array:23 [
  "pii" => "S0210569119302311"
  "issn" => "02105691"
  "doi" => "10.1016/j.medin.2019.09.013"
  "estado" => "S300"
  "fechaPublicacion" => "2020-03-01"
  "aid" => "1397"
  "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2020;44:69-71"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 8
    "formatos" => array:2 [
      "HTML" => 4
      "PDF" => 4
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0210569118302444"
    "issn" => "02105691"
    "doi" => "10.1016/j.medin.2018.07.015"
    "estado" => "S300"
    "fechaPublicacion" => "2020-03-01"
    "aid" => "1255"
    "copyright" => "Elsevier España, S.L.U. y SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2020;44:72-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 33
      "formatos" => array:3 [
        "EPUB" => 5
        "HTML" => 11
        "PDF" => 17
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Evaluaci&#243;n sobre la t&#233;cnica de compresiones tor&#225;cicas usando APP&#46; &#191;Ayudan o entorpecen la reanimaci&#243;n cardiopulmonar&#63;"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "72"
          "paginaFinal" => "79"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Evaluation of the thoracic compression technique using APPs&#46; Do they help or hinder cardiopulmonary resuscitation&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1375
              "Ancho" => 2500
              "Tamanyo" => 212202
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Diagrama de la investigaci&#243;n&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Fern&#225;ndez-M&#233;ndez, R&#46; Barcala-Furelos, M&#46; Otero-Agra, M&#46; Fern&#225;ndez-M&#233;ndez, M&#46; Santos-Folgar, A&#46; Rodr&#237;guez-N&#250;&#241;ez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Fern&#225;ndez-M&#233;ndez"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Barcala-Furelos"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Otero-Agra"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Fern&#225;ndez-M&#233;ndez"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Santos-Folgar"
            ]
            5 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Rodr&#237;guez-N&#250;&#241;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173572719302140"
        "doi" => "10.1016/j.medine.2018.07.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719302140?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118302444?idApp=WMIE"
    "url" => "/02105691/0000004400000002/v1_202002230623/S0210569118302444/v1_202002230623/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S0210569119301986"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2019.07.014"
      "estado" => "S300"
      "fechaPublicacion" => "2020-03-01"
      "aid" => "1382"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2020;44:96-100"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1
        "HTML" => 1
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit&#58; An efficacy and safety comparison study"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "es"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "96"
            "paginaFinal" => "100"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Inserci&#243;n tradicional versus eco-dirigida de cat&#233;teres venosos femorales en la unidad de cuidados intensivos pedi&#225;tricos&#58; un estudio comparativo de eficacia y seguridad"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "es" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46;F&#46; Pietroboni, C&#46;M&#46; Carvajal, Y&#46;I&#46; Zuleta, P&#46;L&#46; Ortiz, Y&#46;C&#46; Lucero, M&#46; Drago, B&#46; vonDessauer"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "P&#46;F&#46;"
                "apellidos" => "Pietroboni"
              ]
              1 => array:2 [
                "nombre" => "C&#46;M&#46;"
                "apellidos" => "Carvajal"
              ]
              2 => array:2 [
                "nombre" => "Y&#46;I&#46;"
                "apellidos" => "Zuleta"
              ]
              3 => array:2 [
                "nombre" => "P&#46;L&#46;"
                "apellidos" => "Ortiz"
              ]
              4 => array:2 [
                "nombre" => "Y&#46;C&#46;"
                "apellidos" => "Lucero"
              ]
              5 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Drago"
              ]
              6 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "vonDessauer"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572720300102"
          "doi" => "10.1016/j.medine.2019.09.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300102?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119301986?idApp=WMIE"
      "url" => "/02105691/0000004400000002/v1_202002230623/S0210569119301986/v1_202002230623/en/main.assets"
    ]
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Central venous cannulation in the critically ill pediatric patient&#58; Another victory for ultrasound"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "69"
        "paginaFinal" => "71"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "P&#46; Blanco"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Blanco"
