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que se observa claramente en la evoluci&#243;n de la pir&#225;mide poblacional de Espa&#241;a &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; lo que sin duda conllevar&#225; una mayor demanda de recursos sanitarios &#40;y consecuentemente de las camas de UCI&#41; lo que har&#225; necesario una mayor racionalizaci&#243;n de los mismos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio ha sido comparar el pron&#243;stico del grupo de pacientes ancianos &#40;&#8805;75 a&#241;os&#41; con los de menor edad en una cohorte de pacientes cr&#237;ticos ventilados mec&#225;nicamente&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">An&#225;lisis secundario de un estudio observacional&#44; prospectivo y multic&#233;ntrico llevado a cabo durante 2 a&#241;os en 13 UCI polivalentes espa&#241;olas&#46; Se llev&#243; a cabo un an&#225;lisis retrospectivo de los pacientes adultos ventilados mec&#225;nicamente durante m&#225;s de 24 horas e incluidos en la base de datos del proyecto &#171;modelo de probabilidad de ventilaci&#243;n mec&#225;nica prolongada&#187;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Criterios de exclusi&#243;n&#58; pacientes menores de 18 a&#241;os&#46; Pacientes a los que se les hab&#237;a considerado limitaci&#243;n de esfuerzo terap&#233;utico previamente a la inclusi&#243;n&#46; Pacientes que estuviesen incluidos en otro estudio del que derivase alguna intervenci&#243;n que pudiera tener influencia sobre el resultado&#46; Quemados cr&#237;ticos&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica del &#225;rea de salud del centro coordinador &#40;HVL&#41;&#46; Por sus caracter&#237;sticas &#40;observacional&#44; an&#243;nimo y sin intervenci&#243;n&#41; se eximi&#243; de la necesidad de solicitar consentimiento informado&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Variables analizadas&#58; Acute Physiology and Chronic Health Evaluation II &#40;APACHE II&#41; y Sequential Organ Failure Assessment &#40;SOFA&#41; en las primeras 24 horas de ventilaci&#243;n&#44; edad&#44; sexo&#44; motivo de ventilaci&#243;n mec&#225;nica&#44; duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; realizaci&#243;n de traqueotom&#237;a&#44; reintubaci&#243;n precoz &#40;en las primeras 48 horas de la extubaci&#243;n&#41;&#44; reintubaci&#243;n tard&#237;a &#40;m&#225;s de 48 horas de extubaci&#243;n&#41;&#44; comorbilidad seg&#250;n &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; capacidad funcional seg&#250;n &#237;ndice de Barthel<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; mortalidad en la UCI y mortalidad hospitalaria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los motivos de ventilaci&#243;n mec&#225;nica se incluyeron siguiendo los criterios del Mechanical Ventilation International Study Group<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se expresaron como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o mediana &#40;rango&#41; en funci&#243;n de si se ajustaron o no a una curva de distribuci&#243;n normal&#46; Las variables cualitativas se describieron como recuento &#40;n&#41; y porcentaje&#46; El an&#225;lisis de comparaci&#243;n de medias se realiz&#243; mediante el test de la T de student o la U de Mann Witnney en funci&#243;n de la distribuci&#243;n de las variables&#46; Asimismo&#44; la comparaci&#243;n de variables cualitativas se realiz&#243; mediante la prueba de la chi cuadrado o mediante el test exacto de Fischer seg&#250;n correspondi&#243;&#46; Se consider&#243; significaci&#243;n estad&#237;stica cuando el valor de <span class="elsevierStyleItalic">p</span> de una prueba fue menor de 0&#44;05&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Cuatro de los hospitales que participaron eran universitarios y 12 ten&#237;an acreditaci&#243;n para docencia posgrado en Medicina Intensiva&#46; El n&#250;mero de camas de los hospitales era de 625 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250-1&#46;450&#41;&#46; El n&#250;mero de camas de UCI de 15 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8-44&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 1&#46;661 pacientes&#46; El 67&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;127&#41; eran hombres&#46; Edad media&#58; 62&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;2 a&#241;os&#46; APACHE II&#58; 20&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&#46; SOFA total&#58; 8&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#46; El 25&#44;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>423&#41; de la totalidad de los pacientes ten&#237;an &#8805; 75 a&#241;os&#46; La distribuci&#243;n por edades se muestra en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La causa m&#225;s frecuente de ventilaci&#243;n mec&#225;nica fue la insuficiencia respiratoria aguda &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El &#237;ndice de comorbilidad de Charlson fue mayor y el &#237;ndice de capacidad funcional de Barthel menor en el grupo de pacientes &#8805; 75 a&#241;os que en el de los menores de esa edad &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8 vs 1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 y 90&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;6 vs 93&#44;4 vs 14&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No hubo diferencias en cuanto a tiempo de ventilaci&#243;n mec&#225;nica&#44; incidencia de reintubaci&#243;n &#40;precoz o tard&#237;a&#41; e incidencia de traqueotom&#237;a entre ambos grupos&#46; La mortalidad en la UCI fue superior en el grupo de ancianos &#40;33&#44;6&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41; que en los m&#225;s j&#243;venes &#40;25&#44;9&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>321&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Igualmente&#44; la mortalidad acumulada intrahospitalaria fue m&#225;s alta en aquellos &#40;41&#44;8&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>177 vs 31&#44;8&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>394&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La mortalidad en funci&#243;n de las causas de ventilaci&#243;n mec&#225;nica mostraron que solo los ancianos ventilados por neumon&#237;a&#44; sepsis o trauma presentaron una mortalidad m&#225;s alta que el grupo de pacientes m&#225;s j&#243;venes para las mismas causas &#40;46&#44;3 vs 33&#44;1&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#59; 55 vs 25&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; 63&#44;6 vs 4&#44;5&#37; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001 respectivamente&#41;&#46; Para el resto de motivos de ventilaci&#243;n mec&#225;nica las diferencias no alcanzaron significaci&#243;n estad&#237;stica &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran una mayor mortalidad en la UCI y en el hospital en los ancianos pero sin un mayor consumo de recursos tales como duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; incidencia de reintubaciones o incidencia de traqueotom&#237;as&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La preocupaci&#243;n por el incremento de la poblaci&#243;n anciana en las UCI se viene produciendo desde hace d&#233;cadas&#46; En 2 estudios llevados a cabo en Suiza<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> y en Noruega<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> ya se observ&#243; un cambio en las caracter&#237;sticas de los pacientes ingresados en las UCI entre las d&#233;cadas 80 y 90&#44; evidenciando un crecimiento del porcentaje de mayores de 70 a&#241;os&#44; a los que adem&#225;s se les somet&#237;a a una mayor cantidad de procedimientos&#46; Estos hallazgos han sido ratificados m&#225;s recientemente por Bagshaw et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> quienes han observado retrospectivamente un incremento del 13&#37; de ingresos de pacientes &#8805; 80 a&#241;os durante un periodo de 6 a&#241;os en Australia y Nueva Zelanda&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la d&#233;cada de los 90 se publicaron diversos estudios dirigidos a evaluar el pron&#243;stico de los ancianos ventilados&#46; En la mayor&#237;a se encontraron pobres resultados&#44; si bien muchos de ellos fueron estudios limitados por su dise&#241;o retrospectivo&#44; por tener muestras escasas o por la falta de una poblaci&#243;n generalizada de pacientes