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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Although mechanical ventilation is potentially lifesaving in patients with acute respiratory distress syndrome &#40;ARDS&#41;&#44; it may cause ventilator-associated lung injury&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a> In 2000 the ARDSNetwork study demonstrated that ventilation with low tidal volume &#40;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#41; and positive end expiratory pressure &#40;PEEP&#41; application may reduce ARDS mortality near 9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a> So&#44; protective mechanical ventilation with lower tidal volume &#40;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#41; and PEEP application was generalized&#46; Nonetheless&#44; the mortality of ARDS still remains high&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Ventilation with PEEP is essential for patients with ARDS&#44; as it was early observed that PEEP greatly improves oxygenation in ARDS&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a> but also it may induce lung injury&#46; High PEEP levels may open collapsed alveoli and decrease intrapulmonary shunt and avoid repetitive alveolar opening and closing during the respiratory cycle&#44; but also may induce overdistension promoting lung injury&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#44;7</span></a> Several methods have been proposed to set the level of PEEP&#44; although the preferred method is still controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Previously&#44; we conducted an open&#44; randomized controlled pilot study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> to test the hypothesis that individualized PEEP set based on highest compliance would improve oxygenation&#44; compared to setting PEEP based on FiO<span class="elsevierStyleInf">2</span> &#40;fraction of inspired oxygen&#41; according to ARDSNetwork study&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a> We found that&#44; although there were not differences on oxygenation&#44; patients with ARDS ventilated with PEEP determined according their highest compliance had a strong trend toward lower mortality at day 28 and a significant increase in organ-dysfunction-free days at 28 days&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">This current study is a post hoc analysis of our earlier study&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> We stratified patients with ARDS according to the last Berlin definition&#44; evaluating the mortality at day 28 and at day 90 as primary end-points&#44; and some important outcomes as secondary end-points &#40;oxygenation&#44; respiratory parameters&#44; presence and length of multiple organ failure&#44; length of mechanical ventilation&#41; following the new Berlin definition of ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">9&#44;10</span></a> We hypothesized that patients who received an individualized PEEP setting based on highest compliance would improve their outcomes according to severity of ARDS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Although previously reported&#44; our original study which this current unplanned post hoc analysis is based on was an open&#44; randomized controlled pilot study to test the hypothesis that individualized PEEP set based on highest compliance would improve oxygenation&#44; compared to setting PEEP based on FiO<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">It was conducted in a 14-bed medical-surgical intensive care unit &#40;ICU&#41; in Spain during 60 months &#40;2002&#8211;2007&#41;&#44; after being approved by our institution&#39;s Ethics and Clinical Trials Committee &#40;protocol number&#58; 18&#47;2006&#41; and registered on clinicaltrials&#46;gov with the number&#58; <a href="ctgov:NCT01119872">NCT01119872</a>&#46; Written informed consent was required for inclusion and obtained from the nearest relatives of the patient&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We included all patients with ARDS who meet criteria for ARDS according to the American-European Consensus Conference definition<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a> before and after 24<span class="elsevierStyleHsp" style=""></span>h under mechanical ventilation&#44; ventilated with low <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> &#40;6&#8211;8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg predicted body weight &#40;PBW&#41;&#41;&#44; an inspiratory plateau pressure below 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#44; initial respiratory rate of 30<span class="elsevierStyleHsp" style=""></span>breaths&#47;min adjusted to maintain a pH between 7&#46;30 and 7&#46;45 and limited to a maximum of 35<span class="elsevierStyleHsp" style=""></span>breaths&#47;min&#44; FiO<span class="elsevierStyleInf">2</span> ensuring arterial oxygen saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41; 88&#8211;95&#37; or arterial partial oxygen pressure &#40;PaO<span class="elsevierStyleInf">2</span>&#41; of 55&#8211;80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; and a PEEP level adjusted to achieve the best oxygenation with the lowest FiO<span class="elsevierStyleInf">2</span> without adverse hemodynamic effects&#46; If the plateau pressure was greater than 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O with <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 6<span class="elsevierStyleHsp" style=""></span>ml&#47;kg PBW&#44; a stepwise reduction of <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> of 1<span class="elsevierStyleHsp" style=""></span>ml&#47;kg PBW to 5 and 4<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;PBW was allowed&#46; If this was the case&#44; the plateau pressure limit was set at 35<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were excluded if they declined enrolment &#40;refusal of nearest relatives of patient to sign the informed consent&#41;&#44; younger than 18 years&#44; pregnant&#44; or had neuromuscular disease&#44; intracranial hypertension&#44; head trauma&#44; left ventricular dysfunction &#40;on