            "email" => array:1 [
              0 => "ohtusabes@gmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Intensive Care Physician&#44; Intensive Care Unit&#44; Cl&#237;nica Cruz Azul&#44; 2651&#44; 60 St&#46;&#44; Necochea 7630&#44; Argentina"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Canulaci&#243;n venosa central en el paciente cr&#237;tico pedi&#225;trico&#58; otra victoria de la ecograf&#237;a"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1123
            "Ancho" => 1500
            "Tamanyo" => 197044
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Real-time techniques for ultrasound-guided vascular cannulation&#46; Upper panel&#58; short axis&#44; out-of-plane technique&#46; &#40;a&#41; The needle is inserted at the middle of the transducer and then is advanced&#59; &#40;b&#41; Corresponding ultrasound images&#46; The needle is observed as an echogenic spot &#40;arrow&#41; along with flattening of the anterior vessel wall&#46; Lower panel&#58; long axis&#44; in- plane technique&#58; &#40;c&#41; The needle is inserted and advanced from one corner of the transducer&#59; &#40;d&#41; Corresponding ultrasound images&#46; The needle is entirely observed &#40;arrows&#41;&#44; including the bevel &#40;arrowhead&#41; inside the vessel&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound &#40;POCUS&#41; has revolutionized the care of the critically ill patient&#44; serving as a useful tool in the diagnosis and monitoring of a wide range of clinical scenarios&#44; and providing interventional guidance as well&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Regarding the last point&#44; ultrasound-guided central venous cannulation &#40;USCVC&#41; is the main procedure performed in the intensive care unit &#40;ICU&#41; adult patient&#44; although it is not used as frequently as expected&#44; since approximately half of the central venous catheters are placed under ultrasound guidance&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The evidence for USCVC in the critically ill adult patient is clear&#46; Improved cannulation success and reduced complications such as arterial puncture are well demonstrated&#44; strongly indicating that all cannulations should be performed under ultrasound guidance&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> For the critically ill pediatric patient&#44; the evidence is more limited&#46; In this regard&#44; the study of Pietroboni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> provides light in that issue and confirmed what was a priori expected&#58; USCVC &#40;femoral vein&#41; is better than the landmark technique&#46; Selection of this vein for cannulation looks wise since it avoids any possibility of needle-stick injury of the pleura or the carotid artery which could add serious morbidity to the patient when attempting veins of the upper body&#44; and also because&#44; in the pediatric field&#44; the femoral catheters have similar rates of infection when compared with non-femoral catheters&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Improved cannulation of this vein and reduced arterial puncture using ultrasound guidance when compared with the traditional technique are the key findings of this study&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition&#44; several other points of this investigation are worth mentioning&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly&#44; to perform USCVC with proficiency&#44; intensivists must be properly trained&#46; Otherwise&#44; cannulation success is compromised and&#44; more importantly&#44; patient safety is at risk&#46; In this study&#44; intensivists&#8217; training for USCVC was achieved through a combination of 2-h theory and 2-h practice in vascular phantom models&#46; Although this short 4-h training sounds enough at first glance&#44; it is important to know how many &#8220;real&#8221; USCVC were performed by these practitioners before the study&#44; since if experienced practitioners performed most cannulations&#44; this could explain the favorable results observed in the USCVC group&#46; However&#44; a point of this training merits consideration and is worth to be reinforced&#58; using phantoms is a &#8220;must do&#8221;&#46; Using vascular phantoms helps trainees to learn all the practical variables of the procedure&#44; without putting any patient at risk&#46; Several phantom models have been created and although a &#8220;champion phantom&#8221; does not seem to exist&#44; one model deserves attention&#58; those created with chicken breast &#40;simulating the background echogenicity&#41; and modeling balloons &#40;simulating the vessels&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> This phantom replicates accurately the ultrasound appearance of vessels and surrounding tissues and&#44; what is also important&#44; the resistance of the tissues as the needle is advanced&#46; In addition&#44; it is reusable&#44; affordable&#44; and allows practitioners to perform multiple punctures over the entire training session given that balloons &#40;vessels&#41; are easily filled and replaced&#46; Also&#44; varying degrees of complexity can be created&#44; for