ventilados<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;19</span></a>&#46; Estudios m&#225;s recientes con muestras m&#225;s amplias han comunicado pobres resultados en pacientes ventilados mec&#225;nicamente con edades superiores a 65<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a>&#44; 70<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#44; 80<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;26&#44;27</span></a> u 85 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;28</span></a> habi&#233;ndose descrito una mortalidad de hasta el 68&#44;1&#37; en pacientes mayores de 85 a&#241;os&#44; que llega al 86&#37; si se asocia a fallo de 2 &#243;rganos y al 100&#37; si se asocia al fallo de 3 o m&#225;s &#243;rganos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestro pa&#237;s 2 estudios se han centrado en esta problem&#225;tica&#46; Garc&#237;a Lizana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> estudiaron el pron&#243;stico de 313 pacientes &#8805; 65 a&#241;os ingresados en la UCI&#46; Encontraron una mortalidad del 30&#37; en la UCI&#44; 10&#37; en el hospital y 11&#37; tras el alta&#46; La mortalidad al a&#241;o fue del 51&#37;&#46; De los supervivientes&#44; el 58&#44;6&#37; ten&#237;an buen estado de salud al a&#241;o de seguimiento y eran independientes&#44; el 24&#44;3&#37; ten&#237;an alg&#250;n grado de discapacidad y el 17&#37; eran dependientes&#46; No se diferenci&#243; entre pacientes ventilados y no ventilados&#46; Santana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> evaluaron retrospectivamente el pron&#243;stico de los pacientes &#8805; 70 a&#241;os con estancia en UCI mayor de 30 d&#237;as&#46; Todos ellos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; fueron ventilados mec&#225;nicamente durante una media de 37 d&#237;as&#46; La mortalidad intra-UCI fue del 30&#37;&#46; El hallazgo m&#225;s importante seg&#250;n los autores fue que el 60&#37; permanec&#237;an vivos al a&#241;o del alta&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sin embargo&#44; ni de los resultados obtenidos en otros &#225;mbitos geogr&#225;ficos&#44; ni de los obtenidos en nuestro pa&#237;s se pueden obtener conclusiones definitivas&#46; Primero&#58; es dif&#237;cil comparar los resultados entre diferentes an&#225;lisis cuando el punto de corte &#171;edad&#187; es distinto entre ellos&#44; con un rango que oscila entre los 65 y los 85 a&#241;os&#46; Segundo&#58; no es f&#225;cil establecer este punto de corte y en la mayor&#237;a de los trabajos o se establece de forma arbitraria o siguiendo un criterio &#171;socio-laboral&#187; como es la edad de jubilaci&#243;n&#46; Sin embargo&#44; en Espa&#241;a&#44; donde la expectativa de vida al nacimiento en el a&#241;o 2010 se situ&#243; en 78&#44;9 a&#241;os para los hombres y 84&#44;9 a&#241;os para las mujeres parece irreal situar el l&#237;mite de poblaci&#243;n anciana en 65 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a>&#46; Tercero&#58; mientras algunos analizan solo ancianos ventilados mec&#225;nicamente&#44; otros incluyen enfermos ingresados en la UCI ventilados o no&#44; cuando el hecho de precisar ventilaci&#243;n mec&#225;nica es un criterio de gravedad que obliga a que estos pacientes sean estudiados como un grupo independiente de mayor riesgo&#46; Cuarto&#58; en algunos estudios se analiza solo la mortalidad hospitalaria&#44; en otros la mortalidad al a&#241;o y en pocos la calidad de vida&#46; Actualmente la variable &#171;mortalidad&#187; en t&#233;rminos absolutos tiene un valor relativo&#44; por lo que futuros trabajos deber&#237;an tener como resultado final la calidad de vida tras el alta hospitalaria&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El progresivo incremento de la presi&#243;n asistencial en las UCI&#44; la incertidumbre del pron&#243;stico en el anciano&#44; la escasez de resultados de esta poblaci&#243;n en las UCI espa&#241;olas y la previsi&#243;n del cambio en la pir&#225;mide poblacional en Espa&#241;a&#44; han sido las causas que han conducido a la realizaci&#243;n del an&#225;lisis que se presenta&#46; Su fortaleza reside en evaluar el pron&#243;stico de una amplia muestra de ancianos sometidos&#44; todos&#44; a ventilaci&#243;n mec&#225;nica invasiva&#46; Su limitaci&#243;n&#44; tratarse de un an&#225;lisis retrospectivo y sus consecuencias &#40;falta de seguimiento a largo plazo&#44; falta de evaluaci&#243;n de calidad de vida&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Asumiendo una mayor mortalidad en la poblaci&#243;n anciana ventilada mec&#225;nicamente pero teniendo en cuenta una supervivencia del 52&#44;8&#37; de la que se desconoce seguimiento a largo plazo y calidad de vida&#44; coincidimos con otros<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> en afirmar que en el momento actual la edad en s&#237; misma no debe ser un factor por el que se deba limitar el ingreso en la UCI y la indicaci&#243;n de soporte ventilatorio invasivo&#46; Su consecuencia&#44; teniendo en cuenta los cambios demogr&#225;ficos calculados por el Instituto Nacional de Estad&#237;stica<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; agudiza el conflicto de la distribuci&#243;n de los recursos&#46; El como distribuir unos recursos caros y limitados entre una poblaci&#243;n cada vez m&#225;s envejecida y con una progresiva necesidad de consumo de los mismos agrava un problema econ&#243;mico y &#233;tico b&#225;sico que deber&#237;a ser cuidadosamente analizado y previsto por los responsables de salud&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; nuestros resultados muestran una mayor mortalidad en UCI y hospitalaria en los pacientes ancianos&#46; La falta de seguimiento no nos permite establecer conclusiones en cuanto a mortalidad a largo plazo y calidad de vida&#46; Debido a las previsiones en cuanto al cambio de la pir&#225;mide poblacional se necesita la puesta en marcha de estudios bien dise&#241;ados en los que se eval&#250;e la tendencia de ingresos&#44; supervivencia y calidad de vida al alta hospitalaria de esta poblaci&#243;n de cara a dar respuesta a la previsible demanda de recursos en las UCI en pr&#243;ximos a&#241;os&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el pron&#243;stico de los pacientes ancianos ventilados mec&#225;nicamente en la Unidad de Cuidados Intensivos &#40;UCI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o y &#225;mbito</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario de un estudio observacional prospectivo y multic&#233;ntrico llevado a cabo durante un periodo de 2 a&#241;os en 13 UCI espa&#241;olas&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pacientes adultos que precisaron ventilaci&#243;n mec&#225;nica &#40;VM&#41; invasiva durante m&#225;s de 24 horas&#46;</p> <span class="elsevierStyleSectionTitle">Intervenciones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos&#44; APACHE II&#44; SOFA&#44; motivo de VM&#44; comorbilidad&#44; situaci&#243;n funcional&#44; reintubaci&#243;n&#44; duraci&#243;n de la VM&#44; traqueotom&#237;a&#44; mortalidad en la UCI&#44; mortalidad hospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1&#46;661 pacientes&#46; De ellos 1&#46;127 &#40;67&#44;9&#37;&#41; eran hombres&#46; Edad&#58; 62&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;2 a&#241;os&#46; APACHE II&#58; 20&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&#46; SOFA total&#58; 8&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#46; Cuatrocientos veintitr&#233;s pacientes &#40;25&#44;4&#37;&#41; ten&#237;an 75 a&#241;os o m&#225;s&#46; Los &#237;ndices de comorbilidad y capacidad funcional fueron peor en este grupo de pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para ambas variables&#41;&#46; La mortalidad en la UCI fue superior en este grupo &#40;33&#44;6&#37;&#41; que en los m&#225;s j&#243;venes &#40;25&#44;9&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; al igual que la mortalidad hospitalaria &#40;41&#44;8 vs 31&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; No hubo diferencias en cuanto a tiempo de VM&#44; incidencia de traqueotom&#237;as o &#237;ndice de reintubaciones&#46; Por causas de VM solo los pacientes &#8805; 75 a&#241;os ventilados por neumon&#237;a&#44; sepsis o trauma presentaron una mortalidad en UCI m&#225;s alta que los menores de esa edad &#40;46&#44;3 vs 33&#44;1&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#59; 55 vs 