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have been considered in an attempt to avoid mechanical ventilation in SA subjects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the fact that NIV is widely used in asthma subjects admitted in ICU<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#8211;13</span></a> only few randomized controlled studies &#40;RCT&#41; have been published on pediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;13</span></a> Nevertheless&#44; there is a strong physiological basis behind the use of NIV in asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; HFNC has become popular as it is easy to use and very well tolerated&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#8211;17</span></a> Since last decade&#44; HFNC has been introduced in pediatrics as respiratory support&#44; mainly during seasonal bronchiolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> Currently&#44; HFNC has spread to hospital wards&#44; emergency rooms<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#8211;21</span></a> and transport services&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is an ongoing discussion on the indications of high flow nasal cannula therapy or non-invasive ventilation &#40;NIV&#41; in subjects with acute respiratory failure&#46; The clinical advantages of HFNC have not been established yet and there is a lack of published evidence comparing NIV and HFNC during SA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study is to describe our experience with HFNC and NIV in children with SA admitted to the PICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is a retrospective observational study in children with asthma exacerbation admitted to PICU for respiratory support&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Setting</span><p id="par0035" class="elsevierStylePara elsevierViewall">A multidisciplinary Pediatric Intensive Care Unit &#40;PICU&#41; from a tertiary university hospital with 12 beds and 600 admissions per year&#46; Our hospital covers a population of 200&#44;000 children within 0&#8211;14 years&#46; In 2014&#44; there were 52&#44;335 visits to the Emergency Department &#40;ED&#41; and 4024 hospitalizations per year&#46; With a prevalence of asthma of 10&#37; in the pediatric population&#44; asthma exacerbations count for approximately 5&#37; of the total number of visits to the ED&#46; Of these children&#44; only 82 &#40;3&#46;3&#37;&#41; needed hospital admission and 21 &#40;0&#46;8&#37;&#41; PICU for management&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">Consecutive sampling of all children from 1&#46;5 to 14 years old admitted to the PICU with the diagnosis of SA&#44; from January 2012 to December 2014&#46; The only exclusion criteria was age below 18 months aiming to exclude bronchiolitis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Acute exacerbation of asthma was considered as an acute episode of increased work of breathing with wheeze and prolonged expiratory phase in a child with similar previous episodes unresponsive to nebulized bronchodilators&#44; steroids and magnesium sulphate in the ED&#46; Treatment of acute exacerbation of asthma is performed according to our local guideline at Cruces University Hospital &#40;Supplementary material&#41;&#46; Our subjects are admitted to PICU if there is no response to appropriate therapy in the ED&#44; if the frequency of required aerosol treatments was greater than what could be administered on the ward &#40;usually hourly&#41;&#44; or if the patent was deteriorating significantly despite appropriate therapy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The initial support with HFNC or NIV was decided by the attending PICU physician&#46; The decision relayed solely on the physician&#39;s self-confidence with the technique&#46; In subjects receiving NIV&#44; full face masks &#40;Respironics PerforMax&#44; Philips&#44; Netherlands&#41; or oronasal masks &#40;Respironics PerformaTrak&#44; Philips&#44; Netherlands&#41; were used as interfaces&#44; and BiPAP vision or V60 &#40;Respironics Philips&#44; Philips&#44; Netherlands&#41; were used as mechanical ventilators&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Initially&#44; Inspiratory Positive Airway Pressure &#40;IPAP&#41; of 8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and End-positive Airway Pressure &#40;EPAP&#41; of 4<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O were set up to achieve a tidal volume of 6&#8211;9<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46; Inspiratory and expiratory pressure was titrated in increments of 2<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O based on tidal volume&#44; continuous pulse oximetry&#44; work of breathing&#44; respiratory rate and subject-ventilator synchrony&#46; The EPAP was limited to 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O unless an improvement in <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">aO2</span> or pulse oximetry was proven with higher levels of EPAP&#46; Fraction of inspired oxygen &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#41; was also titrated to maintain a <span class="elsevierStyleItalic">S</span><span class="elsevierStyleInf">pO2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>92&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In subjects receiving HFNC&#44; a cannula of suitable size&#44; an appropriate circuit&#44; humidifier and air&#47;oxygen blender were selected&#46; Cannula size was selected based on subject weight &#40;Fisher&#38;Paykel OPT316 infant or OPT318 pediatric for infants and children up to 12&#46;5<span class="elsevierStyleHsp" style=""></span>kg with maximum flow 20&#8211;25<span class="elsevierStyleHsp" style=""></span>L&#47;min&#44; and Fisher&#38;Paykel size S OPT542&#44; size M OPT544&#44; size L OPT546 adult cannula in children &#62;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; The circuit was also selected based on subject weight &#40;Fisher&#38;Paykel RT 329 small volume circuit tubing for children &#60;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg and Fisher&#38;Paykel RT203 adult circuit tubing for children &#8805;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; Each HFNC system has a humidifier &#40;MR850&#44; Fisher&#38;Paykel&#44; Auckland&#44; New Zealand&#41;&#46; Flow rates were also adjusted to body weight&#58; 2<span class="elsevierStyleHsp" style=""></span>L&#47;kg&#47;min for the first 10<span class="elsevierStyleHsp" style=""></span>kg<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>L&#47;kg&#47;min for each kg above that &#40;maximum flow 50<span class="elsevierStyleHsp" style=""></span>L&#47;min&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Failure of initial support was considered if subject respiratory condition did not improve or even worsened according to the clinical judgment of the attending physician&#46; In this situation&#44; change to a higher level of respiratory support was carried out&#46; Subjects receiving HFNC would be switched to NIV and those receiving NIV would be changed to invasive MV&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study-related assessment of subject status and data collection</span><p id="par0070" class="elsevierStylePara elsevierViewall">The following information was extracted from subject medical records&#58; age&#44; gender&#44; weight&#44; treatment prior to PICU&#44; score Wood&#8211;Downes&#44; heart rate &#40;HR&#41;&#44; respiratory rate &#40;RR&#41;&#44; fraction of inspired oxygen &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#41;&#44; pH&#44; and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span>&#46; Therapy-related complications were also recorded&#46; Blood gas analysis was not routinely performed&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Subjects were classified into two groups&#44; taking into account the respiratory support initially applied by the attending physician&#44; i&#46;e&#46; intention to treat analysis&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">NIV cohort&#58; subjects receiving NIV&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">HFNC cohort&#58; subjects receiving HFNC&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">In a secondary subanalysis&#44; subjects were classified into three categories based on the mode of support finally received&#44; i&#46;e&#46; per protocol analysis&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">a&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">NIV group&#58; subjects receiving NIV&#46; For the analysis&#44; this was considered the reference category&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">b&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">HFNC-success group&#58; subjects receiving HFNC successfully&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">c&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">HFNC-failure group&#58; subjects who initially received HFNC&#44; but they failed and were changed to NIV&#46;</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">In this study&#44; primary outcome was failure of the initial respiratory support&#44; defined as need to change to a higher level of support &#40;HFNC to NIV&#44; NIV to invasive MV&#41;&#46; Secondary outcomes assessed were the duration of respiratory support&#44; and PICU length of stay&#46; The follow-up period was extended until the respiratory support was fully weaned&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical methods</span><p id="par0115" class="elsevierStylePara elsevierViewall">All data were managed with a relational database &#40;MS Access for Windows&#41;&#46; Categorical variables were described as percentages&#46; Continuous variables if normal &#40;Shapiro&#8211;Wilks&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; if not as median with 25th&#8211;75th percentile&#46; Statistical significance was considered with <span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05&#46; Bivariate analysis for categorical variables was made with <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test or Fisher&#39;s exact test&#46; For continuous data&#44; Student <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test were used as appropriate&#46; Survival times are described by medians and the Kaplan Meier graphic method&#44; meanwhile bivariate analysis was done with log-rank test&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">For the multivariate analysis&#44; a logistic regression model is adjusted in binary outcome variables&#44; whereas a Cox proportional hazards model is adjusted in survival times&#46; Adjustment was made according to the Akaike information criterion in both cases&#46; Presence of interactions was initially assessed and proportionality of hazards has been tested graphically&#44; being the result expressed as odds ratios or hazard ratio and their 95&#37; confidence intervals&#46; The discriminatory power of logistic regression model was measured by the area under the ROC curve &#40;trapezoidal method&#41;&#46; Its statistical significance was evaluated with De Long test&#46; Its diagnostic accuracy was established with the Sensitivity&#44; Specificity&#44; and Likelihood Ratios computed for the optimal cut-off settled closest to the left-upper corner of the ROC curve&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical issues</span><p id="par0125" class="elsevierStylePara elsevierViewall">The study was approved by the hospital institutional review board &#40;IRB&#41;&#46; The ethics committee waived the need for consent in this retrospective review of medical records&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Forty-two children met the inclusion criteria and were included in the analysis&#46; Twenty were in the HFNC cohort and 22 were in the NIV cohort&#46; The baseline characteristics of the total sample&#44; as well as the two cohorts are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Age&#44; gender&#44; weight&#44; PRISM III score&#44; Wood&#8211;Downes score&#44; respiratory rate&#44; pH&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span>&#44; and oxygen saturation at admission&#44; were similar between the two groups&#46; The only significant difference was heart rate with a median &#40;p25&#8211;p75&#41; of 164 &#40;141&#8211;167&#41; in the HFNC cohort versus 146 &#40;136&#8211;156&#41; in the NIV cohort &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; No children had comorbidities&#46; Apart from an episode of subcutaneous emphysema&#44; no major complications were reported&#46; None of the subjects required intubation&#46; All patients survive&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">There were 22 subjects in the initial mode of NIV&#46; The respiratory support mode in this group was bi-level positive pressure in 93&#46;5&#37; and in one subject CPAP&#46; The mean EPAP was 5 &#40;4&#8211;7&#41; and the mean IPAP was 12 &#40;8&#8211;17&#41;&#46; There was no treatment failure in this group&#46; In the HFNC group&#44; treatment failure occurred in 8 subjects&#46; These subjects were changed to NIV with clinical improvement observed in all cases&#46; Therefore&#44; the need to change to a higher respiratory support in HFNC group was 40&#37; &#40;8&#47;20&#41;&#44; whereas no subject in the group NIV required higher respiratory support &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the probability of remaining free from treatment failure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In the subgroup analysis&#44; the mean length of ventilator support and PICU LOS were similar in the groups with no failure&#46; However&#44; the Cox model shows that overall length of ventilatory support was three fold higher in HFNC-failure group as compared to NIV group&#46; <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a> show