echocardiography&#41;&#44; patients under mechanical ventilation more than 72<span class="elsevierStyleHsp" style=""></span>h&#44; had barotrauma or developed it during the first 24<span class="elsevierStyleHsp" style=""></span>h of meeting ARDS inclusion criteria &#40;defined as the presence of air outside the tracheobronchial tree&#44; resulting from presumed alveolar rupture&#44; and manifested as interstitial emphysema&#44; pneumothorax&#44; pneumomediastinum&#44; pneumoperitoneum&#44; or subcutaneous emphysema<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a>&#41;&#44; and patients with end-stage conditions &#40;death expected within 90 days&#41; were excluded&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After 24<span class="elsevierStyleHsp" style=""></span>h of inclusion&#44; patients were randomized into two groups according to PEEP determination method&#58; FiO<span class="elsevierStyleInf">2</span>-guided PEEP &#40;control group&#41; or compliance-guided PEEP&#46; Randomization was performed in blocks of 10 using sealed envelopes&#46; In the control group&#44; PEEP was set based on the subject&#39;s FiO<span class="elsevierStyleInf">2</span>&#44; as applied in the ARDSNetwork study&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a> while in the compliance-guided group&#44; PEEP was set daily&#44; according to the best compliance measured by the method described by Suter et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a> Static compliance &#40;Cst&#41; was measured at increasing levels of PEEP&#46; Cst was calculated dividing <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> by the pressure difference at end of inflation hold &#40;2<span class="elsevierStyleHsp" style=""></span>s&#41; and PEEP was increased at steps of 2 cmH<span class="elsevierStyleInf">2</span>O beginning at 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#44; without an upper PEEP titration limit&#46; The highest Cst was considered to be the best PEEP&#46; If at two different PEEP levels Cst was identical&#44; we chose the one with the lower plateau pressure&#46; Driving pressure was calculated as the plateau pressure minus PEEP&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">To set PEEP level&#44; all subjects received sedatives and opioids at the time of PEEP setting &#40;neuromuscular blocking agents only if they required it for low <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> ventilation&#44; although not for the measurement of intrinsic PEEP or plateau pressure&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Except for the way of setting PEEP&#44; all other ventilator parameters and weaning protocol followed the same rules in both study groups&#46; Weaning was begun if the cause of respiratory failure had resolved&#44; PaO<span class="elsevierStyleInf">2</span> was higher than 60<span class="elsevierStyleHsp" style=""></span>mmHg with a FiO<span class="elsevierStyleInf">2</span> at 0&#46;4 or less and PEEP level below 6<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#46; In patients in the compliance-guided group&#44; PEEP level was lowered stepwise by 2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#46; In the control group the protocol described in the ARDSNet study was applied&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Routine care &#40;sedation&#44; analgesia&#41; or special requirements &#40;hemodynamic support&#44; antibiotics&#44; etc&#46;&#41; other than mechanical ventilation were guided according to our local protocols followed by the attending physicians not involved in the study&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">We collected data from each patient about sex&#44; age&#44; risk factors for ARDS&#44; routine laboratory measurements&#44; Acute Physiology and Chronic Health Evaluation II score &#40;APACHE II&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a> daily Lung Injury Score &#40;LIS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">16</span></a> Sepsis-Related Organ Failure Assessment score &#40;SOFA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">17</span></a> multiple organ dysfunction score&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">18</span></a> length of mechanical ventilation&#44; length of ICU and hospital stay&#44; mortality at day 28 and at day 90 after inclusion&#44; pulmonary variables&#44; physiologic measurements&#44; ventilatory variables&#44; cardiovascular variables&#44; adverse events&#44; extra-pulmonary organ failures&#44; sedation&#44; and daily chest X-ray&#46; All variables and data were recorded at study inclusion&#44; at 6<span class="elsevierStyleHsp" style=""></span>h after inclusion&#44; and between 6&#58;00<span class="elsevierStyleHsp" style=""></span>a&#46;m&#46; and 8&#58;00<span class="elsevierStyleHsp" style=""></span>a&#46;m&#46; on days 1&#44; 2&#44; 3&#44; 4&#44; 7&#44; 14&#44; 21&#44; and 28&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In our present study&#44; we retrospectively examined mortality at 28 and at 90 days in subgroups of patients with moderate or severe ARDS according to the last Berlin definition of ARDS<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> &#40;there were no patients with mild ARDS included in the study&#41;&#44; defined by the worse oxygenation data &#40;measured as PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; at baseline and&#47;or in the 24-h period immediately after randomization&#46; The last Berlin definition divided the severity of ARDS into three groups according to the degree of hypoxemia &#40;measured as PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41;&#58; &#40;a&#41; mild&#58; 200<span class="elsevierStyleHsp" style=""></span>mmHg<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mmHg&#44; &#40;b&#41; moderate&#58; 100<span class="elsevierStyleHsp" style=""></span>mmHg<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>mmHg&#44; and &#40;c&#41; severe&#58; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> We also examined oxygenation improvement&#44; ventilator-free days at day 28 and at day 90&#44; ICU and hospital stay&#44; multiple organ dysfunction &#40;MOD&#41; free