25&#44;8&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; 63&#44;6 vs 4&#44;5&#37; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 respectivamente&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los ancianos &#40;&#8805; 75 a&#241;os&#41; tienen una mayor mortalidad en UCI y hospitalaria que los m&#225;s j&#243;venes sin diferencias en la duraci&#243;n de la VM&#46; Las diferencias son a expensas de patolog&#237;as como neumon&#237;a&#44; sepsis y trauma&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit &#40;ICU&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Design and scope</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Adult patients who required mechanical ventilation &#40;MV&#41; for longer than 24<span class="elsevierStyleHsp" style=""></span>hours&#46;</p> <span class="elsevierStyleSectionTitle">Interventions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p> <span class="elsevierStyleSectionTitle">Study variables</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic data&#44; APACHE II&#44; SOFA&#44; reason for MV&#44; comorbidity&#44; functional condition&#44; reintubation&#44; duration of MV&#44; tracheotomy&#44; ICU mortality&#44; in-hospital mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 1661 patients were recruited&#46; Males accounted for 67&#46;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1127&#41;&#44; with a mean age of 62&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;2 years&#46; APACHE II&#58; 20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5&#46; Total SOFA&#58; 8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#46; Four hundred and twenty-three patients &#40;25&#46;4&#37;&#41; were &#8805; 75 years of age&#46; Comorbidity and functional condition rates were poorer in these patients &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both variables&#41;&#46; Mortality in the ICU was higher in the elderly patients &#40;33&#46;6&#37;&#41; than in the younger subjects &#40;25&#46;9&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Also&#44; in-hospital mortality was higher in those &#8805; 75 years of age&#46; No differences in duration of MV&#44; prevalence of tracheostomy or reintubation incidence were found&#46; Regarding the indication for MV&#44; only the patient &#8805; 75 years of age with pneumonia&#44; sepsis or trauma had a higher in-ICU mortality than the younger patients &#40;46&#46;3&#37; vs 33&#46;1&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#59; 55&#37; vs 25&#46;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#59; 63&#46;6&#37; vs 4&#46;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectively&#41;&#46; No differences were found referred to other reasons for MV&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Older patients &#40;&#8805; 75 years&#41; have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation&#46; Differences in mortality were at the expense of pneumonia&#44; sepsis and trauma&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">1 &#46;Insuficiencia respiratoria aguda&#58;</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="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46;a&#46; Postoperatoria&#58; pacientes que precisaron ventilaci&#243;n mec&#225;nica tras intervenci&#243;n quir&#250;rgica debido a la gravedad de la patolog&#237;a de base&#44; edad o elevado riesgo del procedimiento quir&#250;rgico&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;b&#46; Neumonia&#58; definida como el desarrollo de un nuevo infiltrado alveolar o empeoramiento de infiltrado alveolar previo acompa&#241;ado de fiebre&#47;hipotermia y leucocitosis&#47;leucopenia&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;c&#46; Insuficiencia cardiaca&#58; pacientes con disnea&#44; infiltrado alveolar bilateral&#44; hipoxemia&#44; y evidencia de patolog&#237;a cardiaca o pacientes con shock cardiog&#233;nico&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"><span class="elsevierStyleHsp" style=""></span>1&#46;d&#46; Lesi&#243;n pulmonar aguda&#47;s&#237;ndrome de distr&#233;s respiratorio agudo &#40;LPA&#47;SDRA&#41;&#58; seg&#250;n los criterios de la American-European consensus conference<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;e&#46; Sepsis&#58; seg&#250;n los criterios del American College of Chest Physicians Society of Critical Care Medicine consensus conference<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;f&#46; Trauma&#58; ventilaci&#243;n mec&#225;nica debida a politraumatismo&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;g&#46; Parada cardiaca&#58; ventilation mec&#225;nica debida al cese s&#250;bito e inesperado de las funciones cardiorrespiratorias&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">2&#46; Coma</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que necesitaron ventilaci&#243;n mec&#225;nica por p&#233;rdida de conciencia de origen org&#225;nico &#40;ictus -isqu&#233;mico o hemorr&#225;gico-&#44; meningoencefalitis&#44; traumatismo craneoencef&#225;lico&#41;&#44; metab&#243;lico o por intoxicaci&#243;n&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">3&#46; Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica&#58;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que requirieron ventilaci&#243;n mec&#225;nica por agudizaci&#243;n de una enfermedad respiratoria cr&#243;nica de base &#40;enfermedad pulmonar obstructiva cr&#243;nica agudizada&#44; asma&#44; otras enfermedades respiratorias cr&#243;nicas -no-EPOC-&#41;&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">4&#46; Enfermedad neuromuscular&#58;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes cuya disfunci&#243;n respiratoria fue debida a alteraciones del sistema nervioso perif&#233;rico o muscular&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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"><span class="elsevierStyleItalic">5&#46; Otras&#46;</span>&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ventilaci&#243;n mec&#225;nica debida a otras causas no incluidas en ninguno de los apartados anteriores&#46;&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara">Bernard GR&#44; Artigas A&#44; Brigham KL&#44; Carlet J&#44; Falke K&#44; Hudson L&#44; Lamy M&#44; Legall JR&#44; Morris A&#44; Spragg R&#46; The American-European Consensus Conference on ARDS&#46; Am J Respir Crit Care Med&#46; 1994&#59;149&#58;818-24&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara">Bone RC&#44; Balk RA&#44; Cerra FB&#44; Dellinger RP&#44; Fein AM&#44; Knaus WA&#44; Schein RM&#44; Sibbald WJ&#46; Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis&#46; The ACCP&#47;SCCM Consensus Conference Committee&#46; American College of Chest Physicians&#47;Society of Critical Care Medicine&#46; Chest 1992&#59;101&#58;1644-55&#46;</p>"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Motivos de ventilaci&#243;n mec&#225;nica</p>"
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                  \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
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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">Edad &#8805; 75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>423&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;238&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N &#40;&#37;&#41; pacientes ventilados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Insuficiencia respiratoria Aguda</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LPA&#47;SDRA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">144 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trauma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;4&#44;7&#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"><span class="elsevierStyleHsp" style=""></span>Parada cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">114 &#40;9&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleItalic">Coma</span>&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"><span class="elsevierStyleBold">294 &#40;17&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metab&#243;lico&#47;Intoxicaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;5&#44;1&#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"><span class="elsevierStyleHsp" style=""></span>Ictus&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">21 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101 &#40;8&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122 &#40;7&#44;3&#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"><span class="elsevierStyleHsp" style=""></span>Meningoencefalitis&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">3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;1&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>TCE&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">6 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;3&#44;5&#41;&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">129 &#40;7&#44;7&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>EPOC&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 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">111 &#40;6&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Asma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;0&#44;8&#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">12 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad respiratoria cr&#243;nica &#40;no-EPOC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;0&#44;3&#41;&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  " colspan="4" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\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">1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;0&#44;0001&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</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&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintubaci&#243;n &#40;&#8804;48 horas&#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">39 &#40;9&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105 &#40;8&#44;5&#37;&#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</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintubaci&#243;n &#40;&#62;48 horas&#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;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Traqueotom&#237;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">103 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">343 &#40;27&#44;7&#37;&#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">0&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exitus en UCI&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">142 &#40;33&#44;6&#37;&#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">321 &#40;25&#44;9&#37;&#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">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Motivo de ventilaci&#243;n mec&#225;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad &#8805; 75 a&#241;os Exitus&#47;total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os Exitus&#47;total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#47;157 &#40;33&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;006&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"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#47;37 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#47;40 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LPA&#47;SDRA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#47;27 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#47;117 &#40;42&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;85&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"><span class="elsevierStyleHsp" style=""></span>Trauma&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">7&#47;11 &#40;63&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;67 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parada cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;34 &#40;35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#47;114 &#40;37&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;79&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"><span class="elsevierStyleBold">12&#47;41 &#40;29&#44;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">56&#47;253 &#40;22&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metab&#243;lico&#47;Intoxicaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#47;11 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;75 &#40;10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#47;21 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;32&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"><span class="elsevierStyleHsp" style=""></span>Meningoencefalitis&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">0&#47;3 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;25 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TCE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;52 &#40;28&#44;8&#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">0&#44;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">4&#47;33 &#40;12&#44;1&#41;</span>&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"><span class="elsevierStyleHsp" style=""></span>EPOC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;28 &#40;10&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&#47;83 &#40;18&#41;&nbsp;\t\t\t\t\t\t\n
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Pronóstico de los ancianos ventilados mecánicamente en la UCI
Prognosis of elderly patients subjected to mechanical ventilation in the ICU
J.M. Añona,
Autor para correspondencia
jmaelizalde@gmail.com

Autor para correspondencia.
, V. Gómez-Tellob, E. González-Higuerasa, V. Córcolesc, M. Quintanad, A. García de Lorenzoe, J.J. Oñorob, C. Martín-Delgadof, A. García-Fernándezg, L. Marinah, F. Gordoi, G. Choperenaj, R. Díaz-Alersik, J.C. Montejol, J. López-Martínezm
a Servicio de Medicina Intensiva, Hospital Virgen de la Luz, Cuenca, España
b Servicio de Medicina Intensiva, Hospital Moncloa, Madrid, España
c Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Albacete, Albacete, España
d Servicio de Medicina Intensiva, Hospital Nuestra Señora del Prado, Talavera, España
e Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, España
f Servicio de Medicina Intensiva, Hospital La Mancha Centro, Alcázar de San Juan, España
g Servicio de Medicina Intensiva, Hospital de Mérida, Mérida, España
h Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
i Servicio de Medicina Intensiva, Fundación Hospital Alcorcón, Madrid, España
j Servicio de Medicina Intensiva, Hospital Donostia, San Sebastián, España
k Servicio de Medicina Intensiva, Hospital Universitario Puerto Real, Cádiz, España
l Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
m Servicio de Medicina Intensiva, Hospital Severo Ochoa, Leganés, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La edad avanzada se asocia a una elevada prevalencia de enfermedades cr&#243;nicas y deterioro funcional&#46; A los ancianos se les atribuye no solo una corta esperanza sino tambi&#233;n una pobre calidad de vida lo que hace que sean considerados &#171;a priori&#187; pacientes de mal pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a>&#46; Todo ello hace que se tienda a rechazar su ingreso en las Unidades de Cuidados Intensivos &#40;UCI&#41;&#44; fundamentalmente cuando la patolog&#237;a que motiva su ingreso les hace subsidiarios de ventilaci&#243;n mec&#225;nica invasiva&#46; Sin embargo&#44; ya en los a&#241;os 90 el 12&#44;5&#37; de los pacientes de las UCI espa&#241;olas eran mayores de 75 a&#241;os y el 41&#37; ten&#237;an entre 60 y 75 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> y es de esperar que la tasa de hospitalizaciones y la demanda de las camas de cr&#237;ticos crezca de forma exponencial en las pr&#243;ximas d&#233;cadas entre una poblaci&#243;n cada vez m&#225;s envejecida&#46; El informe &#171;Proyecci&#243;n de la Poblaci&#243;n de Espa&#241;a a largo plazo&#44; 2009-2049&#187;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> pone de manifiesto que de mantenerse los ritmos actuales de reducci&#243;n de la incidencia de la mortalidad por edad&#44; la esperanza de vida al nacimiento en 2048 alcanzar&#237;a los 84&#44;3 a&#241;os en los hombres y los 89&#44;9 a&#241;os en las mujeres&#44; increment&#225;ndose desde 2007 en 6&#44;5 y 5&#44;8 a&#241;os&#44; respectivamente&#46; La simulaci&#243;n realizada muestra el progresivo envejecimiento al que se enfrenta nuestra estructura demogr&#225;fica&#44; que se observa claramente en la evoluci&#243;n de la pir&#225;mide poblacional de Espa&#241;a &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; lo que sin duda conllevar&#225; una mayor demanda de recursos sanitarios &#40;y consecuentemente de las camas de UCI&#41; lo que har&#225; necesario una