the length of ventilatory support &#40;hours&#41; and PICU LOS &#40;days&#41; for the three final &#40;<span class="elsevierStyleItalic">per protocol</span>&#41; groups&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A multivariate logistic regression analysis was performed to identify factors associated with treatment failure in children receiving respiratory support&#46; Heart rate was introduced into the model&#44; in order to avoid confusion because at first both groups were different in relation to this variable&#46; Independent contribution of other variables was tested&#44; and only the heart rate and respiratory rate measured prior to ventilatory support remained in the final model&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The model introduces a highly good discriminatory power&#58; Area under ROC curve &#40;AUC&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;90 &#91;95&#37; CI&#58; 0&#46;81&#8211;0&#46;99 &#40;DeLong&#41;&#93;&#46; And for an optimal threshold of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#44; its diagnostic accuracy is excellent&#58; Sensitivity<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;87 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;47&#8211;0&#46;99&#93;&#44; Specificity<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#8211;0&#46;93&#93;&#44; likelihood ratio of a positive test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;95 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;29&#8211;10&#46;73&#93; and likelihood ratio of a negative test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#8211;0&#46;95&#93;&#46; In our population&#44; this logistic model shows that a HR below 146<span class="elsevierStyleHsp" style=""></span>bpm and a RR below 55<span class="elsevierStyleHsp" style=""></span>bpm would predict HFNC success whereas in the face of a HR above 164<span class="elsevierStyleHsp" style=""></span>bpm&#44; only a RR below 37 would predict HFNC success&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">In this study we present our experience with HFNC and NIV for SA in PICU&#46; Even though both therapies are broadly used in asthmatic children all over the world&#44; the lack of literature comparing them is significant&#46; We have not found any randomized controlled trials on this topic and&#44; to our knowledge&#59; this is the first retrospective study looking at both ways of respiratory support in pediatric asthma&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our hospital covers a population of 200&#44;000 children within 0&#8211;14 years with a prevalence of asthma of 10&#37;&#46; Being asthma such a common disease in children&#44; it is mostly managed by general pediatricians in the communities with very good rates of treatment compliance and success&#46; However&#44; SA is still a common presentation to the ED&#46; Only a small percentage of these children fail to respond to medical treatment and require admission to PICU for further management&#46; Increased use of NIV has been associated with less invasive MV and shorter hospital LOS&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;8&#44;10&#44;12&#44;24</span></a> Several RCTs have proven NIV efficacy in decreasing work of breathing when used as an adjuvant to medical therapy with nebulized bronchodilator and anti-inflammatory therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;25&#44;26</span></a> In Spain&#44; despite the lack of published data&#44; there is a long standing tradition on the use of NIV in pediatric asthmatic subjects with good clinical results and very low rates of intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> In our study 30 subjects were supported by NIV and no one was intubated&#46; In terms of HFNC in asthma&#44; there is also significant paucity of evidence&#46; Kelly et al&#46; described the largest observational study to date&#44; which included 38 children younger than 2 years admitted with status asthmaticus&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> In this study the authors identified three variables associated with increased risk for intubation following HFNC trial&#58; triage RR greater than 90th percentile for age &#40;OR&#44; 2&#46;11&#59; 95&#37; CI&#44; 1&#46;01&#8211;4&#46;43&#41;&#44; initial venous <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span> greater than 50<span class="elsevierStyleHsp" style=""></span>mmHg &#40;OR&#44; 2&#46;51&#59; 95&#37; CI&#44; 1&#46;06&#8211;5&#46;98&#41;&#44; and initial venous pH less than 7&#46;30 &#40;OR&#44; 2&#46;53&#59; 95&#37; CI&#44; 1&#46;12&#8211;5&#46;74&#41;&#46; We identify heart rate and respiratory rate prior to respiratory support as factors related to failure of HFNC&#46; Also Abboud et al&#46; identified the absence of a reduction in <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span> as a predictive factor of HFNC failure in children affected by bronchiolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> On the other hand&#44; HFNC has been shown useful in hypoxemic&#44; not hypercapnic subjects &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">aCO2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mmHg&#41; requiring <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">We compared two groups of children treated with HFNC or NIV for SA in the PICU&#46; Except for the heart rate&#44; which was higher in the group of HFNC&#44; the two groups in our study were similar at the time of PICU admission in terms of age&#44; weight&#44; PRISM III&#44; Wood&#8211;Downes score and <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#46; The reason why HR was higher in the HFNC cannot be determined retrospectively&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We found favorable outcomes in the initial cohort of NIV&#46; The absence of children requiring intubation could be interpreted as less severity of the illness&#46; If we consider that most children with asthma are intubated for &#8220;severe work of breathing&#8221; or &#8220;exhaustion&#8221;&#44; our subjects had a mean Wood&#8211;Downes score of 8 which is an indicator of severity&#46; Also&#44; we think that the fact that NIV is initiated relatively early in the course of SA management may play a role in preventing the need of invasive mechanical ventilation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">An interesting finding in our study is that in the HFNC group&#44; 8 subjects &#40;40&#37;&#41; needed to be escalated to NIV&#46; Subjects in the HFNC-success group showed similar results to those in the NIV group but those in the HFNC-failure group had a three-fold longer time of respiratory support &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; compared with the initial NIV group&#46; In addition&#44; the PICU LOS was higher compared with the same group&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Even though causality cannot be established with our study&#44; it is not unreasonable to think that HFNC&#44; which is a lower level of support&#44; could only be beneficial in selected subjects and that it could delay the initiation of NIV and therefore prolong PICU and hospital LOS&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">We performed a multivariate logistic regression analysis to identify factors associated with treatment failure in children receiving respiratory support&#46; Only heart rate and respiratory rate measured prior to ventilatory support remained in the final model&#46; According to it&#44; we noticed that children with heart rate less than 146<span class="elsevierStyleHsp" style=""></span>bpm and respiratory rate less than 55<span class="elsevierStyleHsp" style=""></span>bpm&#44; HFNC would probably not fail&#46; When heart rate is greater than 164<span class="elsevierStyleHsp" style=""></span>bpm&#44; HFNC would only be potentially successful in those children with RR less than 37<span class="elsevierStyleHsp" style=""></span>rpm&#46; In other words&#44; in the most severely affected pediatric asthma subjects&#44; it is highly likely that HFNC will fail if it is the initial mode of respiratory support applied&#46; Validation of this study&#44; in a randomized controlled trial with a larger sample&#44; would help to identify a more reliable cut-off value which could guide clinicians on an appropriate algorithm to choose one or the other treatment&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Failure criteria have been described in both groups &#40;NIV and HFNC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> The respiratory support failure is associated with increased mortality&#46; NIV is more likely to fail in hypoxemic subject<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> and HFNC in hypercapnic subject&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> It has also been pointed out that their use may delay intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> Because of low sample size and absence of intubation rate&#44; we were not able to compare the differences in mortality or need for intubation&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Several limitations to our study must be mentioned&#46; On the one hand&#44; the sample size is small and there are no subjects in the NIV failure group limiting the value of our findings&#46; On the other hand&#44; this is a retrospective study with lack of randomization&#46; Also&#44; both initial therapy as well as treatment failure were determined by the attending physician preference&#46; Therefore&#44; the potential for bias is significant in terms of physician preference of one technique over the other or when to consider treatment failure&#46; We tried to manage these confounding factors by using multivariate analysis&#46; However&#44; sample size and the fact that one of the groups had different initial HR limits possible comparisons between groups&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Since this audit&#44; our current therapeutic approach&#44; as other researchers reported&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> is to use HFNC in the Emergency Department in children with mild to moderate SA&#46; Once decision is made to admit the child to PICU&#44; NIV is initiated&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0205" class="elsevierStylePara elsevierViewall">In this study comparing NIV with HFNC for SA in children&#44; we observed that early initiation of NIV in association with bronchodilators and systemic steroids is a safe and feasible initial alternative for the treatment of SA&#46; However&#44; more severe cases HFNC could potentially delay the initiation of NIV resulting in a longer stay in PICU&#44; and the consequent increase in morbidity and costs&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Author&#39;s contribution</span><p id="par0210" class="elsevierStylePara elsevierViewall">Javier Pilar&#58; Study design and writing&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Vicente Modesto i Alapont&#58; Analysis of data&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Yolanda M&#46; L&#243;pez-Fern&#225;ndez&#58; Manuscript preparation&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Olaia L&#243;pez-Macias&#58; Data collection&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Diego Garcia Urabayen&#58; Literature search&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Irene Amores Hern&#225;ndez&#58; Review of manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have not disclosed any potential conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2016-11-05"
    "fechaAceptado" => "2017-01-02"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Non-invasive ventilation"
            1 => "High-flow nasal cannula"
            2 => "Asthma exacerbation"
            3 => "Critical care"
            4 => "Children"
            5 => "Length of stay"
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          "palabras" => array:6 [
            0 => "Ventilaci&#243;n no invasiva"
            1 => "Oxigenoterapia de alto flujo"
            2 => "Estatus asm&#225;tico"
            3 => "Cuidados cr&#237;ticos"
            4 => "Ni&#241;os"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The present study describes our experience with the high-flow humidified nasal cannula &#40;HFNC&#41; versus non-invasive ventilation &#40;NIV&#41; in children with severe acute asthma exacerbation &#40;SA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit &#40;PICU&#41; for non-invasive respiratory support was made&#46; The primary outcome measure was failure of initial respiratory support &#40;need to escalate from HFNC to NIV or from NIV to invasive ventilation&#41;&#46; Secondary outcome measures were the duration of respiratory support and PICU length of stay &#40;LOS&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forty-two children met the inclusion criteria&#46; Twenty &#40;47&#46;6&#37;&#41; received HFNC and 22 &#40;52&#46;3&#37;&#41; NIV as initial respiratory support&#46; There were no treatment failures in the NIV group&#46; However&#44; 8 children &#40;40&#37;&#41; in the HFNC group required escalation to NIV&#46; The PICU LOS was similar in both the NIV and HFNC groups&#46; However&#44; on considering the HFNC failure subgroup&#44; the median length of respiratory support was 3-fold longer &#40;63<span class="elsevierStyleHsp" style=""></span>h&#41; and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite its obvious limitations&#44; this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support&#44; and longer PICU LOS&#46;</p></span>"