days at 28 day and at day 90&#44; respiratory and hemodynamic parameters&#46; Organ failure is defined as a SOFA score<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">17</span></a> greater than 2 and MOD requires 2 or more organ failures&#46; Organ dysfunction-free days were defined as days alive and free of any organ dysfunction&#44;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">19&#44;20</span></a> and ventilator &#8211; free days as days of unassisted breathing&#44; both calculated at 28 days &#40;all deaths occurring prior to day 28 were considered as zero organ dysfunction-free or ventilator-free days&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">For the statistical analysis&#44; we used statistics software &#40;SPSS 15&#46;0&#44; SPSS&#44; Chicago&#44; IL&#41;&#46; We first tested normality of data distribution with the Kolmogorov&#8211;Smirnov test&#46; Variables are described as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD in case of quantitative variables with normal distribution&#44; medians and interquartile ranges in case of quantitative variables with non-normal distribution and percentages in case of qualitative variables&#46; They were compared using the Student <span class="elsevierStyleItalic">t</span> test&#44; the Mann&#8211;Whitney test and the chi-square test respectively&#46; Kaplan&#8211;Meier analysis with log-rank test was applied to compare survival at 28 days between groups&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; and results are expressed with their 95&#37; confidence intervals&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">A total of 70 patients were included in the study&#58; 53 patients with moderate ARDS and 17 with severe ARDS&#46; Flow diagram of study is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">At baseline&#44; there were not differences on age&#44; sex&#44; severity of ARDS&#44; severity of illness and causes of ARDS between both groups of study in either severe or moderate ARDS &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Mortality at day 28 was higher in patients with severe ARDS &#40;58&#46;8&#37;&#41; than in those with moderate ARDS&#44; &#40;20&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#59; and also at 90 days &#40;70&#46;6&#37; on severe versus 32&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; We found a trend toward lower mortality on day 28 in compliance-guided group in patients with severe ARDS &#40;33&#46;3&#37; in compliance-guided group versus 72&#46;7&#37; in FiO<span class="elsevierStyleInf">2</span>-guided PEEP group&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;16&#41;&#44; with a lower mortality on day 90 in patients with severe ARDS &#40;33&#46;3&#37; in compliance-guided group versus 90&#46;9&#37; in FiO<span class="elsevierStyleInf">2</span>-guided PEEP group&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; There were no differences on 28-days nor 90-days mortality between both groups of treatment in patients with moderate ARDS &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> also shows other important clinical outcomes according to severity of ARDS&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Concerning respiratory parameters&#44; we found that there was no difference in mean PEEP at study entry between compliance-guided group and FiO<span class="elsevierStyleInf">2</span>-guided PEEP group on moderate and severe ARDS &#40;complete data of respiratory variables during the study are shown in supplementary material&#41;&#46; Among the patients with moderate ARDS&#44; there were no differences on compliance&#44; peak and plateau pressures or oxygenation during the study &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; However&#44; among patients with severe ARDS&#44; there was a trend toward better oxygenation in the compliance-guided group beyond first day of study&#44; without differences in respiratory pressures &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; It is important to remark a strong trend to lower driving pressure between patients included in compliance-guided PEEP adjustment group in both groups of severity of ARDS&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">There were no differences in other respiratory parameters&#44; the presence of auto-PEEP &#40;we did not find any patient with auto-PEEP&#41;&#44; pH and level of hypercapnia&#44; physiologic measurements&#44; cardiovascular measurements&#44; adverse events and development of barotrauma between both groups of study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This unplanned post hoc subgroups analysis found that protective mechanical ventilation with low <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#44; airway pressure limited to 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O and compliance-guided PEEP adjustment&#44; compared to FiO<span class="elsevierStyleInf">2</span>-guided PEEP in patients with severe ARDS&#44; was associated with lower mortality at 90 days&#44; and also&#44; a shorter duration of multiple organ dysfunction at 28 and at 90 days and lower duration of mechanical ventilation at 90 days&#46; However&#44; these benefits are not achieved on moderate ARDS&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The new Berlin definition of ARDS shows that the more severe the ARDS is the higher the mortality and the length of mechanical ventilation are&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> We also found higher mortality rate between patients with severe ARDS&#46; However&#44; Lopez Saubidet et al&#46; observed that there were no differences on hospital and 6 month mortality between patients with moderate or severe ARDS admitted to ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">21</span></a> Some authors<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">10&#44;22</span></a> postulate that the new classification of ARDS may identify subgroups of patients who may benefit from specific adjunctive interventions&#44; as prone position<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> and maybe the way of setting PEEP&#46; In that way&#44; recently&#44; Mansur et al&#46; have