mayor racionalizaci&#243;n de los mismos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo de nuestro estudio ha sido comparar el pron&#243;stico del grupo de pacientes ancianos &#40;&#8805;75 a&#241;os&#41; con los de menor edad en una cohorte de pacientes cr&#237;ticos ventilados mec&#225;nicamente&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">An&#225;lisis secundario de un estudio observacional&#44; prospectivo y multic&#233;ntrico llevado a cabo durante 2 a&#241;os en 13 UCI polivalentes espa&#241;olas&#46; Se llev&#243; a cabo un an&#225;lisis retrospectivo de los pacientes adultos ventilados mec&#225;nicamente durante m&#225;s de 24 horas e incluidos en la base de datos del proyecto &#171;modelo de probabilidad de ventilaci&#243;n mec&#225;nica prolongada&#187;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Criterios de exclusi&#243;n&#58; pacientes menores de 18 a&#241;os&#46; Pacientes a los que se les hab&#237;a considerado limitaci&#243;n de esfuerzo terap&#233;utico previamente a la inclusi&#243;n&#46; Pacientes que estuviesen incluidos en otro estudio del que derivase alguna intervenci&#243;n que pudiera tener influencia sobre el resultado&#46; Quemados cr&#237;ticos&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica del &#225;rea de salud del centro coordinador &#40;HVL&#41;&#46; Por sus caracter&#237;sticas &#40;observacional&#44; an&#243;nimo y sin intervenci&#243;n&#41; se eximi&#243; de la necesidad de solicitar consentimiento informado&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Variables analizadas&#58; Acute Physiology and Chronic Health Evaluation II &#40;APACHE II&#41; y Sequential Organ Failure Assessment &#40;SOFA&#41; en las primeras 24 horas de ventilaci&#243;n&#44; edad&#44; sexo&#44; motivo de ventilaci&#243;n mec&#225;nica&#44; duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; realizaci&#243;n de traqueotom&#237;a&#44; reintubaci&#243;n precoz &#40;en las primeras 48 horas de la extubaci&#243;n&#41;&#44; reintubaci&#243;n tard&#237;a &#40;m&#225;s de 48 horas de extubaci&#243;n&#41;&#44; comorbilidad seg&#250;n &#237;ndice de Charlson<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#44; capacidad funcional seg&#250;n &#237;ndice de Barthel<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44; mortalidad en la UCI y mortalidad hospitalaria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los motivos de ventilaci&#243;n mec&#225;nica se incluyeron siguiendo los criterios del Mechanical Ventilation International Study Group<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables cuantitativas se expresaron como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o mediana &#40;rango&#41; en funci&#243;n de si se ajustaron o no a una curva de distribuci&#243;n normal&#46; Las variables cualitativas se describieron como recuento &#40;n&#41; y porcentaje&#46; El an&#225;lisis de comparaci&#243;n de medias se realiz&#243; mediante el test de la T de student o la U de Mann Witnney en funci&#243;n de la distribuci&#243;n de las variables&#46; Asimismo&#44; la comparaci&#243;n de variables cualitativas se realiz&#243; mediante la prueba de la chi cuadrado o mediante el test exacto de Fischer seg&#250;n correspondi&#243;&#46; Se consider&#243; significaci&#243;n estad&#237;stica cuando el valor de <span class="elsevierStyleItalic">p</span> de una prueba fue menor de 0&#44;05&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">Cuatro de los hospitales que participaron eran universitarios y 12 ten&#237;an acreditaci&#243;n para docencia posgrado en Medicina Intensiva&#46; El n&#250;mero de camas de los hospitales era de 625 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>250-1&#46;450&#41;&#46; El n&#250;mero de camas de UCI de 15 &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8-44&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 1&#46;661 pacientes&#46; El 67&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;127&#41; eran hombres&#46; Edad media&#58; 62&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;2 a&#241;os&#46; APACHE II&#58; 20&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&#46; SOFA total&#58; 8&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#46; El 25&#44;4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>423&#41; de la totalidad de los pacientes ten&#237;an &#8805; 75 a&#241;os&#46; La distribuci&#243;n por edades se muestra en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">La causa m&#225;s frecuente de ventilaci&#243;n mec&#225;nica fue la insuficiencia respiratoria aguda &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; El &#237;ndice de comorbilidad de Charlson fue mayor y el &#237;ndice de capacidad funcional de Barthel menor en el grupo de pacientes &#8805; 75 a&#241;os que en el de los menores de esa edad &#40;2&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8 vs 1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 y 90&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;6 vs 93&#44;4 vs 14&#44;3&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No hubo diferencias en cuanto a tiempo de ventilaci&#243;n mec&#225;nica&#44; incidencia de reintubaci&#243;n &#40;precoz o tard&#237;a&#41; e incidencia de traqueotom&#237;a entre ambos grupos&#46; La mortalidad en la UCI fue superior en el grupo de ancianos &#40;33&#44;6&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41; que en los m&#225;s j&#243;venes &#40;25&#44;9&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>321&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Igualmente&#44; la mortalidad acumulada intrahospitalaria fue m&#225;s alta en aquellos &#40;41&#44;8&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>177 vs 31&#44;8&#37;&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>394&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La mortalidad en funci&#243;n de las causas de ventilaci&#243;n mec&#225;nica mostraron que solo los ancianos ventilados por neumon&#237;a&#44; sepsis o trauma presentaron una mortalidad m&#225;s alta que el grupo de pacientes m&#225;s j&#243;venes para las mismas causas &#40;46&#44;3 vs 33&#44;1&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#59; 55 vs 25&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; 63&#44;6 vs 4&#44;5&#37; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001 respectivamente&#41;&#46; Para el resto de motivos de ventilaci&#243;n mec&#225;nica las diferencias no alcanzaron significaci&#243;n estad&#237;stica &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran una mayor mortalidad en la UCI y en el hospital en los ancianos pero sin un mayor consumo de recursos tales como duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; incidencia de reintubaciones o incidencia de traqueotom&#237;as&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La preocupaci&#243;n por el incremento de la poblaci&#243;n anciana en las UCI se viene produciendo desde hace d&#233;cadas&#46; En 2 estudios llevados a cabo en Suiza<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> y en Noruega<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> ya se observ&#243; un cambio en las caracter&#237;sticas de los pacientes ingresados en las UCI entre las d&#233;cadas 80 y 90&#44; evidenciando un crecimiento del porcentaje de mayores de 70 a&#241;os&#44; a los que adem&#225;s se les somet&#237;a a una mayor cantidad de procedimientos&#46; Estos hallazgos han sido ratificados m&#225;s recientemente por Bagshaw et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> quienes han observado retrospectivamente un incremento del 13&#37; de ingresos de pacientes &#8805; 80 a&#241;os durante un periodo de 6 a&#241;os en Australia y Nueva Zelanda&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la d&#233;cada de los 90 se publicaron diversos estudios dirigidos a evaluar el pron&#243;stico de los ancianos ventilados&#46; En la mayor&#237;a se encontraron pobres resultados&#44; si bien muchos de ellos fueron estudios limitados por su dise&#241;o retrospectivo&#44; por tener muestras escasas o por la falta de una poblaci&#243;n generalizada de pacientes ventilados<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;19</span></a>&#46; Estudios m&#225;s recientes con muestras m&#225;s amplias han comunicado pobres resultados en pacientes ventilados mec&#225;nicamente con edades superiores a 65<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a>&#44; 