example&#44; changing vessel depth and&#47;or using smaller or even partially filled balloons&#44; simulating hypovolemic veins&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Secondly&#44; a few comments regarding the USCVC approach and the vein size&#46; As it is known&#44; the out-of-plane and the in-plane technique have advantages and disadvantages&#44; and one or the other can be chosen based not only on operator preference&#44; but also considering other characteristics such as the size of the vein or the spatial relation between the vein and the artery&#46; Briefly&#44; the out-of-plane cannulation technique is performed when the vessel is in the short axis&#44; and&#44; after the vein is centered on the screen&#44; the needle is inserted at the middle of the transducer and then is advanced intersecting the ultrasound beam&#46; The needle is visualized as an echogenic spot entering from superficial tissues up to the desired vessel&#59; movement of superficial tissues and flattening of the anterior vessel wall are also observed as the needle is advanced &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a and b&#41;&#46; Since the needle tip often exceeds the body of the transducer as is inserted&#44; the needle shaft and needle tip cannot be clearly differentiated in this approach&#46; The out-of-plane technique is better to control the needle at the sides of the vein&#44; and thus preferable to be used when the vein is next to the artery&#46; Also&#44; when the vein is large and close to the transducer&#44; the out-of-plane technique offers a rapid way for the needle to enter into the vein&#44; without wasting time or adding extra complexity if an in-plane technique is attempted &#40;see below&#41;&#46; While distinguishing the needle tip versus the needle shaft can be challenging when using the out-of-plane approach and this is a key factor that is associated with an increased incidence of perforation of the posterior vessel wall&#44; the walkdown or &#8220;follow the tip&#8221; maneuver aids in improving needle tip recognition and should be routinely used in out-of-plane cannulations&#46;<span class="elsevierStyleSup">3</span> The in-plane cannulation technique is performed when the vessel is in the long or in the oblique-axis&#44; and the needle is inserted and advanced from one corner of the transducer following the path of the ultrasound beam&#59; the needle is clearly depicted &#40;shaft and tip&#41; as advanced from superficial tissues up to the desired vessel &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c and d&#41;&#46; To do this accurately&#44; an excellent alignment between the ultrasound beam and the needle is required with this approach&#44; otherwise&#44; cannulation will not be successful and complications may arise&#44; such as posterior vessel wall perforation or injuring a structure at the sides of the desired vessel&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In contrast to the out-of-plane technique&#44; the in-plane approach offers a better control of the needle tip and thus&#44; for example&#44; when the vein is mounted over the artery&#44; aids in controlling the needle tip and minimizing the risk of perforating the posterior venous wall and puncturing the artery&#46; It would be important to know which approach was preferred in this investigation&#44; the reasons behind it and if there is a difference between the two approaches in cannulation outcomes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding vein size&#44; it would be interesting to detail if in this study a cut-off vein diameter was related with more feasible ultrasound-guided cannulations&#46; For example&#44; in adults&#44; this is &#62;7<span class="elsevierStyleHsp" style=""></span>mm for central veins&#44; and &#62;4<span class="elsevierStyleHsp" style=""></span>mm for peripheral veins&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;10</span></a> Knowing the vein size is also of value when selecting the catheter size&#44; since intuitively smaller catheters are suitable for smaller veins&#44; and vice versa&#46; Among other variables&#44; a catheter occupying a large proportion of the vein lumen predisposes to vein thrombosis and infection&#46; While the catheter size is often selected based on clinical needs &#40;e&#46;g&#46;&#44; hemodialysis catheters are necessarily bigger than a simple central catheter&#41;&#44; as a rule of thumb&#44; for the most common types of central venous lines&#44; the AP diameter of the vein indicates the maximum catheter Fr that should be selected for cannulation&#46; For example&#44; a 5-Fr catheter is suitable for a 5-mm or bigger vein&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; although more studies using ultrasound as a guidance to cannulate the femoral vein are needed&#44; trained operators should use ultrasound guidance each time they need to cannulate this vein&#44; since its benefits seem to overcome its drawbacks&#46; As stated by authors&#44; further investigations about the role of ultrasound guidance to cannulate other central veins are necessary in pediatrics&#44; as well as to cannulate peripheral veins&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This work has not been presented at any conferences&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1123
