencia respiratoria es menor que la frecuencia respiratoria deseada&#44; el sistema disminuir&#225; la presi&#243;n de soporte 1 cmH<span class="elsevierStyleInf">2</span>O&#46; Este sistema solo ha sido evaluado en un estudio <a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> que incluye a 106 pacientes en el postoperatorio que son asignados a desconexi&#243;n con reducci&#243;n gradual de la presi&#243;n soporte &#40;53 pacientes&#41; o a desconexi&#243;n con el sistema MRV &#40;53 pacientes&#41;&#46; En el an&#225;lisis por intenci&#243;n de tratar la duraci&#243;n media hasta la extubaci&#243;n fue de 221<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>192 min en el grupo de reducci&#243;n gradual de la presi&#243;n soporte vs&#46; 271<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>369 min en el grupo de MRV &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;375&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En resumen&#44; aunque los sistemas autom&#225;ticos de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica suponen un importante avance&#44; ser&#225;n necesarios m&#225;s estudios para poder precisar qu&#233; poblaci&#243;n de enfermos ventilados se pueden beneficiar de estos sistemas frente a los modos convencionales de desconexi&#243;n&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Otros modos</span><p id="par0090" class="elsevierStylePara elsevierViewall">Basados en el mismo concepto que algunos de los modos previamente descritos &#40;&#8216;el ventilador se adapta al paciente en lugar del paciente al ventilador&#8217;&#41; existen otros nuevos modos de ventilaci&#243;n como el patr&#243;n espont&#225;neo amplificado &#40;PEA&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&#44; la ventilaci&#243;n asistida proporcional &#40;PAV&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">68</span></a>&#44; la ventilaci&#243;n asistida ajustada neuralmente &#40;NAVA&#41;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a>&#44; automode<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">70</span></a>&#44; sin estudios suficientes para poder establecer su posible papel en la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; parece que&#44; por el momento&#44; todos los modos que est&#225;n apareciendo para la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica son m&#233;todos alternativos&#46; Por ello&#44; nosotros pensamos que lo m&#225;s eficaz y sencillo es la realizaci&#243;n de una prueba diaria de respiraci&#243;n espont&#225;nea&#44; de unos treinta minutos de duraci&#243;n&#44; con tubo en T&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Modos alternativos y nuevos modos para la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Ventilaci&#243;n no invasiva"
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            1 => array:2 [
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              "titulo" => "Compensaci&#243;n autom&#225;tica del tubo"
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          "identificador" => "sec0020"
          "titulo" => "Weaning autom&#225;tico con sistemas de circuito cerrado"
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            0 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Ventilaci&#243;n minuto mandatoria"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Ventilaci&#243;n adaptativa de soporte"
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            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Sistemas de weaning automatizados"
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            3 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Otros modos"
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          "titulo" => "Conflicto de intereses"
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        7 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2012-07-07"
    "fechaAceptado" => "2012-08-06"
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            0 => "Destete"
            1 => "Desconexi&#243;n ventilaci&#243;n mec&#225;nica"
            2 => "Ventilaci&#243;n no invasiva"
            3 => "Compensaci&#243;n autom&#225;tica del tubo"
            4 => "Sistemas de weaning autom&#225;tico"
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          "palabras" => array:5 [
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            1 => "Disconnecting mechanical ventilation"
            2 => "Noninvasive ventilation"
            3 => "Automatic tube compensation"
            4 => "Automatic weaning systems"
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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los pacientes que requieren ventilaci&#243;n mec&#225;nica durante m&#225;s de 24 h y que mejoran de la causa que motiv&#243; el soporte ventilatorio pueden ser extubados tras una primera prueba de respiraci&#243;n espont&#225;nea&#46; El reto es c&#243;mo mejorar la desconexi&#243;n de los pacientes que fracasan en esa prueba&#46; Hasta el momento dispon&#237;amos de los m&#233;todos&#44; que podemos denominar tradicionales&#44; como son el tubo en T&#44; la presi&#243;n de soporte o la ventilaci&#243;n mandatoria intermitente sincronizada &#40;SIMV&#41;&#46; En los &#250;ltimos a&#241;os se han descrito nuevas aplicaciones de t&#233;cnicas habituales como la ventilaci&#243;n no invasiva&#44; nuevos m&#233;todos de ventilaci&#243;n como la compensaci&#243;n autom&#225;tica del tubo &#40;ATC&#41;&#44; la ventilaci&#243;n minuto mandatoria &#40;MMV&#41;&#44; la ventilaci&#243;n adaptativa de soporte &#40;ASV&#41; o estrategias autom&#225;ticas de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica basadas en la presi&#243;n de soporte&#46; Queda por definir su posible papel en la desconexi&#243;n de la ventilaci&#243;n mec&#225;nica en los enfermos con desconexi&#243;n dif&#237;cil o prolongada&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Most patients who require mechanical ventilation for longer than 24<span class="elsevierStyleHsp" style=""></span>hours&#44; and who improve the condition leading to the indication of ventilatory support&#44; can be weaned after passing a first spontaneous breathing test&#46; The challenge is to improve the weaning of patients who fail that first test&#46; We have methods that can be referred to as traditional&#44; such as the T-tube&#44; pressure support or synchronized intermittent mandatory ventilation &#40;SIMV&#41;&#46; In recent years&#44; however&#44; new applications of usual techniques as noninvasive ventilation&#44; new ventilation methods such as automatic tube compensation &#40;ATC&#41;&#44; mandatory minute ventilation &#40;MMV&#41;&#44; adaptive support ventilation or automatic weaning systems based on pressure support have been described&#46; Their possible role in weaning from mechanical ventilation among patients with difficult or prolonged weaning remains to be established&#46;</p>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Este art&#237;culo de revisi&#243;n pertenece a la serie &#171;Puesta al d&#237;a en Ventilaci&#243;n Mec&#225;nica&#187; del Grupo de Trabajo de Insuficiencia respiratoria aguda &#40;GT-IRA&#41;&#46;</p>"