70<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#44; 80<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;26&#44;27</span></a> u 85 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;28</span></a> habi&#233;ndose descrito una mortalidad de hasta el 68&#44;1&#37; en pacientes mayores de 85 a&#241;os&#44; que llega al 86&#37; si se asocia a fallo de 2 &#243;rganos y al 100&#37; si se asocia al fallo de 3 o m&#225;s &#243;rganos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestro pa&#237;s 2 estudios se han centrado en esta problem&#225;tica&#46; Garc&#237;a Lizana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> estudiaron el pron&#243;stico de 313 pacientes &#8805; 65 a&#241;os ingresados en la UCI&#46; Encontraron una mortalidad del 30&#37; en la UCI&#44; 10&#37; en el hospital y 11&#37; tras el alta&#46; La mortalidad al a&#241;o fue del 51&#37;&#46; De los supervivientes&#44; el 58&#44;6&#37; ten&#237;an buen estado de salud al a&#241;o de seguimiento y eran independientes&#44; el 24&#44;3&#37; ten&#237;an alg&#250;n grado de discapacidad y el 17&#37; eran dependientes&#46; No se diferenci&#243; entre pacientes ventilados y no ventilados&#46; Santana et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> evaluaron retrospectivamente el pron&#243;stico de los pacientes &#8805; 70 a&#241;os con estancia en UCI mayor de 30 d&#237;as&#46; Todos ellos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; fueron ventilados mec&#225;nicamente durante una media de 37 d&#237;as&#46; La mortalidad intra-UCI fue del 30&#37;&#46; El hallazgo m&#225;s importante seg&#250;n los autores fue que el 60&#37; permanec&#237;an vivos al a&#241;o del alta&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Sin embargo&#44; ni de los resultados obtenidos en otros &#225;mbitos geogr&#225;ficos&#44; ni de los obtenidos en nuestro pa&#237;s se pueden obtener conclusiones definitivas&#46; Primero&#58; es dif&#237;cil comparar los resultados entre diferentes an&#225;lisis cuando el punto de corte &#171;edad&#187; es distinto entre ellos&#44; con un rango que oscila entre los 65 y los 85 a&#241;os&#46; Segundo&#58; no es f&#225;cil establecer este punto de corte y en la mayor&#237;a de los trabajos o se establece de forma arbitraria o siguiendo un criterio &#171;socio-laboral&#187; como es la edad de jubilaci&#243;n&#46; Sin embargo&#44; en Espa&#241;a&#44; donde la expectativa de vida al nacimiento en el a&#241;o 2010 se situ&#243; en 78&#44;9 a&#241;os para los hombres y 84&#44;9 a&#241;os para las mujeres parece irreal situar el l&#237;mite de poblaci&#243;n anciana en 65 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a>&#46; Tercero&#58; mientras algunos analizan solo ancianos ventilados mec&#225;nicamente&#44; otros incluyen enfermos ingresados en la UCI ventilados o no&#44; cuando el hecho de precisar ventilaci&#243;n mec&#225;nica es un criterio de gravedad que obliga a que estos pacientes sean estudiados como un grupo independiente de mayor riesgo&#46; Cuarto&#58; en algunos estudios se analiza solo la mortalidad hospitalaria&#44; en otros la mortalidad al a&#241;o y en pocos la calidad de vida&#46; Actualmente la variable &#171;mortalidad&#187; en t&#233;rminos absolutos tiene un valor relativo&#44; por lo que futuros trabajos deber&#237;an tener como resultado final la calidad de vida tras el alta hospitalaria&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">El progresivo incremento de la presi&#243;n asistencial en las UCI&#44; la incertidumbre del pron&#243;stico en el anciano&#44; la escasez de resultados de esta poblaci&#243;n en las UCI espa&#241;olas y la previsi&#243;n del cambio en la pir&#225;mide poblacional en Espa&#241;a&#44; han sido las causas que han conducido a la realizaci&#243;n del an&#225;lisis que se presenta&#46; Su fortaleza reside en evaluar el pron&#243;stico de una amplia muestra de ancianos sometidos&#44; todos&#44; a ventilaci&#243;n mec&#225;nica invasiva&#46; Su limitaci&#243;n&#44; tratarse de un an&#225;lisis retrospectivo y sus consecuencias &#40;falta de seguimiento a largo plazo&#44; falta de evaluaci&#243;n de calidad de vida&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Asumiendo una mayor mortalidad en la poblaci&#243;n anciana ventilada mec&#225;nicamente pero teniendo en cuenta una supervivencia del 52&#44;8&#37; de la que se desconoce seguimiento a largo plazo y calidad de vida&#44; coincidimos con otros<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> en afirmar que en el momento actual la edad en s&#237; misma no debe ser un factor por el que se deba limitar el ingreso en la UCI y la indicaci&#243;n de soporte ventilatorio invasivo&#46; Su consecuencia&#44; teniendo en cuenta los cambios demogr&#225;ficos calculados por el Instituto Nacional de Estad&#237;stica<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44; agudiza el conflicto de la distribuci&#243;n de los recursos&#46; El como distribuir unos recursos caros y limitados entre una poblaci&#243;n cada vez m&#225;s envejecida y con una progresiva necesidad de consumo de los mismos agrava un problema econ&#243;mico y &#233;tico b&#225;sico que deber&#237;a ser cuidadosamente analizado y previsto por los responsables de salud&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; nuestros resultados muestran una mayor mortalidad en UCI y hospitalaria en los pacientes ancianos&#46; La falta de seguimiento no nos permite establecer conclusiones en cuanto a mortalidad a largo plazo y calidad de vida&#46; Debido a las previsiones en cuanto al cambio de la pir&#225;mide poblacional se necesita la puesta en marcha de estudios bien dise&#241;ados en los que se eval&#250;e la tendencia de ingresos&#44; supervivencia y calidad de vida al alta hospitalaria de esta poblaci&#243;n de cara a dar respuesta a la previsible demanda de recursos en las UCI en pr&#243;ximos a&#241;os&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Pron&#243;stico"
            1 => "Ventilaci&#243;n mec&#225;nica"
            2 => "Ancianos"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec78563"
          "palabras" => array:3 [
            0 => "Prognosis"
            1 => "Mechanical ventilation"
            2 => "Elderly"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar el pron&#243;stico de los pacientes ancianos ventilados mec&#225;nicamente en la Unidad de Cuidados Intensivos &#40;UCI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o y &#225;mbito</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario de un estudio observacional prospectivo y multic&#233;ntrico llevado a cabo durante un periodo de 2 a&#241;os en 13 UCI espa&#241;olas&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pacientes adultos que precisaron ventilaci&#243;n mec&#225;nica &#40;VM&#41; invasiva durante m&#225;s de 24 horas&#46;</p> <span class="elsevierStyleSectionTitle">Intervenciones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p> <span class="elsevierStyleSectionTitle">Variables de inter&#233;s</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos&#44; APACHE II&#44; SOFA&#44; motivo de VM&#44; comorbilidad&#44; situaci&#243;n funcional&#44; reintubaci&#243;n&#44; duraci&#243;n de la VM&#44; traqueotom&#237;a&#44; mortalidad en la UCI&#44; mortalidad hospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 1&#46;661 pacientes&#46; De ellos 1&#46;127 &#40;67&#44;9&#37;&#41; eran hombres&#46; Edad&#58; 62&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;2 a&#241;os&#46; APACHE II&#58; 20&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;5&#46; SOFA total&#58; 8&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#46; Cuatrocientos veintitr&#233;s pacientes &#40;25&#44;4&#37;&#41; ten&#237;an 75 a&#241;os o m&#225;s&#46; Los &#237;ndices de comorbilidad y capacidad funcional fueron peor en este grupo de pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para ambas variables&#41;&#46; La mortalidad en la UCI fue superior en este grupo &#40;33&#44;6&#37;&#41; que en los m&#225;s j&#243;venes &#40;25&#44;9&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; al igual que la mortalidad hospitalaria &#40;41&#44;8 vs 31&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; No hubo diferencias en cuanto a tiempo de VM&#44; incidencia de traqueotom&#237;as o &#237;ndice de reintubaciones&#46; Por causas de VM solo los pacientes &#8805; 75 a&#241;os ventilados