se ha leído el artículo
array:22 [ "pii" => "S0210569116302388" "issn" => "02105691" "doi" => "10.1016/j.medin.2016.11.001" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "989" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Intensiva. 2017;41:1-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2862 "formatos" => array:3 [ "EPUB" => 166 "HTML" => 1824 "PDF" => 872 ] ] "itemSiguiente" => array:18 [ "pii" => "S0210569116301486" "issn" => "02105691" "doi" => "10.1016/j.medin.2016.07.003" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "958" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2017;41:3-11" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2724 "formatos" => array:3 [ "EPUB" => 167 "HTML" => 1750 "PDF" => 807 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "11" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto de una intervención educacional múltiple incluyendo juegos interactivos para la mejora del manejo de la candidiasis invasiva en pacientes críticos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Ferrer, R. Zaragoza, P. Llinares, E. Maseda, A. Rodríguez, G. Quindós" "autores" => array:7 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Ferrer" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Zaragoza" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Llinares" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Maseda" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Rodríguez" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Quindós" ] 6 => array:1 [ "colaborador" => "for the EPICO Project Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116301486?idApp=WMIE" "url" => "/02105691/0000004100000001/v3_201702170036/S0210569116301486/v3_201702170036/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Has the Surviving Sepsis Campaign been successful in Spain?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Á. Castellanos-Ortega, B. Suberviola" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Á." "apellidos" => "Castellanos-Ortega" "email" => array:1 [ 0 => "castellanos_alv@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Suberviola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Ha tenido éxito la campaña sobrevivir a la sepsis en España?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although overall mortality related to sepsis has been increasing due to the increased incidence of sepsis, the case-fatality rate has been decreasing over a similar period of time.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> During the last 20 years there has not been any scientific breakthrough in the sepsis field, thus, many of the recent improvements might be due to the performance improving program “Surviving Sepsis Campaign” (SSC).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The initial aims of the SSC, which arose from the Declaration of Barcelona in October 2002, were to raise public and professional awareness of sepsis and its treatment, and the development of practice guidelines. In partnership with the Institute of Healthcare Improvement, key elements of the first edition guidelines published in 2004 were identified and organized in short treatment protocols called “bundles”. A recent update was published in 2013 with removal of the 24-hour bundle and changes in recommendations for fluids and vasopressor administration based on recent scientific evidence.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Spain, a wide national educational program based on the SSC guidelines (Edusepsis study) was launched in 2006. It was associated with improved guideline compliance and lower hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In 2011 a second education program was launched to promote the early use of antibiotics (ABISS-Edusepsis study).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this issue of Medicina Intensiva Sánchez and colleagues<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> analyze the evolution of sepsis-related mortality in Spain by comparing two cohorts of patients with severe sepsis or septic shock treated in 41 Spanish ICUs during two time periods: the first group (630 patients with data collected between November–December 2005) was the pre-intervention group in the Edusepsis study, and the second group (718 patients with data collected between April–June 2011) was the pre-intervention group in the ABISS-Edusepsis study. In addition, they examined the association between compliance with the bundles and in-hospital mortality in both cohorts. Compliance with resuscitation bundle was significantly higher in the 2011 group (5.7% vs. 9.9%) and was associated to lower risk of mortality [OR 0.60 (0.36–0.99)]. The 2011 group had lower in-hospital mortality (44.0% vs. 32.6%). They conclude that the observed reduction in the in-hospital mortality rate “is attributable to improvements in early sepsis care including a higher compliance with resuscitation bundle”.