            "Ancho" => 1500
            "Tamanyo" => 197044
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Real-time techniques for ultrasound-guided vascular cannulation&#46; Upper panel&#58; short axis&#44; out-of-plane technique&#46; &#40;a&#41; The needle is inserted at the middle of the transducer and then is advanced&#59; &#40;b&#41; Corresponding ultrasound images&#46; The needle is observed as an echogenic spot &#40;arrow&#41; along with flattening of the anterior vessel wall&#46; Lower panel&#58; long axis&#44; in- plane technique&#58; &#40;c&#41; The needle is inserted and advanced from one corner of the transducer&#59; &#40;d&#41; Corresponding ultrasound images&#46; The needle is entirely observed &#40;arrows&#41;&#44; including the bevel &#40;arrowhead&#41; inside the vessel&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A traditional paradigm vs&#46; an ultrasound-supported paradigm in emergency and critical care medicine&#58; a crisis of the mind is needed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2015.02.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "49"
                        "paginaInicial" => "e63"
                        "paginaFinal" => "e64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26014762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasound in intensive care units&#58; assessment of 1073 procedures in a multicentric&#44; prospective&#44; observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Zieleskiewicz"
                            1 => "L&#46; Muller"
                            2 => "K&#46; Lakhal"
                            3 => "Z&#46; Meresse"
                            4 => "C&#46; Arbelot"
                            5 => "P&#46;M&#46; Bertrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-015-3952-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1638"
                        "paginaFinal" => "1647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided vascular cannulation in critical care patients&#58; a practical review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "PMed Intensiva"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "560"
                        "paginaFinal" => "571"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for performing ultrasound guided vascular cannulation&#58; recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Troianos"
                            1 => "G&#46;S&#46; Hartman"
                            2 => "K&#46;E&#46; Glas"
                            3 => "N&#46;J&#46; Skubas"
                            4 => "R&#46;T&#46; Eberhardt"
                            5 => "J&#46;D&#46; Walker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2011.09.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "1291"
                        "paginaFinal" => "1318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lamperti"
                            1 => "A&#46;R&#46; Bodenham"
                            2 => "M&#46; Pittiruti"
                            3 => "M&#46; Blaivas"
                            4 => "J&#46;G&#46; Augoustides"
                            5 => "M&#46; Elbarbary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2597-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit&#58; an efficacy and safety comparison study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Pietroboni"
                            1 => "C&#46; Carvajal"
                            2 => "Y&#46; Zuleta"
                            3 => "Y&#46; Lucero"
                            4 => "P&#46; Ort&#237;z"
                            5 => "M&#46; Drago"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2020"
                        "volumen" => "44"
                        "paginaInicial" => "96"
                        "paginaFinal" => "100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central venous catheter use in the pediatric patient&#58; mechanical and infectious complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;C&#46; de Jonge"
                            1 => "K&#46;H&#46; Polderman"
                            2 => "R&#46;J&#46; Gemke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.PCC.0000161074.94315.0A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "6"
                        "paginaInicial" => "329"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15857534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An affordable and easily constructed model for training in ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Rippey"
                            1 => "P&#46; Blanco"
                            2 => "P&#46;J&#46; Carr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5301/jva.5000384"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Access"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "422"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26349885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and application of model for training ultrasound-guided vascular cannulation in pediatric patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "O&#46; P&#233;rez-Quevedo"