por neumon&#237;a&#44; sepsis o trauma presentaron una mortalidad en UCI m&#225;s alta que los menores de esa edad &#40;46&#44;3 vs 33&#44;1&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#59; 55 vs 25&#44;8&#37; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#59; 63&#44;6 vs 4&#44;5&#37; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 respectivamente&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los ancianos &#40;&#8805; 75 a&#241;os&#41; tienen una mayor mortalidad en UCI y hospitalaria que los m&#225;s j&#243;venes sin diferencias en la duraci&#243;n de la VM&#46; Las diferencias son a expensas de patolog&#237;as como neumon&#237;a&#44; sepsis y trauma&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To analyze the prognosis of mechanically ventilated elderly patients in the Intensive Care Unit &#40;ICU&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Design and scope</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sub-analysis of a prospective multicenter observational cohort study conducted over a period of two years in 13 medical-surgical ICUs in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Adult patients who required mechanical ventilation &#40;MV&#41; for longer than 24<span class="elsevierStyleHsp" style=""></span>hours&#46;</p> <span class="elsevierStyleSectionTitle">Interventions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p> <span class="elsevierStyleSectionTitle">Study variables</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic data&#44; APACHE II&#44; SOFA&#44; reason for MV&#44; comorbidity&#44; functional condition&#44; reintubation&#44; duration of MV&#44; tracheotomy&#44; ICU mortality&#44; in-hospital mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 1661 patients were recruited&#46; Males accounted for 67&#46;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1127&#41;&#44; with a mean age of 62&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;2 years&#46; APACHE II&#58; 20&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;5&#46; Total SOFA&#58; 8&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#46; Four hundred and twenty-three patients &#40;25&#46;4&#37;&#41; were &#8805; 75 years of age&#46; Comorbidity and functional condition rates were poorer in these patients &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 for both variables&#41;&#46; Mortality in the ICU was higher in the elderly patients &#40;33&#46;6&#37;&#41; than in the younger subjects &#40;25&#46;9&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; Also&#44; in-hospital mortality was higher in those &#8805; 75 years of age&#46; No differences in duration of MV&#44; prevalence of tracheostomy or reintubation incidence were found&#46; Regarding the indication for MV&#44; only the patient &#8805; 75 years of age with pneumonia&#44; sepsis or trauma had a higher in-ICU mortality than the younger patients &#40;46&#46;3&#37; vs 33&#46;1&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#59; 55&#37; vs 25&#46;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#59; 63&#46;6&#37; vs 4&#46;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; respectively&#41;&#46; No differences were found referred to other reasons for MV&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Older patients &#40;&#8805; 75 years&#41; have significantly higher in-ICU and in-hospital mortality than younger patients without differences in the duration of mechanical ventilation&#46; Differences in mortality were at the expense of pneumonia&#44; sepsis and trauma&#46;</p>"
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de los pacientes por edad&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" 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"><span class="elsevierStyleItalic">1 &#46;Insuficiencia respiratoria aguda&#58;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#46;a&#46; Postoperatoria&#58; pacientes que precisaron ventilaci&#243;n mec&#225;nica tras intervenci&#243;n quir&#250;rgica debido a la gravedad de la patolog&#237;a de base&#44; edad o elevado riesgo del procedimiento quir&#250;rgico&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;b&#46; Neumonia&#58; definida como el desarrollo de un nuevo infiltrado alveolar o empeoramiento de infiltrado alveolar previo acompa&#241;ado de fiebre&#47;hipotermia y leucocitosis&#47;leucopenia&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;c&#46; Insuficiencia cardiaca&#58; pacientes con disnea&#44; infiltrado alveolar bilateral&#44; hipoxemia&#44; y evidencia de patolog&#237;a cardiaca o pacientes con shock cardiog&#233;nico&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"><span class="elsevierStyleHsp" style=""></span>1&#46;d&#46; Lesi&#243;n pulmonar aguda&#47;s&#237;ndrome de distr&#233;s respiratorio agudo &#40;LPA&#47;SDRA&#41;&#58; seg&#250;n los criterios de la American-European consensus conference<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;e&#46; Sepsis&#58; seg&#250;n los criterios del American College of Chest Physicians Society of Critical Care Medicine consensus conference<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;f&#46; Trauma&#58; ventilaci&#243;n mec&#225;nica debida a politraumatismo&#46;&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"><span class="elsevierStyleHsp" style=""></span>1&#46;g&#46; Parada cardiaca&#58; ventilation mec&#225;nica debida al cese s&#250;bito e inesperado de las funciones cardiorrespiratorias&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">2&#46; Coma</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que necesitaron ventilaci&#243;n mec&#225;nica por p&#233;rdida de conciencia de origen org&#225;nico &#40;ictus -isqu&#233;mico o hemorr&#225;gico-&#44; meningoencefalitis&#44; traumatismo craneoencef&#225;lico&#41;&#44; metab&#243;lico o por intoxicaci&#243;n&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">3&#46; Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica&#58;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes que requirieron ventilaci&#243;n mec&#225;nica por agudizaci&#243;n de una enfermedad respiratoria cr&#243;nica de base &#40;enfermedad pulmonar obstructiva cr&#243;nica agudizada&#44; asma&#44; otras enfermedades respiratorias cr&#243;nicas -no-EPOC-&#41;&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">4&#46; Enfermedad neuromuscular&#58;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pacientes cuya disfunci&#243;n respiratoria fue debida a alteraciones del sistema nervioso perif&#233;rico o muscular&#46;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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&#46; Otras&#46;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ventilaci&#243;n mec&#225;nica debida a otras causas no incluidas en ninguno de los apartados anteriores&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara">Bernard GR&#44; Artigas A&#44; Brigham KL&#44; Carlet J&#44; Falke K&#44; Hudson L&#44; Lamy M&#44; Legall JR&#44; Morris A&#44; Spragg R&#46; The American-European Consensus Conference on ARDS&#46; Am J Respir Crit Care Med&#46; 1994&#59;149&#58;818-24&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara">Bone RC&#44; Balk RA&#44; Cerra FB&#44; Dellinger RP&#44; Fein AM&#44; Knaus WA&#44; Schein RM&#44; Sibbald WJ&#46; Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis&#46; The ACCP&#47;SCCM Consensus Conference Committee&#46; American College of Chest Physicians&#47;Society of Critical Care Medicine&#46; Chest 1992&#59;101&#58;1644-55&#46;</p>"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Motivos de ventilaci&#243;n mec&#225;nica</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" 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">Edad &#8805; 75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>423&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;238&#41; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-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">N &#40;&#37;&#41; pacientes ventilados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Insuficiencia respiratoria Aguda</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">1&#46;144 &#40;68&#44;8&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">107 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">219 &#40;17&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">326 &#40;19&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;12&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">224 &#40;13&#44;4&#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"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;8&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">118 &#40;7&#44;1&#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"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;6&#44;4&#41;&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"><span class="elsevierStyleHsp" style=""></span>LPA&#47;SDRA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;6&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">144 &#40;8&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Trauma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;4&#44;7&#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"><span class="elsevierStyleHsp" style=""></span>Parada cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">114 &#40;9&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">148 &#40;8&#44;9&#41;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleItalic">Coma</span>&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