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Algoritmo para la desconexi&#243;n de la ventilaci&#243;n <a class="elsevierStyleCrossRefs" href="#bib0040">mec&#225;nica</a>&#46;</p>"
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Curva flujo&#47;presi&#243;n inspiratoria en un enfermo con un tubo endotraqueal de 7&#44;5<span class="elsevierStyleHsp" style=""></span>mm de di&#225;metro interno &#40;modificada de referencias <a class="elsevierStyleCrossRefs" href="#bib0190">38 y 39</a>&#41;&#46; Debido a las variaciones en el patr&#243;n del flujo en respiraci&#243;n espont&#225;nea&#44; la resistencia impuesta por el tubo es variable&#46; Si aplicamos una presi&#243;n de soporte constante de 10<span class="elsevierStyleHsp" style=""></span>cmH2O &#40;l&#237;nea horizontal&#41; nos podemos encontrar con 3 situaciones&#58; 1&#41; con flujos inspiratorios bajos&#44; la presi&#243;n de soporte infra-compensa la resistencia del tubo&#44; 2&#41; con flujos inspiratorios medios&#44; la presi&#243;n de soporte compensa la resistencia &#40;intersecci&#243;n entre la curva de la presi&#243;n de resistencia del tubo &#40;&#916;P<span class="elsevierStyleInf">tubo</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleInf">endotraqueal</span>&#41; y la l&#237;nea de presi&#243;n de soporte&#41;&#44; y 3&#41; con flujos altos la presi&#243;n de soporte sobre-compensa la resistencia&#46;</p>"
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          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Representaci&#243;n esquem&#225;tica de los principios b&#225;sicos de funcionamiento de la ventilaci&#243;n adaptativa de soporte &#40;ASV&#41;&#46; &#40;Modificado de referencia <a class="elsevierStyleCrossRef" href="#bib0270">54</a>&#41;&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abreviaturas</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Crs&#58; compliance del sistema respiratorio&#59; f&#58; frecuencia respiratoria&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; MV&#58; ventilaci&#243;n minuto&#59; PEEP&#58; presi&#243;n positiva al final de la espiraci&#243;n&#59; PEEPi&#58; presi&#243;n positiva intr&#237;nseca al final de la espiraci&#243;n&#59; PiMax&#58; presi&#243;n inspiratoria m&#225;xima&#59; Rce&#58; constante tiempo espiratoria&#59; Rrs&#58; Resistencia del sistema respiratorio&#59; VD&#58; espacio muerto anat&#243;mico&#46;</p>"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Adaptada de<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; SIMV&#58; ventilaci&#243;n mandatoria sincronizada intermitente&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Tubo en T&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tomlinson&#44;1989<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&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="left" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8211;&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="left" valign="\n
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">18&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;3&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
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">15&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;9&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">Esen&#44; 1992<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&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">&#8211;&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
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                  \t\t\t\t">17&#47;20 &#40;85&#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="left" valign="\n
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                  \t\t\t\t">15&#47;20 &#40;75&#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="left" valign="\n
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">&#8211;&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="left" valign="\n
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                  \t\t\t\t">10 &#40;&#8722;15&#44;35&#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="left" 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><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">6&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;1&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">9&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;7&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
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                  \t\t\t\t">Brochard&#44; 1994<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&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="left" valign="\n
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                  \t\t\t\t">20&#47;35 &#40;57&#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="left" valign="\n
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                  \t\t\t\t">24&#47;31 &#40;77&#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="left" valign="\n
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                  \t\t\t\t">25&#47;43 &#40;58&#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="left" valign="\n
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                  \t\t\t\t">&#8722;20 &#40;&#8722;42&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;1 &#40;&#8722;23&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;&#8722;2&#44;40&#41;&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="left" valign="\n
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                  \t\t\t\t">8&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;3&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="left" valign="\n
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                  \t\t\t\t">5&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;7&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="left" valign="\n
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                  \t\t\t\t">9&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;2&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">Esteban&#44; 1995<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&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="left" valign="\n
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                  \t\t\t\t">47&#47;62 &#40;76&#41;&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="left" valign="\n
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                  \t\t\t\t">23&#47;37 &#40;62&#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="left" valign="\n
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                  \t\t\t\t">20&#47;29 &#40;69&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;&#8722;5&#44;32&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;&#8722;13&#44;27&#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="left" valign="\n