                            1 => "J&#46;M&#46; L&#243;pez-&#193;lvarez"
                            2 => "J&#46;M&#46; Limi&#241;ana-Ca&#241;al"
                            3 => "J&#46;F&#46; Loro-Ferrer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2015.11.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "364"
                        "paginaFinal" => "370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26746125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;D&#46; Witting"
                            1 => "S&#46;M&#46; Schenkel"
                            2 => "B&#46;J&#46; Lawner"
                            3 => "B&#46;D&#46; Euerle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2009.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "70"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19272730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02105691/0000004400000002/v1_202002230623/S0210569119302311/v1_202002230623/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "443"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004400000002/v1_202002230623/S0210569119302311/v1_202002230623/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302311?idApp=WMIE"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Editorial
Central venous cannulation in the critically ill pediatric patient: Another victory for ultrasound
Canulación venosa central en el paciente crítico pediátrico: otra victoria de la ecografía
P. Blanco
Intensive Care Physician, Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea 7630, Argentina
Leído
5135
Veces
se ha leído el artículo
1875
Total PDF
3260
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S0210569119302311"
  "issn" => "02105691"
  "doi" => "10.1016/j.medin.2019.09.013"
  "estado" => "S300"
  "fechaPublicacion" => "2020-03-01"
  "aid" => "1397"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Med Intensiva. 2020;44:69-71"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 8
    "formatos" => array:2 [
      "HTML" => 4
      "PDF" => 4
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0210569118302444"
    "issn" => "02105691"
    "doi" => "10.1016/j.medin.2018.07.015"
    "estado" => "S300"
    "fechaPublicacion" => "2020-03-01"
    "aid" => "1255"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2020;44:72-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 33
      "formatos" => array:3 [
        "EPUB" => 5
        "HTML" => 11
        "PDF" => 17
      ]
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Evaluaci&#243;n sobre la t&#233;cnica de compresiones tor&#225;cicas usando APP&#46; &#191;Ayudan o entorpecen la reanimaci&#243;n cardiopulmonar&#63;"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "72"
          "paginaFinal" => "79"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Evaluation of the thoracic compression technique using APPs&#46; Do they help or hinder cardiopulmonary resuscitation&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1375
              "Ancho" => 2500
              "Tamanyo" => 212202
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Diagrama de la investigaci&#243;n&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#46; Fern&#225;ndez-M&#233;ndez, R&#46; Barcala-Furelos, M&#46; Otero-Agra, M&#46; Fern&#225;ndez-M&#233;ndez, M&#46; Santos-Folgar, A&#46; Rodr&#237;guez-N&#250;&#241;ez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Fern&#225;ndez-M&#233;ndez"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Barcala-Furelos"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Otero-Agra"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Fern&#225;ndez-M&#233;ndez"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Santos-Folgar"
            ]
            5 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Rodr&#237;guez-N&#250;&#241;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173572719302140"
        "doi" => "10.1016/j.medine.2018.07.016"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719302140?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569118302444?idApp=WMIE"
    "url" => "/02105691/0000004400000002/v1_202002230623/S0210569118302444/v1_202002230623/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S0210569119301986"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2019.07.014"
      "estado" => "S300"
      "fechaPublicacion" => "2020-03-01"
      "aid" => "1382"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2020;44:96-100"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1
        "HTML" => 1
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit&#58; An efficacy and safety comparison study"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "es"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "96"
            "paginaFinal" => "100"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Inserci&#243;n tradicional versus eco-dirigida de cat&#233;teres venosos femorales en la unidad de cuidados intensivos pedi&#225;tricos&#58; un estudio comparativo de eficacia y seguridad"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "es" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "P&#46;F&#46; Pietroboni, C&#46;M&#46; Carvajal, Y&#46;I&#46; Zuleta, P&#46;L&#46; Ortiz, Y&#46;C&#46; Lucero, M&#46; Drago, B&#46; vonDessauer"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "P&#46;F&#46;"