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            "titulo" => "Introduction"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es comparar nuestra experiencia con el uso de oxigenoterapia de alto flujo &#40;OAF&#41; frente a la ventilaci&#243;n no invasiva &#40;NIV&#41; en ni&#241;os con estatus asm&#225;tico &#40;EA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de una cohorte retrospectiva de 42 ni&#241;os con EA ingresados en nuestra Unidad de Cuidados Intensivos Pedi&#225;tricos &#40;UCIP&#41; con soporte respiratorio no invasivo&#46; El objetivo principal del estudio fue valorar el &#233;xito&#47;fracaso del soporte respiratorio inicial &#40;necesidad o no de escalar a un soporte respiratorio superior&#41;&#46; El objetivo secundario fue comparar la duraci&#243;n del soporte respiratorio y del ingreso en la UCIP&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y dos ni&#241;os cumplieron con los criterios de inclusi&#243;n&#46; Veinte &#40;47&#44;6&#37;&#41; fueron tratados con OAF y 22 &#40;52&#44;3&#37;&#41; con VNI como soporte respiratorio inicial&#46; No hubo fracaso terap&#233;utico en el grupo VNI&#44; si bien 8 ni&#241;os &#40;40&#37;&#41; del grupo OAF fueron cambiados a VNI&#46; La duraci&#243;n de la estancia en la UCIP y en el hospital fue similar en ambos grupos NIV y HFNC&#46; Sin embargo&#44; en el subgrupo de fracaso de OAF&#44; la duraci&#243;n del soporte respiratorio &#40;el triple&#44; 63<span class="elsevierStyleHsp" style=""></span>h&#41; y la estancia en la UCIP fueron mucho mayores en comparaci&#243;n con los sujetos que tuvieron &#233;xito en el tratamiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio observacional&#44; con sus evidentes limitaciones&#44; podr&#237;a sugerir que el uso de HFNC en algunos sujetos con EA puede retrasar el inicio de la VNI y potencialmente causar un soporte respiratorio m&#225;s prolongado y una mayor estancia en la UCIP&#46;</p></span>"
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            "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0075"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of the probability of remaining free from treatment failure&#46; Log-rank test&#58; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#46; Censoring marks identify children weaned off the ventilatory support&#46; The figure shows 95&#37; confidence interval for the median&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of the probability of remaining in ventilatory support&#46; <span class="elsevierStyleItalic">Per protocol</span> sub-group analysis&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of PICU LOS &#40;days&#41;&#46; <span class="elsevierStyleItalic">Per protocol</span> sub-group analysis&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HFNC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>high-flow nasal cannula&#59; NIV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>non-invasive ventilation&#59; <span class="elsevierStyleItalic">S</span><span class="elsevierStyleInf">pO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>saturation measured via pulse oximetry&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>carbon dioxide tension&#59; <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>fraction of inspired oxygen&#59; ED<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Emergency Department&#46; Continuous variables are expressed in median &#91;Perc 25&#44; Perc 75&#93;&#44; except &#40;&#42;&#41; in median &#40;95&#37; CI&#41;&#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" 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">HFNC&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">NIV&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 &#40;HFNC versus NIV&#41;&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"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&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"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;98 &#91;1&#46;52&#59; 4&#46;42&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;74 &#91;2&#46;77&#59; 6&#46;47&#93;&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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex &#40;&#37; men&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;8 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#47;8 &#40;77&#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;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#91;14&#46;25&#59; 21&#46;5&#93;&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;10&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"><span class="elsevierStyleItalic">PRISM III</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#91;1&#46;75&#59; 6&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#91;0&#46;25&#44; 4&#93;&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;17&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"><span class="elsevierStyleItalic">Wood&#8211;Downes score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#91;7&#59; 9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#91;7&#59; 9&#46;75&#93;&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;67&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"><span class="elsevierStyleItalic">Heart rate &#40;bpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#91;141&#59; 167&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146 &#91;136&#59; 156&#93;&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="elsevierStyleBold">0&#46;009</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"><span class="elsevierStyleItalic">Respiratory rate &#40;rpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#91;37&#59; 57&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#91;33&#59; 50&#93;&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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">CO2</span></span><span class="elsevierStyleItalic">&#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#91;39&#59; 47&#46;75&#93;&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"><span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">IO2</span></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#91;96&#59; 99&#93;&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;5 &#91;4&#46;75&#59; 10&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#91;3&#59; 12&#93;&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;18&#46;18&#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;66&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#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="elsevierStyleBold">0&#46;001</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"><span class="elsevierStyleHsp" style=""></span>Time on VS &#40;h&#41;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;16&#8211;30&#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;45&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"><span class="elsevierStyleHsp" style=""></span>LOS in PICU &#40;days&#41;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#8211;&#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;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;22&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="elsevierStyleBold">0&#46;02</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#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">0&#46;06&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "bib0160"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric status asthmaticus"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Carroll"
                            1 => "K&#46;A&#46; Sala"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ccc.2012.12.001"
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                        "tituloSerie" => "Crit Care Clin"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "153"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective randomized controlled trial on the efficacy of NIV in severe acute asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "A&#46; Nath"
                            2 => "R&#46; Agarwal"
                            3 => "D&#46; Behera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "536"
                        "paginaFinal" => "543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20420722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                  ]
                ]
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              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation for asthma&#58; a 10-year experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;C&#46; Kao"
                            1 => "S&#46; Jain"
                            2 => "K&#46;K&#46; Guntupalli"
                            3 => "V&#46; Bandi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/02770900801999090"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2008"
                        "volumen" => "45"
                        "paginaInicial" => "552"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18773325"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0175"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Critical care for pediatric asthma&#58; wide care variability and challenges for study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Bratton"
                            1 => "C&#46;J&#46; Newth"
                            2 => "A&#46;F&#46; Zuppa"
                            3 => "F&#46;W&#46; Moler"
                            4 => "K&#46;L&#46; Meert"
                            5 => "R&#46;A&#46; Berg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318238b428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "407"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22067984"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved outcomes from acute severe asthma in Australian intensive care units &#40;1996&#8211;2003&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;J&#46; Stow"
                            1 => "D&#46; Pilcher"
                            2 => "J&#46; Wilson"
                            3 => "C&#46; George"
                            4 => "M&#46; Bailey"
                            5 => "T&#46; Higlett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2006.075317"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "842"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17389751"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlates of prolonged hospitalization in inner-city ICU subjects receiving noninvasive and invasive positive pressure ventilation for status asthmaticus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Gehlbach"
                            1 => "J&#46;P&#46; Kress"
                            2 => "J&#46; Kahn"
                            3 => "C&#46; DeRuiter"
                            4 => "A&#46; Pohlman"
                            5 => "J&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "122"
                        "paginaInicial" => "1709"
                        "paginaFinal" => "1714"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12426275"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0190"
              "etiqueta" => "7"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is non-invasive ventilation safe in acute severe asthma&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Pallin"
                            1 => "M&#46; Hew"
                            2 => "M&#46; Naughton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/resp.12428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respirology"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "251"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25376643"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive pressure ventilation via face mask&#46; First-line intervention in subjects with acute hypercapnic and hypoxemic respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;U&#46; Meduri"
                            1 => "R&#46;E&#46; Turner"
                            2 => "N&#46; Abou-Shala"
                            3 => "R&#46; Wunderink"
                            4 => "E&#46; Tolley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "109"
                        "paginaInicial" => "179"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8549183"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive ventilation for the treatment of status asthmaticus in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Carroll"
                            1 => "C&#46;M&#46; Schramm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1081-1206(10)60913-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Allergy Asthma Immunol"
                        "fecha" => "2006"
                        "volumen" => "96"
                        "paginaInicial" => "454"
                        "paginaFinal" => "459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597080"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety&#44; efficacy&#44; and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric subjects admitted with status asthmaticus&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Basnet"
                            1 => "G&#46; Mander"
                            2 => "J&#46; Andoh"
                            3 => "H&#46; Klaska"
                            4 => "S&#46; Verhulst"
                            5 => "J&#46; Koirala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318238b07a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "393"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22067982"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0210"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive ventilation in pediatric status asthmaticus&#58; a prospective observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Mayordomo-Colunga"
                            1 => "A&#46; Medina"
                            2 => "C&#46; Rey"
                            3 => "A&#46; Concha"
                            4 => "S&#46; Men&#233;ndez"
                            5 => "M&#46;L&#46; Arcos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.21466"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2011"