reported a benefit on mortality in patients with severe ARDS with statin treatment&#44; benefit that was not shown on mild or moderate ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Unexpectedly&#44; we found higher mortality at 90 days on severe ARDS than expected compared to the Berlin definition and to the level of severity of illness&#44; being this different due to an increased mortality in patients with severe ARDS included on the FiO<span class="elsevierStyleInf">2</span>-guided PEEP group&#46; This might be due to the small number of patients with severe ARDS included in our study&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">An individualized PEEP setting may improve outcomes and oxygenation on ARDS patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">9&#44;20&#44;25&#44;26</span></a> None of these studies have demonstrated a decrease in mortality in the group treated with individualized PEEP&#46; We find that PEEP selection based on best static compliance in patients with severe ARDS seems to improve oxygenation rolling along the evolution of disease&#46; However&#44; we did not find a significant difference in PEEP levels between the two groups of treatment&#46; When we compared the PEEP level that the patients included on compliance-guided PEEP group should have received with the one they should have received according to the FiO<span class="elsevierStyleInf">2</span> applied&#44; we found it was different &#40;higher or lower PEEP levels than those prescribed according to the PEEP&#47;FiO<span class="elsevierStyleInf">2</span> table&#41; in 85&#37; of patients with severe ARDS and 66&#37; of patients with moderate ARDS&#46; Thus&#44; similar mean PEEP values in our opinion do not exclude that&#44; individual compliance-guided settings may be distributed over a wider range of values and be associated with less ventilator-induced lung injury&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Recently&#44; Amato et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">14</span></a> performed a multilevel mediation analysis with nine previous randomized trials on patients with ARDS<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#44;20&#44;25&#44;27&#8211;32</span></a> to examine if the driving pressure &#40;<span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#47;respiratory-system compliance&#41; was an independent variable associated with survival&#46; They found that the increase of driving pressure was directly associated with an increment of mortality at 60 days&#44; even in patients receiving &#8220;protective&#8221; plateau pressures &#40;limited to 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#41; and low <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#46; The survival benefits found in the <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> trials<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#44;27&#8211;30</span></a> were proportional to reductions in driving pressure driven by treatment-group assignment rather than to reductions in <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span>&#59; similarly&#44; the survival benefits observed in the PEEP trials<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">20&#44;25&#44;31&#44;32</span></a> occurred in relation to reductions in driving pressure&#46; This study supports our theory that PEEP effect is beneficial when&#44; applied individually&#44; it improves compliance&#46; Interestingly&#44; we have found that patients randomized to compliance-guided PEEP adjustment group had a strong trend to lower driving pressure mainly at the beginning of the evolution of the disease&#46; This finding was very similar regardless of severity of ARDS&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">We also observed that customizing PEEP to the individual subject was associated with shorter duration of MOD at 28 days on severe ARDS&#44; which correlates with a shorter duration of ICU stay and length of mechanical ventilation&#46; These findings were not shown in the moderate ARDS group&#46; Several studies<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#44;33&#8211;35</span></a> have demonstrated that an array of inflammatory cytokines is released into the systemic circulation as a consequence of high <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> or high PEEP&#44; which correlates with higher morbidity and mortality&#44; and cytokine release might be proportional to the severity of the ARDS&#46; Unfortunately&#44; we did not measure inflammatory cytokines to support the findings on MOD&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">One of our strengths is that we only included patients who full-fillled the ARDS criteria<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a> after 24<span class="elsevierStyleHsp" style=""></span>h of mechanical ventilation&#46; Several studies have demonstrated that after a short period of mechanical ventilation&#44; patients may improve their PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> ratio above 200<span class="elsevierStyleHsp" style=""></span>mmHg and this improvement may be associated with lower mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">36&#8211;38</span></a> Villar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a> demonstrated that there are a marked PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> variability within the first 24<span class="elsevierStyleHsp" style=""></span>h of ARDS diagnosis that may introduce a bias in the assessment of ARDS severity&#46; And to the best of our knowledge&#44; this investigation is the first to evaluate the impact of individualized PEEP on the mortality of patients with ARDS according to the new Berlin definition of ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; It is a retrospective analysis of a previous pilot study<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">9</span></a> designed to determine if an individualized level of PEEP on patients with ARDS improves oxygenation&#44; and carried out in a single center&#59; so&#44; we have a small sample size with a reduced number of patients on each group which limits the possibility