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                  \t\t\t\t">&#8722;7 &#40;&#8722;20&#44;16&#41;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediana 3 P25&#44;75&#58;1&#44;6&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
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                  \t\t\t\t">Mediana 4 P25&#44;75&#58;1&#46;1&#44; 2&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="left" valign="\n
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                  \t\t\t\t">Mediana 5 P25&#44;75&#58;3&#46;1&#44; 1&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  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Agrupaci&#243;n de la diferencia en el riesgo para destete con &#233;xito</td><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">&#8722;3 &#40;&#8722;36&#44;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;&#8722;11&#44;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;&#8722;7&#44; 23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara">Las diferencias de riesgo se expresan como la diferencia en los porcentajes de pacientes desconectados con &#233;xito entre los diferentes modos&#46; Los n&#250;meros negativos indican una tasa de &#233;xito menor y los n&#250;meros positivos una tasa de &#233;xito mayor&#46; Entre par&#233;ntesis se indica el intervalo de confianza al 95&#37;&#46;</p>"
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          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los resultados de los ensayos cl&#237;nicos donde se comparan los modos tradicionales de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Abreviaturas&#58; BiPAP&#58; Bilevel positive airway pressure&#59; SIMV&#58; Ventilaci&#243;n mandatoria sincronizada intermitente&#59; PS&#58; presi&#243;n de soporte&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" 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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poblaci&#243;n incluida&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  " colspan="3" align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Estrategias comparadas</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Grupo control&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Grupo experimental</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="middle">Nava&#44; 1998<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar obstructiva cr&#243;nica&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="middle">N &#61; 25Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en T o CPAP menor de 5 cmH2O&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="middle">N &#61; 25Presi&#243;n de soporte no invasiva aplicada a trav&#233;s de mascara facial&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Girault&#44; 1999<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar cr&#243;nica &#40;obstructiva&#44; restrictiva o mixta&#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="left" valign="middle">N &#61; 16Presi&#243;n de soporte invasiva&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="middle">N &#61; 17Presi&#243;n de soporte no invasiva aplicada a trav&#233;s de mascara facial o nasal&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Hill&#44; 2000<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&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="middle">Pacientes con insuficiencia respiratoria aguda&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="middle">N &#61; 9Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en 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="left" valign="middle">N &#61; 12Ventilaci&#243;n no invasiva utilizando un ventilador espec&#237;fico &#40;VPAP&#174;&#41; en modo ST-A&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Chen&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar obstructiva cr&#243;nica&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="middle">N &#61; 12Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en 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="left" valign="middle">N &#61; 12BiPAP&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Ferrer&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&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="middle">Pacientes con Insuficiencia respiratoria aguda que fracasan tres pruebas de respiraci&#243;n espont&#225;nea&#40;77&#37; enfermos con patolog&#237;a pulmonar cr&#243;nica&#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="left" valign="middle">N &#61; 22Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en T o CPAP menor de 5 cmH2O&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="middle">N &#61; 21Ventilacion no invasiva en modo S&#47;T aplicada a trav&#233;s de mascara facial o nasal&#46;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Rabie&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">a</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar obstructiva cr&#243;nica&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="middle">N &#61; 18Presi&#243;n de soporte invasiva&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="middle">N &#61; 19<span class="elsevierStyleItalic">Proportional Assist Ventilation&#47;Timed Mode</span> a trav&#233;s de mascara facial o nasal&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Wang&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&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="middle">Pacientes con enfermedad pulmonar obstructiva cr&#243;nica e infecci&#243;n broncopulmonar&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="middle">N &#61; 14SIMV&#43;PSPrueba de respiraci&#243;n espont&#225;nea con tubo en 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="left" valign="middle">N &#61; 14Presi&#243;n de soporte no invasiva aplicada a trav&#233;s de m&#225;scara no especificada&#46;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Zheng&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&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="middle">Pacientes con enfermedad pulmonar obstructiva cr&#243;nica e infecci&#243;n broncopulmonar&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="middle">N &#61; 16Presi&#243;n de soporte invasiva&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="middle">N &#61; 17BiPAP aplicada a trav&#233;s de mascara facial o nasal&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Zou&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&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="middle">Pacientes con enfermedad pulmonar obstructiva cr&#243;nica e infecci&#243;n broncopulmonar&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="middle">N &#61; 38SIMV&#43;PS&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="middle">N &#61; 38BIPAP en modo ST aplicada a trav&#233;s de mascara facial o