                        "volumen" => "46"
                        "paginaInicial" => "949"
                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21520437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive pressure ventilation in acute asthmatic attack"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Soroksky"
                            1 => "E&#46; Klinowski"
                            2 => "E&#46; Ilgyev"
                            3 => "A&#46; Mizrachi"
                            4 => "A&#46; Miller"
                            5 => "T&#46;M&#46; Ben Yehuda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09059180.00006109"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir Rev"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "39"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive-pressure ventilation in children with lower airway obstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Thill"
                            1 => "J&#46;K&#46; McGuire"
                            2 => "H&#46;P&#46; Baden"
                            3 => "T&#46;P&#46; Green"
                            4 => "P&#46;A&#46; Checchia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2004"
                        "volumen" => "5"
                        "paginaInicial" => "337"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15215002"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Children with respiratory distress treated with high-flow nasal cannula"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46; Spentzas"
                            1 => "M&#46; Minarik"
                            2 => "A&#46;B&#46; Patters"
                            3 => "B&#46; Vinson"
                            4 => "G&#46; Stidham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066609340622"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "323"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19703816"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evidence for high flow nasal cannula devices in infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Haq"
                            1 => "S&#46; Gopalakaje"
                            2 => "A&#46;C&#46; Fenton"
                            3 => "M&#46;C&#46; McKean"
                            4 => "C&#46; J&#46;O&#8217;Brien"
                            5 => "M&#46; Brodlie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.prrv.2013.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Paediatr Respir Rev"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "124"
                        "paginaFinal" => "134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24472697"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of high flow nasal cannula in critically ill infants&#44; children and adults&#58; a critical review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;H&#46; Lee"
                            1 => "K&#46;J&#46; Rehder"
                            2 => "L&#46; Williford"
                            3 => "I&#46;M&#46; Cheifetz"
                            4 => "D&#46;A&#46; Turner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2743-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23143331"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula&#58; recommendations for daily practice in pediatrics"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Mil&#233;si"
                            1 => "M&#46; Boubal"
                            2 => "A&#46; Jacquot"
                            3 => "J&#46; Baleine"
                            4 => "S&#46; Durand"
                            5 => "M&#46;P&#46; Odena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Intensive Care"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0245"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula oxygen therapy for infants with bronchiolitis&#58; pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "F&#46; Bogossian"
                            2 => "L&#46; O&#8217;Malley"
                            3 => "A&#46; Schibler"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jpc.12509"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Paediatr Child Health"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "373"
                        "paginaFinal" => "378"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24612137"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0250"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Wing"
                            1 => "C&#46; James"
                            2 => "L&#46;S&#46; Maranda"
                            3 => "C&#46;C&#46; Armsby"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e31827122a9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "1117"
                        "paginaFinal" => "1123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23114231"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0255"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula use in children with respiratory distress in the emergency department&#58; predicting the need for subsequent intubation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;S&#46; Kelly"
                            1 => "H&#46;K&#46; Simon"
                            2 => "J&#46;J&#46; Sturm"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e31829e7f2f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "888"
                        "paginaFinal" => "892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23903677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            20 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of high-flow nasal cannula for acute dyspnea and hypoxemia in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Rittayamai"
                            1 => "J&#46; Tscheikuna"
                            2 => "N&#46; Praphruetkit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.03837"
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                        "tituloSerie" => "Respir Care"
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                        "volumen" => "60"
                        "paginaInicial" => "1377"
                        "paginaFinal" => "1382"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26060321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0265"
              "etiqueta" => "22"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula &#40;HFNC&#41; support in interhospital transport of critically ill children"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            1 => "J&#46; Schaefer"
                            2 => "A&#46;M&#46; Brady"
                            3 => "S&#46; Mayfield"
                            4 => "A&#46; Schibler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-014-3226-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "592"
                        "paginaFinal" => "599"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24531340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is there a role for humidified heated high-flow nasal cannula therapy in pediatric emergency departments&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Long"
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                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/emermed-2015-204914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J"
                        "fecha" => "2016"
                        "volumen" => "33"
                        "paginaInicial" => "386"
                        "paginaFinal" => "389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26727972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
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              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of mechanical ventilation for asthma exacerbations&#58; analysis of a national database"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Nanchal"
                            1 => "G&#46; Kumar"
                            2 => "T&#46; Majumdar"
                            3 => "A&#46; Taneja"
                            4 => "J&#46; Patel"
                            5 => "G&#46; Dagar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.02505"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2014"
                        "volumen" => "59"
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Original article
High-flow nasal cannula therapy versus non-invasive ventilation in children with severe acute asthma exacerbation: An observational cohort study
Oxigenoterapia de alto flujo frente a ventilación no invasiva en niños con estatus asmático: estudio observacional de cohortes
J. Pilara,
Autor para correspondencia
, V. Modesto i Alapontb, Y.M. Lopez-Fernandeza, O. Lopez-Maciasa, D. Garcia-Urabayena, I. Amores-Hernandeza
a PICU, Cruces University Hospital, Plaza de Cruces s/n, Barakaldo 48903, Spain
b PICU, Hospital Universitari i Politècnic La Fe de Valencia, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Severe acute asthma exacerbation &#40;SA&#41; can be a potentially life-threatening condition<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> and is a frequent cause of admission to a pediatric intensive care unit &#40;PICU&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> Endotracheal intubation and invasive mechanical ventilation &#40;invasive MV&#41; are associated with a substantial risk of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#8211;6</span></a> Therefore&#44; the use of other forms of respiratory support such as non-invasive ventilation &#40;NIV&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> and high flow nasal cannula &#40;HFNC&#41; have been considered in an attempt to avoid mechanical ventilation in SA subjects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the fact that NIV is widely used in asthma subjects admitted in ICU<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#8211;13</span></a> only few randomized controlled studies &#40;RCT&#41; have been published on pediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;13</span></a> Nevertheless&#44; there is a strong physiological basis behind the use of NIV in asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand&#44; HFNC has become popular as it is easy to use and very well tolerated&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#8211;17</span></a> Since last decade&#44; HFNC has been introduced in pediatrics as respiratory support&#44; mainly during seasonal bronchiolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> Currently&#44; HFNC has spread to hospital wards&#44; emergency rooms<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#8211;21</span></a> and transport services&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is an ongoing discussion on the indications of high flow nasal cannula therapy or non-invasive ventilation &#40;NIV&#41; in subjects with acute respiratory failure&#46; The clinical advantages of HFNC have not been established yet and there is a lack of published evidence comparing NIV and HFNC during SA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study is to describe our experience with HFNC and NIV in children with SA admitted to the PICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">This is a retrospective observational study in children with asthma exacerbation admitted to PICU for respiratory support&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Setting</span><p id="par0035" class="elsevierStylePara elsevierViewall">A multidisciplinary Pediatric Intensive Care Unit &#40;PICU&#41; from a tertiary university hospital with 12 beds and 600 admissions per year&#46; Our hospital covers a population of 200&#44;000 children within 0&#8211;14 years&#46; In 2014&#44; there were 52&#44;335 visits to the Emergency Department &#40;ED&#41; and 4024 hospitalizations per year&#46; With a prevalence of asthma of 10&#37; in the pediatric population&#44; asthma exacerbations count for approximately 5&#37; of the total number of visits to the ED&#46; Of these children&#44; only 82 &#40;3&#46;3&#37;&#41; needed hospital admission and 21 &#40;0&#46;8&#37;&#41; PICU for management&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">Consecutive sampling of all children from 1&#46;5 to 14 years old admitted to the PICU with the diagnosis of SA&#44; from January 2012 to December 2014&#46; The only exclusion criteria was age below 18 months aiming to exclude bronchiolitis&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Acute exacerbation of asthma was considered as an acute episode of increased work of breathing with wheeze and prolonged expiratory phase in a child with similar previous episodes unresponsive to nebulized bronchodilators&#44; steroids and magnesium sulphate in the ED&#46; Treatment of acute exacerbation of asthma is performed according to our local guideline at Cruces University Hospital &#40;Supplementary material&#41;&#46; Our subjects are admitted to PICU if there is no response to appropriate therapy in the ED&#44; if the frequency of required aerosol treatments was greater than what could be administered on the ward &#40;usually hourly&#41;&#44; or if the patent was deteriorating significantly despite appropriate therapy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The initial support with HFNC or NIV was decided by the attending PICU physician&#46; The decision relayed solely on the physician&#39;s self-confidence with the technique&#46; In subjects receiving NIV&#44; full face masks &#40;Respironics PerforMax&#44; Philips&#44; Netherlands&#41; or oronasal masks &#40;Respironics PerformaTrak&#44; Philips&#44; Netherlands&#41; were used as interfaces&#44; and BiPAP vision or V60 &#40;Respironics Philips&#44; Philips&#44; Netherlands&#41; were used as mechanical