of a multivariate analysis of mortality&#46; The study was un-blinded and bias cannot be excluded&#46; Throughout the study there were some difficulties in setting PEEP at best compliance&#58; sometimes several time-consuming attempts were required to find the best PEEP in the compliance group&#44; including the need for muscle relaxants&#44; or the study procedures had to be interrupted to allow for endotracheal suctioning&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study showed that individualized PEEP setting based on the best static compliance in subjects with ARDS treated with low <span class="elsevierStyleItalic">V</span><span class="elsevierStyleInf">T</span> and limited plateau pressure benefit patients with severe ARDS&#44; according to new Berlin definition&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> The results showed a lower mortality at day 90&#44; with a significant increase in organ-dysfunction-free days at 28 and 90 days and a trend toward a lower driving pressure&#44; although oxygenation did not improve&#46; No benefits were found on patients with moderate ARDS&#46; It seems clear that to individualize PEEP level in patients with ARDS according to the severity&#44; may improve the outcomes of these patients&#46; Further studies are necessary to clearly address this question&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financial disclosure</span><p id="par0155" class="elsevierStylePara elsevierViewall">This study nor any of the authors have received some funding for carrying out the same&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">No author has a conflict of interest regarding this study&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To study the effect of setting positive end-expiratory pressure &#40;PEEP&#41; in an individualized manner &#40;based on highest static compliance&#41; compared to setting PEEP according to FiO<span class="elsevierStyleInf">2</span> upon mortality at 28 and 90 days&#44; in patients with different severity acute respiratory distress syndrome &#40;ARDS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Setting</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A Spanish medical&#8211;surgical ICU&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A post hoc analysis of a randomized controlled pilot study&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients with ARDS&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Ventilation with low tidal volumes and pressure limitation at 30<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>H<span class="elsevierStyleInf">2</span>O&#44; randomized in two groups according to the method used to set PEEP&#58; FiO<span class="elsevierStyleInf">2</span>-guided PEEP group according to FiO<span class="elsevierStyleInf">2</span> applied and compliance-guided group according to the highest compliance&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Primary variables of interest</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Demographic data&#44; risk factors and severity of ARDS&#44; APACHE II and SOFA scores&#44; daily Lung Injury Score&#44; ventilatory measurements&#44; ICU and hospital stay&#44; organ failure and mortality at day 28 and 90 after inclusion&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 159 patients with ARDS were evaluated&#44; but just 70 patients were included&#46; Severe ARDS patients showed more organ dysfunction-free days at 28 days &#40;12&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;70 versus 3&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;23&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; and at 90 days &#40;6&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;31 vs&#46; 54&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#46;14&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#41;&#44; and a trend toward lower 90-days mortality &#40;33&#46;3&#37; vs&#46; 90&#46;9&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#44; when PEEP was applied according to the best static compliance&#46; Patients with moderate ARDS did not show these effects&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In patients with severe ARDS&#44; individualized PEEP selection based on the best static compliance was associated to lower mortality at 90 days&#44; with an increase in organ dysfunction-free days at 28 and 90 days&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudiar el efecto de programar la presi&#243;n positiva al final de la espiraci&#243;n &#40;PEEP&#41; de manera individualizada &#40;basada en la mejor complianza est&#225;tica&#41; comparada con la programada seg&#250;n la FiO<span class="elsevierStyleInf">2</span> sobre la mortalidad a 28 y 90 d&#237;as&#44; en pacientes con diferente gravedad de s&#237;ndrome de distr&#233;s respiratorio agudo &#40;SDRA&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">UCI espa&#241;ola m&#233;dico-quir&#250;rgica&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Dise&#241;o</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis <span class="elsevierStyleItalic">post hoc</span> de un estudio piloto controlado y aleatorizado&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pacientes con SDRA&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ventilaci&#243;n con vol&#250;menes tidales bajos y presi&#243;n limitada a 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; divididos en funci&#243;n de la manera de programar la PEEP&#58; seg&#250;n la fracci&#243;n inspirada de ox&#237;geno o la mejor complianza est&#225;tica pulmonar&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s principales</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Datos demogr&#225;ficos&#44; factores de riesgo y gravedad del SDRA&#44; escalas APACHE II y SOFA&#44; Escala de Da&#241;o Pulmonar diaria&#44; par&#225;metros ventilatorios&#44; estancia en UCI y hospitalaria&#44; fracaso org&#225;nico y mortalidad a d&#237;a 28 y 90&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Valoramos 159 pacientes con SDRA&#44; de los que se incluyeron 70&#46; En los pacientes con SDRA grave&#44; observamos un mayor n&#250;mero de d&#237;as sin fracaso