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The major methodological weakness of this study is the lack of a control group. Even though various logistic regression models were developed using the baseline risk factors available to the investigators, comparing mortality rates before and after an intervention ignores the underlying secular trend and may lead to misleading conclusions.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Furthermore, baseline patients’ characteristics were different regarding location before ICU admission and the source of infection. A time series analysis would have been helpful to determine whether the rate of change of mortality changed significantly once the campaign was introduced. A cluster randomized trial including hospitals with and without an SSC program would provide better scientific evidence.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several questions arise from the findings of this study: First, the reduction in mortality was seen with modest improvements in bundle compliance, which could suggest that either the interventions included are powerful elements in decreasing mortality or other factors like earlier patient identification, better coordination among departments, or other institutional cultural changes could have accounted for the mortality benefit. Nevertheless, the bundle implementation process itself could also explain in part that discrepancy. “Bundles” were described as “a group of interventions that, when executed together, result in better outcomes than when implemented individually”. In one single-center quasi-experimental study with a resuscitation bundle compliance of 11%, the accomplishment of more than four out of seven interventions of the bundle was associated with a significant reduced risk of mortality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The mortality has been also found to be lower even if completion of the bundle was achieved a little beyond the specific time limits. All these findings suggest that it might not be strictly necessary to complete all the tasks to obtain benefits. Second, ¿how long did the participant ICUs maintain the SSC program? A first observational analysis of the international SSC database showed that the longer a hospital continued the SSC program, the better its compliance with the bundles, and the lower observed in-hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The implementation of a national sepsis program in the Netherlands during 3.5 years decreased mortality in both sepsis and non-sepsis patients but only in participating hospitals.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Finally, the 2011 study group showed statiscally significant improvements in compliance with the elements of the Early goal-directed therapy (EGDT). Recent trials addressed to validate the EGDT strategy in the emergency department showed no differences in comparison with less invasive hemodynamic resuscitation protocols, what raises questions about whether the original study was flawed. However, recent comprehensive analysis suggest the low mortality reported in the studies ProCESS, ARISE, and ProMISe might reflect not only patient selection but also improvements in care during the last decade.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite the observed decrease in mortality there is still a room for improvement. The main challenge remains early recognition and rapid response to patients with sepsis. Screening for sepsis in the emergency department and hospital wards is essential. Integration of clinical assessment, laboratory and microbiological results using clinical informatics will provide rapid diagnostic and prognostic information. Biomarkers such as procalcitonin and advanced PCR/electrospray ionization mass spectrometry are helpful for early invasive bacterial infection detection and prompt pathogens identification respectively. In addition, strategies to reduce ICU delayed transfer such as the setting-up of Rapid Response Systems (RRS) supported by automated alert systems should be considered. According to recent research the National New Early Warning Score which is widely used by RRSs is more accurate than the qSOFA score for predicting death and ICU transfer in non-ICU patients with suspected infection.