ventilators&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Initially&#44; Inspiratory Positive Airway Pressure &#40;IPAP&#41; of 8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and End-positive Airway Pressure &#40;EPAP&#41; of 4<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O were set up to achieve a tidal volume of 6&#8211;9<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46; Inspiratory and expiratory pressure was titrated in increments of 2<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O based on tidal volume&#44; continuous pulse oximetry&#44; work of breathing&#44; respiratory rate and subject-ventilator synchrony&#46; The EPAP was limited to 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O unless an improvement in <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">aO2</span> or pulse oximetry was proven with higher levels of EPAP&#46; Fraction of inspired oxygen &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#41; was also titrated to maintain a <span class="elsevierStyleItalic">S</span><span class="elsevierStyleInf">pO2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>92&#37;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In subjects receiving HFNC&#44; a cannula of suitable size&#44; an appropriate circuit&#44; humidifier and air&#47;oxygen blender were selected&#46; Cannula size was selected based on subject weight &#40;Fisher&#38;Paykel OPT316 infant or OPT318 pediatric for infants and children up to 12&#46;5<span class="elsevierStyleHsp" style=""></span>kg with maximum flow 20&#8211;25<span class="elsevierStyleHsp" style=""></span>L&#47;min&#44; and Fisher&#38;Paykel size S OPT542&#44; size M OPT544&#44; size L OPT546 adult cannula in children &#62;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; The circuit was also selected based on subject weight &#40;Fisher&#38;Paykel RT 329 small volume circuit tubing for children &#60;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg and Fisher&#38;Paykel RT203 adult circuit tubing for children &#8805;12&#46;5<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; Each HFNC system has a humidifier &#40;MR850&#44; Fisher&#38;Paykel&#44; Auckland&#44; New Zealand&#41;&#46; Flow rates were also adjusted to body weight&#58; 2<span class="elsevierStyleHsp" style=""></span>L&#47;kg&#47;min for the first 10<span class="elsevierStyleHsp" style=""></span>kg<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;5<span class="elsevierStyleHsp" style=""></span>L&#47;kg&#47;min for each kg above that &#40;maximum flow 50<span class="elsevierStyleHsp" style=""></span>L&#47;min&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Failure of initial support was considered if subject respiratory condition did not improve or even worsened according to the clinical judgment of the attending physician&#46; In this situation&#44; change to a higher level of respiratory support was carried out&#46; Subjects receiving HFNC would be switched to NIV and those receiving NIV would be changed to invasive MV&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study-related assessment of subject status and data collection</span><p id="par0070" class="elsevierStylePara elsevierViewall">The following information was extracted from subject medical records&#58; age&#44; gender&#44; weight&#44; treatment prior to PICU&#44; score Wood&#8211;Downes&#44; heart rate &#40;HR&#41;&#44; respiratory rate &#40;RR&#41;&#44; fraction of inspired oxygen &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#41;&#44; pH&#44; and <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span>&#46; Therapy-related complications were also recorded&#46; Blood gas analysis was not routinely performed&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Subjects were classified into two groups&#44; taking into account the respiratory support initially applied by the attending physician&#44; i&#46;e&#46; intention to treat analysis&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;a&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">NIV cohort&#58; subjects receiving NIV&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;b&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">HFNC cohort&#58; subjects receiving HFNC&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">In a secondary subanalysis&#44; subjects were classified into three categories based on the mode of support finally received&#44; i&#46;e&#46; per protocol analysis&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">a&#46;</span><p id="par0095" class="elsevierStylePara elsevierViewall">NIV group&#58; subjects receiving NIV&#46; For the analysis&#44; this was considered the reference category&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">b&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">HFNC-success group&#58; subjects receiving HFNC successfully&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">c&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">HFNC-failure group&#58; subjects who initially received HFNC&#44; but they failed and were changed to NIV&#46;</p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">In this study&#44; primary outcome was failure of the initial respiratory support&#44; defined as need to change to a higher level of support &#40;HFNC to NIV&#44; NIV to invasive MV&#41;&#46; Secondary outcomes assessed were the duration of respiratory support&#44; and PICU length of stay&#46; The follow-up period was extended until the respiratory support was fully weaned&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical methods</span><p id="par0115" class="elsevierStylePara elsevierViewall">All data were managed with a relational database &#40;MS Access for Windows&#41;&#46; Categorical variables were described as percentages&#46; Continuous variables if normal &#40;Shapiro&#8211;Wilks&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#44; if not as median with 25th&#8211;75th percentile&#46; Statistical significance was considered with <span class="elsevierStyleItalic">p</span>-value &#60;0&#46;05&#46; Bivariate analysis for categorical variables was made with <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test or Fisher&#39;s exact test&#46; For continuous data&#44; Student <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test were used as appropriate&#46; Survival times are described by medians and the Kaplan Meier graphic method&#44; meanwhile bivariate analysis was done with log-rank test&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">For the multivariate analysis&#44; a logistic regression model is adjusted in binary outcome variables&#44; whereas a Cox proportional hazards model is adjusted in survival times&#46; Adjustment was made according to the Akaike information criterion in both cases&#46; Presence of interactions was initially assessed and proportionality of hazards has been tested graphically&#44; being the result expressed as odds ratios or hazard ratio and their 95&#37; confidence intervals&#46; The discriminatory power of logistic regression model was measured by the area under the ROC curve &#40;trapezoidal method&#41;&#46; Its statistical significance was evaluated with De Long test&#46; Its diagnostic accuracy was established with the Sensitivity&#44; Specificity&#44; and Likelihood Ratios computed for the optimal cut-off settled closest to the left-upper corner of the ROC curve&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical issues</span><p id="par0125" class="elsevierStylePara elsevierViewall">The study was approved by the hospital institutional review board &#40;IRB&#41;&#46; The ethics committee waived the need for consent in this retrospective review of medical records&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0130" class="elsevierStylePara elsevierViewall">Forty-two children met the inclusion criteria and were included in the analysis&#46; Twenty were in the HFNC cohort and 22 were in the NIV cohort&#46; The baseline characteristics of the total sample&#44; as well as the two cohorts are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Age&#44; gender&#44; weight&#44; PRISM III score&#44; Wood&#8211;Downes score&#44; respiratory rate&#44; pH&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span>&#44; and oxygen saturation at admission&#44; were similar between the two groups&#46; The only significant difference was heart rate with a median &#40;p25&#8211;p75&#41; of 164 &#40;141&#8211;167&#41; in the HFNC cohort versus 146 &#40;136&#8211;156&#41; in the NIV cohort &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; No children had comorbidities&#46; Apart from an episode of subcutaneous emphysema&#44; no major complications were reported&#46; None of the subjects required intubation&#46; All patients survive&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">There were 22 subjects in the initial mode of NIV&#46; The respiratory support mode in this group was bi-level positive pressure in 93&#46;5&#37; and in one subject CPAP&#46; The mean EPAP was 5 &#40;4&#8211;7&#41; and the mean IPAP was 12 &#40;8&#8211;17&#41;&#46; There was no treatment failure in this group&#46; In the HFNC group&#44; treatment failure occurred in 8 subjects&#46; These subjects were changed to NIV with clinical improvement observed in all cases&#46; Therefore&#44; the need to change to a higher respiratory support in HFNC group was 40&#37; &#40;8&#47;20&#41;&#44; whereas no subject in the group NIV required higher respiratory support &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the probability of remaining free from treatment failure&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">In the subgroup analysis&#44; the mean length of ventilator support and PICU LOS were similar in the groups with no failure&#46; However&#44; the Cox model shows that overall length of ventilatory support was three fold higher in HFNC-failure group as compared to NIV group&#46; <a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a> show the length of ventilatory support &#40;hours&#41; and PICU LOS &#40;days&#41; for the three final &#40;<span class="elsevierStyleItalic">per protocol</span>&#41; groups&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A multivariate logistic regression analysis was performed to identify factors associated with treatment failure in children receiving respiratory support&#46; Heart rate was introduced into the model&#44; in order to avoid confusion because at first both groups were different in relation to this variable&#46; Independent contribution of other variables was tested&#44; and only the heart rate and respiratory rate measured prior to ventilatory support remained in the final model&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The model introduces a highly good discriminatory power&#58; Area under ROC curve &#40;AUC&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;90 &#91;95&#37; CI&#58; 0&#46;81&#8211;0&#46;99 &#40;DeLong&#41;&#93;&#46; And for an optimal threshold of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#44; its diagnostic accuracy is excellent&#58; Sensitivity<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;87 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;47&#8211;0&#46;99&#93;&#44; Specificity<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;82 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;65&#8211;0&#46;93&#93;&#44; likelihood ratio of a positive test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;95 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;29&#8211;10&#46;73&#93; and likelihood ratio of a negative test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15 &#91;95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#8211;0&#46;95&#93;&#46; In our population&#44; this logistic model shows that a HR below 146<span class="elsevierStyleHsp" style=""></span>bpm and a RR below 55<span class="elsevierStyleHsp" style=""></span>bpm would predict HFNC success whereas in the face of a HR above 164<span class="elsevierStyleHsp" style=""></span>bpm&#44; only a RR below 37 would predict HFNC success&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">In this study we present our experience with HFNC and NIV for SA in PICU&#46; Even though both therapies are broadly used in asthmatic children all over the world&#44; the lack of literature comparing them is significant&#46; We have not found any randomized controlled trials on this topic and&#44; to our knowledge&#59; this is the first retrospective study looking at both ways of respiratory support in pediatric asthma&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our hospital covers a population of 200&#44;000 children within 0&#8211;14 years with a prevalence of asthma of 10&#37;&#46; Being asthma such a common disease in children&#44; it is mostly managed by general pediatricians in the communities with very good rates of treatment compliance and success&#46; However&#44; SA is still a common presentation to the ED&#46; Only a small percentage of these children fail to respond to medical treatment and require admission to PICU for further management&#46; Increased use of NIV has been associated with less invasive MV and shorter hospital LOS&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;8&#44;10&#44;12&#44;24</span></a> Several RCTs have proven NIV efficacy in decreasing work of breathing when used as an adjuvant to medical therapy with nebulized bronchodilator and anti-inflammatory therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;25&#44;26</span></a> In Spain&#44; despite the lack of published data&#44; there is a long standing tradition on the use of NIV in pediatric asthmatic subjects with good clinical results and very low rates of intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a> In our study 30 subjects were supported by NIV and no one was intubated&#46; In terms of HFNC in asthma&#44; there is also significant paucity