oronasal&#46;&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Wang&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&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="middle">Pacientes con enfermedad pulmonar obstructiva cr&#243;nica e infecci&#243;n broncopulmonar&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="middle">N &#61; 43SIMV&#43;PS&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="middle">N &#61; 47BiPAP&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Trevisan&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&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="middle">Pacientes con ventilaci&#243;n mec&#225;nica mayor de 48 horas &#40;35&#37; enfermos con patolog&#237;a pulmonar cr&#243;nica&#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="left" valign="middle">N &#61; 37Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en 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="left" valign="middle">N &#61; 28BiPAP a trav&#233;s de m&#225;scara facial&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Prasad&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar obstructiva cr&#243;nica&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="middle">N &#61; 15Presi&#243;n desoporte invasiva&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="middle">N &#61; 15BiPAP a trav&#233;s de m&#225;scara facial&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="" 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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="middle">Girault&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&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="middle">Pacientes con reagudizaci&#243;n de enfermedad pulmonar cr&#243;nica &#40;obstructiva&#44; restrictiva o mixta&#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="left" valign="middle">N &#61; 69Presi&#243;n de soporte invasivaPrueba de respiraci&#243;n espont&#225;nea con tubo en T o presi&#243;n de soporte&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">N&#61;70 Oxigenoterapia sin soporte ventilatorio&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">N &#61; 70Presi&#243;n de soporte no invasiva a trav&#233;s de m&#225;scara facial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0050"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Estudios publicados s&#243;lo como comunicaci&#243;n a congreso&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudios que han evaluado la ventilaci&#243;n no invasiva como m&#233;todo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&#46; Poblaci&#243;n y estrategias comparadas</p>"
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      5 => array:7 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" 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-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Neumon&#237;a adquirida en la UCI&#44; &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Duraci&#243;n ventilaci&#243;n mec&#225;nica&#44; d&#237;as&#44; media &#40;desviaci&#243;n est&#225;ndar&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Reintubaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a>&#44; &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mortalidad<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a>&#44; &#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Grupo control&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">Grupo experimental&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">Grupo control&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">Grupo experimental&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">Grupo control&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">Grupo experimental&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">Grupo control&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">Grupo experimental&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nava&#44; 1998<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&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">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&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
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                  \t\t\t\t">17&#40;12&#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
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                  \t\t\t\t">10 &#40;7&#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">&#8211;&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">&#8211;&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">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Girault&#44;1999<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&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">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" 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><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">&#8211;&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">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hill&#44; 2000<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&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">&#8211;&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">&#8211;&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">&#8211;&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">&#8211;&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">33&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chen&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&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">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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">&#8211;&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">&#8211;&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">&#8211;&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">&#8211;&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">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ferrer&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&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">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">20&#40;13&#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
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                  \t\t\t\t">11 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">59&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">28&#44;5&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rabie&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&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">22&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&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
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#37;&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="char" valign="\n
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                  \t\t\t\t">Wang&#44; 2004<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Zheng&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zou&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&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