multiorg&#225;nico a los 28 &#40;12&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;70 vs&#46; 3&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;23&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; y 90 d&#237;as &#40;6&#44;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;31 vs&#46; 54&#44;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#44;14&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#44; y una menor mortalidad a 90 d&#237;as &#40;33&#44;3&#37; vs&#46; 72&#44;7&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;16&#41;&#44; cuando la PEEP se programaba seg&#250;n la mejor complianza est&#225;tica&#46; No encontramos dichos efectos en el SDRA moderado&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En pacientes con SDRA grave&#44; programar la PEEP seg&#250;n la mejor complianza est&#225;tica se asocia a una menor mortalidad a 90 d&#237;as y a un aumento de los d&#237;as libres de fracaso multiorg&#225;nico a 28 y 90 d&#237;as&#46;</p></span>"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; peak pressure&#44; plateau pressure and driving pressure on moderate ARDS&#46;</p>"
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        "figura" => array:1 [
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; peak pressure&#44; plateau pressure and driving pressure on severe ARDS&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">No&#46;&#44; number of patients&#59; S&#46;D&#46;&#44; standard deviation&#59; APACHE II&#44; Acute Physiology and Chronic Health Evaluation II score&#59; SOFA&#44; sepsis-related organ failure assessment score&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate ARDS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Severe ARDS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FiO<span class="elsevierStyleInf">2</span>-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compliance-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FiO<span class="elsevierStyleInf">2</span>-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compliance-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;68<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male&#44; no&#46; &#40;&#37;&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;80&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;60&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;81&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;50&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE II score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SOFA score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;24<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple Organ Dysfunction Score&#44; median<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung Injury Score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ARDS of pulmonary origin&#44; no&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;68&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;46&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe Chest trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diffuse alveolar haemorrage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cryptogenetic organizing pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Aspiration of gastric contents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ARDS of non-pulmonary origin&#44; no&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;32&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;53&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;36&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute pancreatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple blood transfusions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Drug overdose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatomyositis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Severe nonthoracic trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">No&#46;&#44; number of patients&#59; S&#46;D&#46;&#44; standard deviation&#59; ICU&#44; intensive care unit&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Italic values&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate ARDS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Severe ARDS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FiO<span class="elsevierStyleInf">2</span>-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compliance-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FiO<span class="elsevierStyleInf">2</span>-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compliance-guided PEEP &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">28-day mortality&#44; no&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;24&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;17&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;72&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple-organ-dysfunction-free days at 28 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU-free days at 28 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ventilator-free days at 28 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;71<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">90-day mortality&#44; no&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;28&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;35&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;90&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;02</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Multiple-organ-dysfunction-free days at 90 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&#46;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;03</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU-free days at 90 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;17<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;04</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ventilator-free days at 90 days&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>S&#46;D&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&#46;00<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>34&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;05</span>&nbsp;\t\t\t\t\t\t\n
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