                "apellidos" => "Pietroboni"
              ]
              1 => array:2 [
                "nombre" => "C&#46;M&#46;"
                "apellidos" => "Carvajal"
              ]
              2 => array:2 [
                "nombre" => "Y&#46;I&#46;"
                "apellidos" => "Zuleta"
              ]
              3 => array:2 [
                "nombre" => "P&#46;L&#46;"
                "apellidos" => "Ortiz"
              ]
              4 => array:2 [
                "nombre" => "Y&#46;C&#46;"
                "apellidos" => "Lucero"
              ]
              5 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Drago"
              ]
              6 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "vonDessauer"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572720300102"
          "doi" => "10.1016/j.medine.2019.09.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572720300102?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119301986?idApp=WMIE"
      "url" => "/02105691/0000004400000002/v1_202002230623/S0210569119301986/v1_202002230623/en/main.assets"
    ]
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Central venous cannulation in the critically ill pediatric patient&#58; Another victory for ultrasound"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "69"
        "paginaFinal" => "71"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "P&#46; Blanco"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Blanco"
            "email" => array:1 [
              0 => "ohtusabes@gmail.com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Intensive Care Physician&#44; Intensive Care Unit&#44; Cl&#237;nica Cruz Azul&#44; 2651&#44; 60 St&#46;&#44; Necochea 7630&#44; Argentina"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Canulaci&#243;n venosa central en el paciente cr&#237;tico pedi&#225;trico&#58; otra victoria de la ecograf&#237;a"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1123
            "Ancho" => 1500
            "Tamanyo" => 197044
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Real-time techniques for ultrasound-guided vascular cannulation&#46; Upper panel&#58; short axis&#44; out-of-plane technique&#46; &#40;a&#41; The needle is inserted at the middle of the transducer and then is advanced&#59; &#40;b&#41; Corresponding ultrasound images&#46; The needle is observed as an echogenic spot &#40;arrow&#41; along with flattening of the anterior vessel wall&#46; Lower panel&#58; long axis&#44; in- plane technique&#58; &#40;c&#41; The needle is inserted and advanced from one corner of the transducer&#59; &#40;d&#41; Corresponding ultrasound images&#46; The needle is entirely observed &#40;arrows&#41;&#44; including the bevel &#40;arrowhead&#41; inside the vessel&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound &#40;POCUS&#41; has revolutionized the care of the critically ill patient&#44; serving as a useful tool in the diagnosis and monitoring of a wide range of clinical scenarios&#44; and providing interventional guidance as well&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Regarding the last point&#44; ultrasound-guided central venous cannulation &#40;USCVC&#41; is the main procedure performed in the intensive care unit &#40;ICU&#41; adult patient&#44; although it is not used as frequently as expected&#44; since approximately half of the central venous catheters are placed under ultrasound guidance&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The evidence for USCVC in the critically ill adult patient is clear&#46; Improved cannulation success and reduced complications such as arterial puncture are well demonstrated&#44; strongly indicating that all cannulations should be performed under ultrasound guidance&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> For the critically ill pediatric patient&#44; the evidence is more limited&#46; In this regard&#44; the study of Pietroboni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> provides light in that issue and confirmed what was a priori expected&#58; USCVC &#40;femoral vein&#41; is better than the landmark technique&#46; Selection of this vein for cannulation looks wise since it avoids any possibility of needle-stick injury of the pleura or the carotid artery which could add serious morbidity to the patient when attempting veins of the upper body&#44; and also because&#44; in the pediatric field&#44; the femoral catheters have similar rates of infection when compared with non-femoral catheters&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Improved cannulation of this vein and reduced arterial puncture using ultrasound guidance when compared with the traditional technique are the key findings of this study&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition&#44; several other points of this investigation are worth mentioning&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly&#44; to