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The results of this study should encourage efforts to implement the SSC revised protocols as a means to improve outcomes, even if the mechanisms of how change occurred are still unclear. It makes sense to continue with the quality improvement strategy based on multifaceted intervention, powerful educational program, recruitment of multidisciplinary leaders, and a database allowing for audit and feedback.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0045" class="elsevierStylePara elsevierViewall">Both authors declare that they have not received funding for the editorial article that we refer to.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">Both authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financing" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and recent trends of severe sepsis in Spain: a nationwide population-based analysis (2006–2011)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Bouza" 1 => "T. López-Cuadrado" 2 => "Z. Saz-Parkinson" 3 => "J.M. Amate-Blanco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12879-014-0717-7" "Revista" => array:5 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2014" "volumen" => "14" "paginaInicial" => "3863" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25528662" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Damiani" 1 => "A. Donati" 2 => "G. Serafini" 3 => "L. Rinaldi" 4 => "E. Adrario" 5 => "P. Pelaia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal. pone.0125827" "Revista" => array:5 [ "tituloSerie" => "PLOS ONE" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "e0125827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25946168" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the Edusepsis Study Group" "etal" => true "autores" => array:6 [ 0 => "R. Ferrer" 1 => "A. Artigas" 2 => "M.M. Levy" 3 => "J. Blanco" 4 => "G. González-Díaz" 5 => "J. Garnacho-Montero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.19.2294" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "2294" "paginaFinal" => "2303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18492971" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Declining mortality for severe sepsis and septic shock in Spanish ICUs: a two cohorts study in 2005 and 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Sánchez" 1 => "R. Ferrer" 2 => "D. Suárez" 3 => "E. Romay" 4 => "E. Piacentini" 5 => "G. Gomà" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protocol-based resuscitation bundle to improve outcomes in septic shock patients: evaluation of the Michigan Health and Hospital Association Keystone Sepsis Collaborative" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.P. Thompson" 1 => "M.J. Reeves" 2 => "B.L. Bogan" 3 => "B. DiGiovine" 4 => "P.J. Posa" 5 => "S.R. Watson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000055402.68581.DC" "Revista" => array:3 [ "tituloSerie" => "Crit Care Med" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12626981" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Castellanos-Ortega" 1 => "B. Suberviola" 2 => "L.A. García-Astudillo" 3 => "M.S. Holanda" 4 => "F. Ortiz" 5 => "J. Llorca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3181d455b6" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "1036" "paginaFinal" => "1043" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20154597" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Levy" 1 => "R.P. Dellinger" 2 => "S.R. Townsend" 3 => "W.T. Linde-Zwirble" 4 => "J.C. Marshall" 5 => "J. Bion" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-009-1738-3" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "222" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20069275" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guideline bundles adherence and mortality in severe sepsis and septic shock" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Netherlands Patient Safety Agency Sepsis Expert Group" "etal" => false "autores" => array:6 [ 0 => "A.R. Van Zanten" 1 => "S. Brinkman" 2 => "M.S. Arbous" 3 => "A. Abu-Hanna" 4 => "M.M. Levy" 5 => "N.F. de Keizer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000000297" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2014" "volumen" => "42" "paginaInicial" => "1890" "paginaFinal" => "1898" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24670937" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early goal-directed therapy: do we have a definitive answer?