of evidence&#46; Kelly et al&#46; described the largest observational study to date&#44; which included 38 children younger than 2 years admitted with status asthmaticus&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> In this study the authors identified three variables associated with increased risk for intubation following HFNC trial&#58; triage RR greater than 90th percentile for age &#40;OR&#44; 2&#46;11&#59; 95&#37; CI&#44; 1&#46;01&#8211;4&#46;43&#41;&#44; initial venous <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span> greater than 50<span class="elsevierStyleHsp" style=""></span>mmHg &#40;OR&#44; 2&#46;51&#59; 95&#37; CI&#44; 1&#46;06&#8211;5&#46;98&#41;&#44; and initial venous pH less than 7&#46;30 &#40;OR&#44; 2&#46;53&#59; 95&#37; CI&#44; 1&#46;12&#8211;5&#46;74&#41;&#46; We identify heart rate and respiratory rate prior to respiratory support as factors related to failure of HFNC&#46; Also Abboud et al&#46; identified the absence of a reduction in <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span> as a predictive factor of HFNC failure in children affected by bronchiolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">27</span></a> On the other hand&#44; HFNC has been shown useful in hypoxemic&#44; not hypercapnic subjects &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">aCO2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mmHg&#41; requiring <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;4&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">We compared two groups of children treated with HFNC or NIV for SA in the PICU&#46; Except for the heart rate&#44; which was higher in the group of HFNC&#44; the two groups in our study were similar at the time of PICU admission in terms of age&#44; weight&#44; PRISM III&#44; Wood&#8211;Downes score and <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span>&#46; The reason why HR was higher in the HFNC cannot be determined retrospectively&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We found favorable outcomes in the initial cohort of NIV&#46; The absence of children requiring intubation could be interpreted as less severity of the illness&#46; If we consider that most children with asthma are intubated for &#8220;severe work of breathing&#8221; or &#8220;exhaustion&#8221;&#44; our subjects had a mean Wood&#8211;Downes score of 8 which is an indicator of severity&#46; Also&#44; we think that the fact that NIV is initiated relatively early in the course of SA management may play a role in preventing the need of invasive mechanical ventilation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">An interesting finding in our study is that in the HFNC group&#44; 8 subjects &#40;40&#37;&#41; needed to be escalated to NIV&#46; Subjects in the HFNC-success group showed similar results to those in the NIV group but those in the HFNC-failure group had a three-fold longer time of respiratory support &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; compared with the initial NIV group&#46; In addition&#44; the PICU LOS was higher compared with the same group&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Even though causality cannot be established with our study&#44; it is not unreasonable to think that HFNC&#44; which is a lower level of support&#44; could only be beneficial in selected subjects and that it could delay the initiation of NIV and therefore prolong PICU and hospital LOS&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">We performed a multivariate logistic regression analysis to identify factors associated with treatment failure in children receiving respiratory support&#46; Only heart rate and respiratory rate measured prior to ventilatory support remained in the final model&#46; According to it&#44; we noticed that children with heart rate less than 146<span class="elsevierStyleHsp" style=""></span>bpm and respiratory rate less than 55<span class="elsevierStyleHsp" style=""></span>bpm&#44; HFNC would probably not fail&#46; When heart rate is greater than 164<span class="elsevierStyleHsp" style=""></span>bpm&#44; HFNC would only be potentially successful in those children with RR less than 37<span class="elsevierStyleHsp" style=""></span>rpm&#46; In other words&#44; in the most severely affected pediatric asthma subjects&#44; it is highly likely that HFNC will fail if it is the initial mode of respiratory support applied&#46; Validation of this study&#44; in a randomized controlled trial with a larger sample&#44; would help to identify a more reliable cut-off value which could guide clinicians on an appropriate algorithm to choose one or the other treatment&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Failure criteria have been described in both groups &#40;NIV and HFNC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> The respiratory support failure is associated with increased mortality&#46; NIV is more likely to fail in hypoxemic subject<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> and HFNC in hypercapnic subject&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> It has also been pointed out that their use may delay intubation&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> Because of low sample size and absence of intubation rate&#44; we were not able to compare the differences in mortality or need for intubation&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Several limitations to our study must be mentioned&#46; On the one hand&#44; the sample size is small and there are no subjects in the NIV failure group limiting the value of our findings&#46; On the other hand&#44; this is a retrospective study with lack of randomization&#46; Also&#44; both initial therapy as well as treatment failure were determined by the attending physician preference&#46; Therefore&#44; the potential for bias is significant in terms of physician preference of one technique over the other or when to consider treatment failure&#46; We tried to manage these confounding factors by using multivariate analysis&#46; However&#44; sample size and the fact that one of the groups had different initial HR limits possible comparisons between groups&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Since this audit&#44; our current therapeutic approach&#44; as other researchers reported&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> is to use HFNC in the Emergency Department in children with mild to moderate SA&#46; Once decision is made to admit the child to PICU&#44; NIV is initiated&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0205" class="elsevierStylePara elsevierViewall">In this study comparing NIV with HFNC for SA in children&#44; we observed that early initiation of NIV in association with bronchodilators and systemic steroids is a safe and feasible initial alternative for the treatment of SA&#46; However&#44; more severe cases HFNC could potentially delay the initiation of NIV resulting in a longer stay in PICU&#44; and the consequent increase in morbidity and costs&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Author&#39;s contribution</span><p id="par0210" class="elsevierStylePara elsevierViewall">Javier Pilar&#58; Study design and writing&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Vicente Modesto i Alapont&#58; Analysis of data&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Yolanda M&#46; L&#243;pez-Fern&#225;ndez&#58; Manuscript preparation&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Olaia L&#243;pez-Macias&#58; Data collection&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Diego Garcia Urabayen&#58; Literature search&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Irene Amores Hern&#225;ndez&#58; Review of manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have not disclosed any potential conflicts of interest&#46;</p></span></span>"
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            0 => "Non-invasive ventilation"
            1 => "High-flow nasal cannula"
            2 => "Asthma exacerbation"
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            0 => "Ventilaci&#243;n no invasiva"
            1 => "Oxigenoterapia de alto flujo"
            2 => "Estatus asm&#225;tico"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The present study describes our experience with the high-flow humidified nasal cannula &#40;HFNC&#41; versus non-invasive ventilation &#40;NIV&#41; in children with severe acute asthma exacerbation &#40;SA&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational study of a retrospective cohort of 42 children with SA admitted to a Pediatric Intensive Care Unit &#40;PICU&#41; for non-invasive respiratory support was made&#46; The primary outcome measure was failure of initial respiratory support &#40;need to escalate from HFNC to NIV or from NIV to invasive ventilation&#41;&#46; Secondary outcome measures were the duration of respiratory support and PICU length of stay &#40;LOS&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forty-two children met the inclusion criteria&#46; Twenty &#40;47&#46;6&#37;&#41; received HFNC and 22 &#40;52&#46;3&#37;&#41; NIV as initial respiratory support&#46; There were no treatment failures in the NIV group&#46; However&#44; 8 children &#40;40&#37;&#41; in the HFNC group required escalation to NIV&#46; The PICU LOS was similar in both the NIV and HFNC groups&#46; However&#44; on considering the HFNC failure subgroup&#44; the median length of respiratory support was 3-fold longer &#40;63<span class="elsevierStyleHsp" style=""></span>h&#41; and the PICU LOS was also longer compared with the rest of subjects exhibiting treatment success&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Despite its obvious limitations&#44; this observational study could suggest that HFNC in some subjects with SA may delay NIV support and potentially cause longer respiratory support&#44; and longer PICU LOS&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es comparar nuestra experiencia con el uso de oxigenoterapia de alto flujo &#40;OAF&#41; frente a la ventilaci&#243;n no invasiva &#40;NIV&#41; en ni&#241;os con estatus asm&#225;tico &#40;EA&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional de una cohorte retrospectiva de 42 ni&#241;os con EA ingresados en nuestra Unidad de Cuidados Intensivos Pedi&#225;tricos &#40;UCIP&#41; con soporte respiratorio no invasivo&#46; El objetivo principal del estudio fue valorar el &#233;xito&#47;fracaso del soporte respiratorio inicial &#40;necesidad o no de escalar a un soporte respiratorio superior&#41;&#46; El objetivo secundario fue comparar la duraci&#243;n del soporte respiratorio y del ingreso en la UCIP&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cuarenta y dos ni&#241;os cumplieron con los criterios de inclusi&#243;n&#46; Veinte &#40;47&#44;6&#37;&#41; fueron tratados con OAF y 22 &#40;52&#44;3&#37;&#41; con VNI como soporte respiratorio inicial&#46; No hubo fracaso terap&#233;utico en el grupo VNI&#44; si bien 8 ni&#241;os &#40;40&#37;&#41; del grupo OAF fueron cambiados a VNI&#46; La duraci&#243;n de la estancia en la UCIP y en el hospital fue similar en ambos grupos NIV y HFNC&#46; Sin embargo&#44; en el subgrupo de fracaso de OAF&#44; la duraci&#243;n del soporte respiratorio &#40;el triple&#44; 63<span class="elsevierStyleHsp" style=""></span>h&#41; y la estancia en la UCIP fueron mucho mayores en comparaci&#243;n con los sujetos que tuvieron &#233;xito en el tratamiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este estudio observacional&#44; con sus evidentes limitaciones&#44; podr&#237;a sugerir que el uso de HFNC en algunos sujetos con EA puede retrasar el inicio de la VNI y potencialmente causar un soporte respiratorio m&#225;s prolongado y una mayor estancia en la UCIP&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of the probability of remaining free from treatment failure&#46; Log-rank test&#58; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#46; Censoring marks identify children weaned off the ventilatory support&#46; The figure shows 95&#37; confidence interval for the median&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of the probability of remaining in ventilatory support&#46; <span class="elsevierStyleItalic">Per protocol</span> sub-group analysis&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier analysis of PICU LOS &#40;days&#41;&#46; <span class="elsevierStyleItalic">Per protocol</span> sub-group analysis&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HFNC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>high-flow nasal cannula&#59; NIV<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>non-invasive ventilation&#59; <span class="elsevierStyleItalic">S</span><span class="elsevierStyleInf">pO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>saturation measured via pulse oximetry&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf">CO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>carbon dioxide tension&#59; <span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf">IO2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>fraction of inspired oxygen&#59; ED<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Emergency Department&#46; Continuous variables are expressed in median &#91;Perc 25&#44; Perc 75&#93;&#44; except &#40;&#42;&#41; in median &#40;95&#37; CI&#41;&#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" 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">HFNC&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">NIV&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 &#40;HFNC versus NIV&#41;&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"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&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"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;98 &#91;1&#46;52&#59; 4&#46;42&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;74 &#91;2&#46;77&#59; 6&#46;47&#93;&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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex &#40;&#37; men&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;8 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#47;8 &#40;77&#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;80&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"><span class="elsevierStyleItalic">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;1 &#91;10&#46;53&#59; 20&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#91;14&#46;25&#59; 21&#46;5&#93;&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;10&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"><span class="elsevierStyleItalic">PRISM III</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#91;1&#46;75&#59; 6&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#91;0&#46;25&#44; 4&#93;&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;17&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"><span class="elsevierStyleItalic">Wood&#8211;Downes score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#91;7&#59; 9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#91;7&#59; 9&#46;75&#93;&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;67&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"><span class="elsevierStyleItalic">Heart rate &#40;bpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#91;141&#59; 167&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146 &#91;136&#59; 156&#93;&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="elsevierStyleBold">0&#46;009</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"><span class="elsevierStyleItalic">Respiratory rate &#40;rpm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#91;37&#59; 57&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#91;33&#59; 50&#93;&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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">CO2</span></span><span class="elsevierStyleItalic">&#40;mmHg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#91;41&#59; 51&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#91;39&#59; 47&#46;75&#93;&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"><span class="elsevierStyleItalic">F</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">IO2</span></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6 &#91;0&#46;4&#59; 0&#46;83&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;55 &#91;0&#46;35&#59; 0&#46;8&#93;&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;38&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"><span class="elsevierStyleItalic">S</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">pO2</span></span><span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98 &#91;96&#44;100&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97 &#91;96&#59; 99&#93;&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></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time in ED &#40;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;5 &#91;4&#46;75&#59; 10&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#91;3&#59; 12&#93;&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"><span class="elsevierStyleItalic">HFNC in ED &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;18&#46;18&#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;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Outcomes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Treatment failure &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#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="elsevierStyleBold">0&#46;001</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"><span class="elsevierStyleHsp" style=""></span>Time on VS &#40;h&#41;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;5 &#40;16&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;16&#8211;30&#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;45&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"><span class="elsevierStyleHsp" style=""></span>LOS in PICU &#40;days&#41;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#8211;&#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;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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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" 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">Estimates&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">Odds ratio&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">Lower 95&#37; CI&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">Upper 95&#37; CI&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">&#40;Intercept&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;23&#46;50351&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;20<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10e&#8722;11&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;92<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>10e&#8722;18&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;00132&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="elsevierStyleBold">0&#46;006</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">HR prior to VS&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;10666&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#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">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;22&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="elsevierStyleBold">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">RR prior to VS&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;10873&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#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">0&#46;994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#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">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric status asthmaticus"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Carroll"
                            1 => "K&#46;A&#46; Sala"
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                      "doi" => "10.1016/j.ccc.2012.12.001"
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                        "tituloSerie" => "Crit Care Clin"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "153"
                        "paginaFinal" => "166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23537669"
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                          ]
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              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective randomized controlled trial on the efficacy of NIV in severe acute asthma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gupta"
                            1 => "A&#46; Nath"
                            2 => "R&#46; Agarwal"
                            3 => "D&#46; Behera"
                          ]
                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2010"
                        "volumen" => "55"
                        "paginaInicial" => "536"
                        "paginaFinal" => "543"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20420722"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Mechanical ventilation for asthma&#58; a 10-year experience"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;C&#46; Kao"
                            1 => "S&#46; Jain"
                            2 => "K&#46;K&#46; Guntupalli"
                            3 => "V&#46; Bandi"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1080/02770900801999090"
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                        "tituloSerie" => "J Asthma"
                        "fecha" => "2008"
                        "volumen" => "45"
                        "paginaInicial" => "552"
                        "paginaFinal" => "556"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18773325"
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                          ]
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                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Bratton"
                            1 => "C&#46;J&#46; Newth"
                            2 => "A&#46;F&#46; Zuppa"
                            3 => "F&#46;W&#46; Moler"
                            4 => "K&#46;L&#46; Meert"
                            5 => "R&#46;A&#46; Berg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318238b428"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "13"
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                        "paginaFinal" => "414"
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                          0 => array:2 [
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              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improved outcomes from acute severe asthma in Australian intensive care units &#40;1996&#8211;2003&#41;"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;J&#46; Stow"
                            1 => "D&#46; Pilcher"
                            2 => "J&#46; Wilson"
                            3 => "C&#46; George"
                            4 => "M&#46; Bailey"
                            5 => "T&#46; Higlett"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2006.075317"
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                        "tituloSerie" => "Thorax"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "842"
                        "paginaFinal" => "847"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17389751"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0185"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlates of prolonged hospitalization in inner-city ICU subjects receiving noninvasive and invasive positive pressure ventilation for status asthmaticus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "J&#46;P&#46; Kress"
                            2 => "J&#46; Kahn"
                            3 => "C&#46; DeRuiter"
                            4 => "A&#46; Pohlman"
                            5 => "J&#46; Hall"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2002"
                        "volumen" => "122"
                        "paginaInicial" => "1709"
                        "paginaFinal" => "1714"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12426275"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
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              ]
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              "etiqueta" => "7"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Is non-invasive ventilation safe in acute severe asthma&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Pallin"
                            1 => "M&#46; Hew"
                            2 => "M&#46; Naughton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/resp.12428"
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                        "tituloSerie" => "Respirology"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "251"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25376643"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0195"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive pressure ventilation via face mask&#46; First-line intervention in subjects with acute hypercapnic and hypoxemic respiratory failure"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;U&#46; Meduri"
                            1 => "R&#46;E&#46; Turner"
                            2 => "N&#46; Abou-Shala"
                            3 => "R&#46; Wunderink"
                            4 => "E&#46; Tolley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "109"
                        "paginaInicial" => "179"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8549183"
                            "web" => "Medline"
                          ]
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                  ]
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              "etiqueta" => "9"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Non-invasive ventilation for the treatment of status asthmaticus in children"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Carroll"
                            1 => "C&#46;M&#46; Schramm"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S1081-1206(10)60913-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Allergy Asthma Immunol"
                        "fecha" => "2006"
                        "volumen" => "96"
                        "paginaInicial" => "454"
                        "paginaFinal" => "459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16597080"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0205"
              "etiqueta" => "10"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Safety&#44; efficacy&#44; and tolerability of early initiation of noninvasive positive pressure ventilation in pediatric subjects admitted with status asthmaticus&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "G&#46; Mander"
                            2 => "J&#46; Andoh"
                            3 => "H&#46; Klaska"
                            4 => "S&#46; Verhulst"
                            5 => "J&#46; Koirala"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318238b07a"
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "393"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22067982"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0210"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive ventilation in pediatric status asthmaticus&#58; a prospective observational study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Mayordomo-Colunga"
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                            2 => "C&#46; Rey"
                            3 => "A&#46; Concha"