                  \t\t\t\t</td><td class="td" title="\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
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">294 &#40;17&#44;6&#41;</span>&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"><span class="elsevierStyleHsp" style=""></span>Metab&#243;lico&#47;Intoxicaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">86 &#40;5&#44;1&#41;&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"><span class="elsevierStyleHsp" style=""></span>Ictus&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">21 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101 &#40;8&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122 &#40;7&#44;3&#41;&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"><span class="elsevierStyleHsp" style=""></span>Meningoencefalitis&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">3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;1&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>TCE&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">6 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;3&#44;5&#41;&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"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica</span>&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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">129 &#40;7&#44;7&#41;</span>&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"><span class="elsevierStyleHsp" style=""></span>EPOC&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 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">111 &#40;6&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Asma&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">1 &#40;0&#44;2&#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">11 &#40;0&#44;8&#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">12 &#40;0&#44;7&#41;&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"><span class="elsevierStyleHsp" style=""></span>Enfermedad respiratoria cr&#243;nica &#40;no-EPOC&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 &#40;0&#44;9&#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" style="border-bottom: 2px solid black">Edad &#8805; 75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>423&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75 a&#241;os &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;238&#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">Indice de Charlson&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60;0&#44;0001&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">Tiempo en 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
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                  \t\t\t\t">8 &#40;2-165&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintubaci&#243;n &#40;&#8804;48 horas&#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</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">105 &#40;8&#44;5&#37;&#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</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">Reintubaci&#243;n &#40;&#62;48 horas&#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;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;4&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;4&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">Traqueotom&#237;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">103 &#40;24&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">343 &#40;27&#44;7&#37;&#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">0&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exitus en UCI&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">142 &#40;33&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">321 &#40;25&#44;9&#37;&#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</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">Exitus hospital&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">394 &#40;31&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Edad &#8805; 75 a&#241;os Exitus&#47;total &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postoperatoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neumon&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#47;67 &#40;46&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#47;157 &#40;33&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;006&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"><span class="elsevierStyleHsp" style=""></span>Insuficiencia cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LPA&#47;SDRA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#47;27 &#40;40&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#47;117 &#40;42&#44;7&#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">0&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trauma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;11 &#40;63&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;67 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#44;001&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"><span class="elsevierStyleHsp" style=""></span>Parada cardiaca&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;34 &#40;35&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#47;114 &#40;37&#44;7&#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\ttop\n
                  \t\t\t\t">0&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coma</span>&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"><span class="elsevierStyleBold">12&#47;41 &#40;29&#44;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">56&#47;253 &#40;22&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;31</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metab&#243;lico&#47;Intoxicaci&#243;n&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">0&#47;11 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;75 &#40;10&#44;7&#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\ttop\n
                  \t\t\t\t">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
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ictus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#47;21 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;32&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"><span class="elsevierStyleHsp" style=""></span>Meningoencefalitis&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">0&#47;3 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;25 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;7&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TCE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;52 &#40;28&#44;8&#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">0&#44;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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"><span class="elsevierStyleItalic">Agudizaci&#243;n de enfermedad respiratoria cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">4&#47;33 &#40;12&#44;1&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">15&#47;96 &#40;15&#44;6&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;5</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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Información del artículo
ISSN: 02105691
Idioma original: Español
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