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. De Backer" 1 => "J.L. Vincent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4295-6" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "1048" "paginaFinal" => "1050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26951428" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "qSOFA, SIRS, and early warning scores for detecting clinical deterioration in infected patients outside the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Churpek" 1 => "A. Snyder" 2 => "X. Han" 3 => "S. Sokol" 4 => "N. Pettit" 5 => "M.D. Howell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200904-0493OC" "Revista" => array:3 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19797159" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/02105691/0000004100000001/v3_201702170036/S0210569116302388/v3_201702170036/en/main.assets" "Apartado" => array:4 [ "identificador" => "18742" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004100000001/v3_201702170036/S0210569116302388/v3_201702170036/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569116302388?idApp=WMIE" ]
año/Mes | Html | Total | |
---|---|---|---|
2024 Noviembre | 10 | 13 | 23 |
2024 Octubre | 86 | 52 | 138 |
2024 Septiembre | 75 | 33 | 108 |
2024 Agosto | 83 | 43 | 126 |
2024 Julio | 54 | 31 | 85 |
2024 Junio | 67 | 71 | 138 |
2024 Mayo | 57 | 24 | 81 |
2024 Abril | 67 | 47 | 114 |
2024 Marzo | 53 | 30 | 83 |
2024 Febrero | 54 | 47 | 101 |
2024 Enero | 31 | 27 | 58 |
2023 Diciembre | 33 | 27 | 60 |
2023 Noviembre | 35 | 37 | 72 |
2023 Octubre | 38 | 32 | 70 |
2023 Septiembre | 35 | 34 | 69 |
2023 Agosto | 32 | 19 | 51 |
2023 Julio | 86 | 27 | 113 |
2023 Junio | 31 | 17 | 48 |
2023 Mayo | 34 | 33 | 67 |
2023 Abril | 31 | 24 | 55 |
2023 Marzo | 57 | 35 | 92 |
2023 Febrero | 63 | 30 | 93 |
2023 Enero | 69 | 19 | 88 |
2022 Diciembre | 60 | 29 | 89 |
2022 Noviembre | 49 | 32 | 81 |
2022 Octubre | 88 | 42 | 130 |
2022 Septiembre | 40 | 36 | 76 |
2022 Agosto | 58 | 49 | 107 |
2022 Julio | 59 | 38 | 97 |
2022 Junio | 94 | 34 | 128 |
2022 Mayo | 52 | 39 | 91 |
2022 Abril | 67 | 43 | 110 |
2022 Marzo | 67 | 42 | 109 |
2022 Febrero | 32 | 30 | 62 |
2022 Enero | 53 | 45 | 98 |
2021 Diciembre | 44 | 46 | 90 |
2021 Noviembre | 64 | 50 | 114 |
2021 Octubre | 92 | 92 | 184 |
2021 Septiembre | 46 | 34 | 80 |
2021 Agosto | 39 | 64 | 103 |
2021 Julio | 27 | 43 | 70 |
2021 Junio | 55 | 49 | 104 |
2021 Mayo | 49 | 73 | 122 |
2021 Abril | 155 | 113 | 268 |
2021 Marzo | 87 | 38 | 125 |
2021 Febrero | 74 | 38 | 112 |
2021 Enero | 81 | 41 | 122 |
2020 Diciembre | 73 | 34 | 107 |
2020 Noviembre | 71 | 40 | 111 |
2020 Octubre | 60 | 30 | 90 |
2020 Septiembre | 48 | 30 | 78 |
2020 Agosto | 35 | 23 | 58 |
2020 Julio | 45 | 33 | 78 |
2020 Junio | 35 | 17 | 52 |
2020 Mayo | 26 | 14 | 40 |
2020 Abril | 61 | 23 | 84 |
2020 Marzo | 43 | 17 | 60 |
2020 Febrero | 167 | 56 | 223 |
2020 Enero | 49 | 36 | 85 |
2019 Diciembre | 34 | 30 | 64 |
2019 Noviembre | 52 | 37 | 89 |
2019 Octubre | 67 | 28 | 95 |
2019 Septiembre | 53 | 23 | 76 |
2019 Agosto | 42 | 24 | 66 |
2019 Julio | 42 | 19 | 61 |
2019 Junio | 36 | 19 | 55 |
2019 Mayo | 51 | 33 | 84 |
2019 Abril | 26 | 22 | 48 |
2019 Marzo | 39 | 35 | 74 |
2019 Febrero | 28 | 29 | 57 |
2019 Enero | 34 | 36 | 70 |
2018 Diciembre | 77 | 47 | 124 |
2018 Noviembre | 118 | 57 | 175 |
2018 Octubre | 86 | 22 | 108 |
2018 Septiembre | 31 | 10 | 41 |
2018 Agosto | 34 | 15 | 49 |
2018 Julio | 43 | 13 | 56 |
2018 Junio | 54 | 18 | 72 |
2018 Mayo | 41 | 9 | 50 |
2018 Abril | 55 | 12 | 67 |
2018 Marzo | 57 | 11 | 68 |
2018 Febrero | 71 | 6 | 77 |
2018 Enero | 49 | 27 | 76 |
2017 Diciembre | 41 | 12 | 53 |
2017 Noviembre | 35 | 15 | 50 |
2017 Octubre | 34 | 11 | 45 |
2017 Septiembre | 42 | 14 | 56 |
2017 Agosto | 32 | 24 | 56 |
2017 Julio | 31 | 21 | 52 |
2017 Junio | 41 | 33 | 74 |
2017 Mayo | 62 | 36 | 98 |
2017 Abril | 54 | 7 | 61 |
2017 Marzo | 4 | 11 | 15 |
2017 Febrero | 34 | 35 | 69 |
2017 Enero | 3 | 11 | 14 |
2016 Diciembre | 0 | 1 | 1 |