                            4 => "S&#46; Men&#233;ndez"
                            5 => "M&#46;L&#46; Arcos"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ppul.21466"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2011"
                        "volumen" => "46"
                        "paginaInicial" => "949"
                        "paginaFinal" => "955"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21520437"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0215"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive pressure ventilation in acute asthmatic attack"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Soroksky"
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                            2 => "E&#46; Ilgyev"
                            3 => "A&#46; Mizrachi"
                            4 => "A&#46; Miller"
                            5 => "T&#46;M&#46; Ben Yehuda"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1183/09059180.00006109"
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                        "tituloSerie" => "Eur Respir Rev"
                        "fecha" => "2010"
                        "volumen" => "19"
                        "paginaInicial" => "39"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956164"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive positive-pressure ventilation in children with lower airway obstruction"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Thill"
                            1 => "J&#46;K&#46; McGuire"
                            2 => "H&#46;P&#46; Baden"
                            3 => "T&#46;P&#46; Green"
                            4 => "P&#46;A&#46; Checchia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
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                        "volumen" => "5"
                        "paginaInicial" => "337"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15215002"
                            "web" => "Medline"
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                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Children with respiratory distress treated with high-flow nasal cannula"
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                      "doi" => "10.1177/0885066609340622"
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                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2009"
                        "volumen" => "24"
                        "paginaInicial" => "323"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19703816"
                            "web" => "Medline"
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                      ]
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                ]
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              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The evidence for high flow nasal cannula devices in infants"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Haq"
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                            3 => "M&#46;C&#46; McKean"
                            4 => "C&#46; J&#46;O&#8217;Brien"
                            5 => "M&#46; Brodlie"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.prrv.2013.12.002"
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                        "tituloSerie" => "Paediatr Respir Rev"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "124"
                        "paginaFinal" => "134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24472697"
                            "web" => "Medline"
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                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Use of high flow nasal cannula in critically ill infants&#44; children and adults&#58; a critical review of the literature"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            3 => "I&#46;M&#46; Cheifetz"
                            4 => "D&#46;A&#46; Turner"
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23143331"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0240"
              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula&#58; recommendations for daily practice in pediatrics"
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                          "etal" => true
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                            2 => "A&#46; Jacquot"
                            3 => "J&#46; Baleine"
                            4 => "S&#46; Durand"
                            5 => "M&#46;P&#46; Odena"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Intensive Care"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula oxygen therapy for infants with bronchiolitis&#58; pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "F&#46; Bogossian"
                            2 => "L&#46; O&#8217;Malley"
                            3 => "A&#46; Schibler"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Paediatr Child Health"
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                      "titulo" => "Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                    0 => array:2 [
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                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "1117"
                        "paginaFinal" => "1123"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23114231"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "20"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula use in children with respiratory distress in the emergency department&#58; predicting the need for subsequent intubation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;S&#46; Kelly"
                            1 => "H&#46;K&#46; Simon"
                            2 => "J&#46;J&#46; Sturm"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e31829e7f2f"
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                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2013"
                        "volumen" => "29"
                        "paginaInicial" => "888"
                        "paginaFinal" => "892"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23903677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0260"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of high-flow nasal cannula for acute dyspnea and hypoxemia in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Rittayamai"
                            1 => "J&#46; Tscheikuna"
                            2 => "N&#46; Praphruetkit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.03837"
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                        "tituloSerie" => "Respir Care"
                        "fecha" => "2015"
                        "volumen" => "60"
                        "paginaInicial" => "1377"
                        "paginaFinal" => "1382"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26060321"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "22"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-flow nasal cannula &#40;HFNC&#41; support in interhospital transport of critically ill children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46;J&#46; Schlapbach"
                            1 => "J&#46; Schaefer"
                            2 => "A&#46;M&#46; Brady"
                            3 => "S&#46; Mayfield"
                            4 => "A&#46; Schibler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-014-3226-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "paginaInicial" => "592"
                        "paginaFinal" => "599"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24531340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is there a role for humidified heated high-flow nasal cannula therapy in pediatric emergency departments&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Long"
                            1 => "F&#46;E&#46; Babl"
                            2 => "T&#46; Duke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/emermed-2015-204914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Emerg Med J"
                        "fecha" => "2016"
                        "volumen" => "33"
                        "paginaInicial" => "386"
                        "paginaFinal" => "389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26727972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of mechanical ventilation for asthma exacerbations&#58; analysis of a national database"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Nanchal"
                            1 => "G&#46; Kumar"
                            2 => "T&#46; Majumdar"
                            3 => "A&#46; Taneja"
                            4 => "J&#46; Patel"
                            5 => "G&#46; Dagar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.02505"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2014"
                        "volumen" => "59"
                        "paginaInicial" => "644"
                        "paginaFinal" => "653"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24106317"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
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              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective and randomized study for improvement of acute asthma by non-Invasive positive pressure ventilation &#40;NPPV&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "M&#46; Hino"
                            2 => "K&#46; Kida"
                            3 => "S&#46; Kudoh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2008"
                        "volumen" => "47"
                        "paginaInicial" => "493"
                        "paginaFinal" => "501"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18344635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Noninvasive ventilation in acute asthma"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Pallin"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2014.03.011"
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                        "tituloSerie" => "J Crit Care"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "586"
                        "paginaFinal" => "593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24735521"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure"
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                          "autores" => array:6 [
                            0 => "J&#46;P&#46; Frat"
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                            3 => "C&#46; Girault"
                            4 => "S&#46; Ragot"
                            5 => "S&#46; Perbet"
                          ]
                        ]
                      ]
                    ]
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "372"
                        "paginaInicial" => "2185"
                        "paginaFinal" => "2196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25981908"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "Predictors of failure in infants with viral bronchiolitis treated with high-flow&#44; high-humidity nasal cannula therapy"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            2 => "C&#46;L&#46; Skiles"
                            3 => "A&#46; Stolfi"
                            4 => "M&#46;E&#46; Rowin"
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                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e31825b546f"
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "e343"
                        "paginaFinal" => "e349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22805160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benefits and risks of success or failure of noninvasive ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Demoule"
                            1 => "E&#46; Girou"
                            2 => "J&#46;C&#46; Richard"
                            3 => "S&#46; Taille"
                            4 => "L&#46; Brochard"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-006-0324-1"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "1756"
                        "paginaFinal" => "1765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17019559"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Noninvasive positive-pressure ventilation for respiratory failure after extubation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Esteban"
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                            3 => "Y&#46; Arabi"
                            4 => "C&#46; Apeztegu&#237;a"
                            5 => "M&#46; Gonz&#225;lez"
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                      ]
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                    0 => array:2 [
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2004"
                        "volumen" => "350"
                        "paginaInicial" => "2452"
                        "paginaFinal" => "2460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15190137"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Failure of high-flow nasal cannula therapy may delay intubation and increase mortality"
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                            0 => "B&#46;J&#46; Kang"
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                            2 => "C&#46;M&#46; Lim"
                            3 => "J&#46;W&#46; Huh"
                            4 => "S&#46; Baek"
                            5 => "M&#46; Han"
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                        ]
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                    ]
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