perform USCVC with proficiency&#44; intensivists must be properly trained&#46; Otherwise&#44; cannulation success is compromised and&#44; more importantly&#44; patient safety is at risk&#46; In this study&#44; intensivists&#8217; training for USCVC was achieved through a combination of 2-h theory and 2-h practice in vascular phantom models&#46; Although this short 4-h training sounds enough at first glance&#44; it is important to know how many &#8220;real&#8221; USCVC were performed by these practitioners before the study&#44; since if experienced practitioners performed most cannulations&#44; this could explain the favorable results observed in the USCVC group&#46; However&#44; a point of this training merits consideration and is worth to be reinforced&#58; using phantoms is a &#8220;must do&#8221;&#46; Using vascular phantoms helps trainees to learn all the practical variables of the procedure&#44; without putting any patient at risk&#46; Several phantom models have been created and although a &#8220;champion phantom&#8221; does not seem to exist&#44; one model deserves attention&#58; those created with chicken breast &#40;simulating the background echogenicity&#41; and modeling balloons &#40;simulating the vessels&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> This phantom replicates accurately the ultrasound appearance of vessels and surrounding tissues and&#44; what is also important&#44; the resistance of the tissues as the needle is advanced&#46; In addition&#44; it is reusable&#44; affordable&#44; and allows practitioners to perform multiple punctures over the entire training session given that balloons &#40;vessels&#41; are easily filled and replaced&#46; Also&#44; varying degrees of complexity can be created&#44; for example&#44; changing vessel depth and&#47;or using smaller or even partially filled balloons&#44; simulating hypovolemic veins&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Secondly&#44; a few comments regarding the USCVC approach and the vein size&#46; As it is known&#44; the out-of-plane and the in-plane technique have advantages and disadvantages&#44; and one or the other can be chosen based not only on operator preference&#44; but also considering other characteristics such as the size of the vein or the spatial relation between the vein and the artery&#46; Briefly&#44; the out-of-plane cannulation technique is performed when the vessel is in the short axis&#44; and&#44; after the vein is centered on the screen&#44; the needle is inserted at the middle of the transducer and then is advanced intersecting the ultrasound beam&#46; The needle is visualized as an echogenic spot entering from superficial tissues up to the desired vessel&#59; movement of superficial tissues and flattening of the anterior vessel wall are also observed as the needle is advanced &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a and b&#41;&#46; Since the needle tip often exceeds the body of the transducer as is inserted&#44; the needle shaft and needle tip cannot be clearly differentiated in this approach&#46; The out-of-plane technique is better to control the needle at the sides of the vein&#44; and thus preferable to be used when the vein is next to the artery&#46; Also&#44; when the vein is large and close to the transducer&#44; the out-of-plane technique offers a rapid way for the needle to enter into the vein&#44; without wasting time or adding extra complexity if an in-plane technique is attempted &#40;see below&#41;&#46; While distinguishing the needle tip versus the needle shaft can be challenging when using the out-of-plane approach and this is a key factor that is associated with an increased incidence of perforation of the posterior vessel wall&#44; the walkdown or &#8220;follow the tip&#8221; maneuver aids in improving needle tip recognition and should be routinely used in out-of-plane cannulations&#46;<span class="elsevierStyleSup">3</span> The in-plane cannulation technique is performed when the vessel is in the long or in the oblique-axis&#44; and the needle is inserted and advanced from one corner of the transducer following the path of the ultrasound beam&#59; the needle is clearly depicted &#40;shaft and tip&#41; as advanced from superficial tissues up to the desired vessel &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>c and d&#41;&#46; To do this accurately&#44; an excellent alignment between the ultrasound beam and the needle is required with this approach&#44; otherwise&#44; cannulation will not be successful and complications may arise&#44; such as posterior vessel wall perforation or injuring a structure at the sides of the desired vessel&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In contrast to the out-of-plane technique&#44; the in-plane approach offers a better control of the needle tip and thus&#44; for example&#44; when the vein is mounted over the artery&#44; aids in controlling the needle tip and minimizing the risk of perforating the posterior venous wall and puncturing the artery&#46; It would be important to know which approach was preferred in this investigation&#44; the reasons behind it and if there is a difference between the