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                  \t\t\t\t">39&#37;&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">18&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&#46;5 &#40;9&#46;5&#41;&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
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                  \t\t\t\t">34&#37;&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
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                  \t\t\t\t">13&#37;&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
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                  \t\t\t\t">29&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wang&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&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
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                  \t\t\t\t">28&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;8&#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">11 &#40;6&#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
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">16&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trevisan&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&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">46&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#37;&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
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                  \t\t\t\t">17&#40;10&#41;&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
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                  \t\t\t\t">15 &#40;10&#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
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                  \t\t\t\t">13&#37;&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">32&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Prasad&#44;2009<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&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">33&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">&#8211;&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">&#8211;&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
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Girault&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a><a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">14&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#8211;&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
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                  \t\t\t\t">&#8211;&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">39&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">32&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \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">19&#37;&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Global&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">32&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diferencia ponderada de medias efectos</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">19&#37;</span>&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"><span class="elsevierStyleItalic">22&#44;5&#37;</span>&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"><span class="elsevierStyleItalic">13&#44;5&#37;</span>&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="" 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
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                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo efectos aleatorios&#40;intervalo de confianza para el 95&#37;&#41;0&#44;37 &#40;0&#44;23 a 0&#44;61&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">aleatorios&#8722;4&#44;61 &#40;&#8722;5&#44;97 a &#8722;3&#44;25&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo efectos aleatorios&#40;intervalo de confianza para el 95&#37;&#41;0&#44;74 &#40;0&#44;52 a 1&#44;21&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo efectos aleatorios&#40;intervalo de confianza para el 95&#37;&#41;0&#44;64 &#40;0&#44;40 a 1&#44;03&#41;</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara">En el estudio de Girault et al &#40;33&#41; s&#243;lo se muestran los resultados correspondientes al grupo experimental de ventilaci&#243;n no invasiva</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Abreviaturas&#58; ATC&#58; compensaci&#243;n autom&#225;tica del tubo&#59; CPAP&#58; presi&#243;n positiva continua en la v&#237;a a&#233;rea&#59; PS&#58; presi&#243;n de soporte&#46;</p>"
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                  \t\t\t\t">&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="left" valign="\n
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                  \t\t\t\t">Poblaci&#243;n incluida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Estrategias comparadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Fracaso en la primera prueba de respiraci&#243;n espont&#225;nea</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Reintubaci&#243;n</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&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" style="border-bottom: 2px solid black">&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">ATC&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Otros m&#233;todos</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">ATC&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Otros m&#233;todos</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">Haberth&#252;r&#44; 2002<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica m&#225;s de 24 h por insuficiencia respiratoria aguda&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">Prueba de respiraci&#243;n espont&#225;nea con&#58;ATC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;PS 5 cmH<span class="elsevierStyleInf">2</span>O &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;Tubo en T &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS 5 cmH<span class="elsevierStyleInf">2</span>O&#58; 17&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo en T&#58; 20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS 5 cmH<span class="elsevierStyleInf">2</span>O&#58; 23&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo en T&#58; 17&#37;&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">Cohen&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica m&#225;s de 24 h por cualquier indicaci&#243;n&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">Prueba de respiraci&#243;n espont&#225;nea con&#58;ATC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;CPAP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP&#58; 15&#37;</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">14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP&#58; 24&#37;</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">Cohen&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica m&#225;s de 24 hpor cualquier indicaci&#243;n&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">Prueba de respiraci&#243;n espont&#225;nea con&#58;ATC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#41;PS 7 cmH<span class="elsevierStyleInf">2</span>O &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>93&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS 7 cmH<span class="elsevierStyleInf">2</span>O&#58; 14&#37;</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">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS 7 cmH<span class="elsevierStyleInf">2</span>O&#58; 15&#37;</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">Figueroa-Casas&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica m&#225;s de 24 h por cualquier indicaci&#243;n&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">Prueba de respiraci&#243;n espont&#225;nea con&#58;ATC &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;CPAP &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP&#58; 13&#37;</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">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP&#58; 7&#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Global</span>&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"><span class="elsevierStyleItalic">5&#37;</span>&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">15&#37;</span></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"><span class="elsevierStyleItalic">14&#37;</span>&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">16&#37;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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="" 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="" 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  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo efectos aleatorios &#40;intervalo de confianza para el 95&#37;&#41;0&#44; 33 &#40;0&#44;18 a 0&#44;62&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Riesgo relativo efectos aleatorios &#40;intervalo de confianza para el 95&#37;&#41;0&#44;86 &#40;0&#44;56 a 1&#44;32&#41;</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Ensayos cl&#237;nicos donde se compara la compensaci&#243;n autom&#225;tica del tubo &#40;ATC&#41; con otros m&#233;todos para la prueba de respiraci&#243;n espont&#225;nea</p>"
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      7 => array:7 [
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ASV&#58; ventilaci&#243;n adaptativa de soporte&#59; CVPR&#58; ventilaci&#243;n controlada por volumen regulada por presi&#243;n&#59; PS&#58; presi&#243;n de soporte&#59; PCV&#58; ventilaci&#243;n controlada por presi&#243;n&#59; SIMV&#58; ventilaci&#243;n mandatoria sincronizada intermitente&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Poblaci&#243;n incluida&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">Estrategias comparadas&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">Desenlace principal&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">Resultados desenlace principal<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&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">Otros resultados&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">Sulzer&#44; 2001<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a>&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">Pacientes en el postoperatorio de revascularizaci&#243;n coronaria&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">ASV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41; vs&#46;SIMV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de ventilaci&#243;n mec&#225;nica postoperatoria&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">ASV&#58; 193 min&#40;149 &#8211; 273&#41;SIMV&#58; 243 min&#40;186 -516&#41;&#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#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="" 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></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">Petter&#44; 2003<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&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">Pacientes en el postoperatorio de cirug&#237;a cardiaca&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">ASV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41; vs&#46;SIMV&#47;PS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de intubaci&#243;n postoperatoria&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">ASV&#58; 2&#44;7 h&#40;2&#44;1 &#8211; 4&#44;2&#41;SIMV&#47;PS&#58; 3&#44;2 h&#40;2&#44;7 &#8211; 4&#44;0&#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="" 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></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">Gruber&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a>&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">Pacientes en el postoperatorio de revascularizaci&#243;n coronaria&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">ASV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41; vs&#46; CVPR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>automode &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de intubaci&#243;n postoperatoria&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">ASV&#58; 300 min&#40;205 &#8211; 365&#41;CVPR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>automode&#58; 540 min&#40;462 &#8211; 580&#41;&#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extubaci&#243;n<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>8 horas&#58;ASV&#58; 1&#37;CVPR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>automode&#58; 68&#37;&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">Dongelmans&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a>&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">Pacientes en el postoperatorio de revascularizaci&#243;n coronaria&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">ASV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#41; vs&#46;PCV&#47;PS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>64&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n de intubaci&#243;n postoperatoria&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">ASV&#58; 16&#44;4 h&#40;12&#44;5 &#8211; 20&#44;8&#41;PCV&#47;PS&#58; 16&#44;3 horas &#40;13&#44;7 &#8211; 19&#44;3&#41;&#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;97&#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="" 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></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">Kirakli&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a>&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">Pacientes con reagudizaci&#243;n de una enfermedad pulmonar obstructiva cr&#243;nica&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">ASV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41; vs&#46;PCV&#47;PS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiempo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica&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">ASV&#58; 24 h&#40;20 &#8211; 62&#41;PCV&#47;PS&#58; 72 horas&#40;24 &#8211; 144&#41;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&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">Fracaso de weaningASV&#58; 28&#44;5&#37;PCV&#47;PS&#58; 31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara">Todos los resultados est&#225;n expresados en mediana &#40;rango intercuart&#237;lico&#41;&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Ensayos cl&#237;nicos que han evaluado la ventiaci&#243;n adaptativa de soporte &#40;ASV&#41; como m&#233;todo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica</p>"
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        "identificador" => "tbl0025"
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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">Poblaci&#243;n incluida<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>&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">Estrategias comparadas&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">Desenlace principal&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">Resultados desenlace principal<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">a</span></a>&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">Otros resultados&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">Lellouche&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica por cualquier indicaci&#243;n m&#225;s de 24 h&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">Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;Desconexi&#243;n est&#225;ndar<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">b</span></a>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiempo hasta extubaci&#243;n exitosa&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">SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 3 d&#237;as&#40;2-8&#41;Desconexi&#243;n est&#225;ndar&#58;5 d&#237;as&#40;2-12&#41;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&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">Reintubaci&#243;n en las primeras 72 h&#58;SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 16&#37;Desconexi&#243;n est&#225;ndar&#58; 23&#37;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;40&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">Jiang&#44; 2006<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&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">Pacientes con reagudizaci&#243;n de enfermedad pulmonar obstructiva cr&#243;nica&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">Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;Prueba de respiraci&#243;n espont&#225;nea&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extubaci&#243;n exitosa en los primeros 7 d&#237;as de desconexi&#243;n&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">SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 77&#37;Prueba de respiraci&#243;n espont&#225;nea&#58; 40&#37;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&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">Tiempo de desconexi&#243;nMedia &#40;DE&#41;SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 8&#44;5 d&#237;as &#40;2&#41;Prueba de respiraci&#243;n espont&#225;nea&#58; 13 d&#237;as &#40;2&#41;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;25&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">Rose&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica por cualquier indicaci&#243;n m&#225;s de 24 h&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">Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#41;Reducci&#243;n gradual de la presi&#243;n de soporte &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiempo hasta que cumple criterios para extubaci&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">d</span></a>&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">SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 20 horas&#40;2-40&#41;Reducci&#243;n gradual de la presi&#243;n de soporte&#58; 8 h&#40;2-43&#41;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;3&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="" 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></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">Sch&#228;dler&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a>&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">Pacientes con ventilaci&#243;n mec&#225;nica por cualquier indicaci&#243;n m&#225;s de 9 h&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
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                  \t\t\t\t">Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;Desconexi&#243;n est&#225;ndar <a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">e</span></a>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#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">Tiempo total de ventilaci&#243;n mec&#225;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 31 horas &#40;19-101&#41;Desconexi&#243;n est&#225;ndar&#58; 39 h &#40;20-118&#41;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;178&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
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                  \t\t\t\t">Tiempo hasta primera extubaci&#243;n&#58;Mediana &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;Desconexi&#243;n con SmartCare<span class="elsevierStyleSup">&#174;</span>&#58; 8 h &#40;3-29&#41;Desconexi&#243;n est&#225;ndar&#58; 10 h &#40;3-49&#41;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;687&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara">Todos los resultados de variables continuas est&#225;n expresados en mediana &#40;rango intercuart&#237;lico&#41;</p>"
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            1 => array:3 [
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              "identificador" => "tblfn0035"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara">Art&#237;culo en chino&#44; datos obtenidos del abstract en ingl&#233;s</p>"
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            3 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara">Definido en el art&#237;culo original como &#8216;tiempo hasta separaci&#243;n&#8217; que es el tiempo desde que se randomiza al enfermo &#40;inmediatamente despu&#233;s de pasar con &#233;xito una prueba de 30 min con presi&#243;n de soporte de hasta 20 cmH<span class="elsevierStyleInf">2</span>O&#41; hasta que pasan una prueba de 1 h de duraci&#243;n con presi&#243;n de soporte de 7 cmH<span class="elsevierStyleInf">2</span>O y PEEP de 5 cmH<span class="elsevierStyleInf">2</span>O&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Ensayos cl&#237;nicos que han evaluado el sistema SmartCare<span class="elsevierStyleSup">&#174;</span> como m&#233;todo de desconexi&#243;n de la ventilaci&#243;n mec&#225;nica</p>"
        ]
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