two approaches in cannulation outcomes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding vein size&#44; it would be interesting to detail if in this study a cut-off vein diameter was related with more feasible ultrasound-guided cannulations&#46; For example&#44; in adults&#44; this is &#62;7<span class="elsevierStyleHsp" style=""></span>mm for central veins&#44; and &#62;4<span class="elsevierStyleHsp" style=""></span>mm for peripheral veins&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4&#44;10</span></a> Knowing the vein size is also of value when selecting the catheter size&#44; since intuitively smaller catheters are suitable for smaller veins&#44; and vice versa&#46; Among other variables&#44; a catheter occupying a large proportion of the vein lumen predisposes to vein thrombosis and infection&#46; While the catheter size is often selected based on clinical needs &#40;e&#46;g&#46;&#44; hemodialysis catheters are necessarily bigger than a simple central catheter&#41;&#44; as a rule of thumb&#44; for the most common types of central venous lines&#44; the AP diameter of the vein indicates the maximum catheter Fr that should be selected for cannulation&#46; For example&#44; a 5-Fr catheter is suitable for a 5-mm or bigger vein&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; although more studies using ultrasound as a guidance to cannulate the femoral vein are needed&#44; trained operators should use ultrasound guidance each time they need to cannulate this vein&#44; since its benefits seem to overcome its drawbacks&#46; As stated by authors&#44; further investigations about the role of ultrasound guidance to cannulate other central veins are necessary in pediatrics&#44; as well as to cannulate peripheral veins&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">This work has not been presented at any conferences&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1123
            "Ancho" => 1500
            "Tamanyo" => 197044
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Real-time techniques for ultrasound-guided vascular cannulation&#46; Upper panel&#58; short axis&#44; out-of-plane technique&#46; &#40;a&#41; The needle is inserted at the middle of the transducer and then is advanced&#59; &#40;b&#41; Corresponding ultrasound images&#46; The needle is observed as an echogenic spot &#40;arrow&#41; along with flattening of the anterior vessel wall&#46; Lower panel&#58; long axis&#44; in- plane technique&#58; &#40;c&#41; The needle is inserted and advanced from one corner of the transducer&#59; &#40;d&#41; Corresponding ultrasound images&#46; The needle is entirely observed &#40;arrows&#41;&#44; including the bevel &#40;arrowhead&#41; inside the vessel&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A traditional paradigm vs&#46; an ultrasound-supported paradigm in emergency and critical care medicine&#58; a crisis of the mind is needed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2015.02.045"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "49"
                        "paginaInicial" => "e63"
                        "paginaFinal" => "e64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26014762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasound in intensive care units&#58; assessment of 1073 procedures in a multicentric&#44; prospective&#44; observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Zieleskiewicz"
                            1 => "L&#46; Muller"
                            2 => "K&#46; Lakhal"
                            3 => "Z&#46; Meresse"
                            4 => "C&#46; Arbelot"
                            5 => "P&#46;M&#46; Bertrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-015-3952-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "1638"
                        "paginaFinal" => "1647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26160727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided vascular cannulation in critical care patients&#58; a practical review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Blanco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "PMed Intensiva"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "560"
                        "paginaFinal" => "571"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for performing ultrasound guided vascular cannulation&#58; recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Troianos"
                            1 => "G&#46;S&#46; Hartman"
                            2 => "K&#46;E&#46; Glas"
                            3 => "N&#46;J&#46; Skubas"
                            4 => "R&#46;T&#46; Eberhardt"
                            5 => "J&#46;D&#46; Walker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.echo.2011.09.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Echocardiogr"
                        "fecha" => "2011"
                        "volumen" => "24"
                        "paginaInicial" => "1291"
                        "paginaFinal" => "1318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lamperti"
                            1 => "A&#46;R&#46; Bodenham"
                            2 => "M&#46; Pittiruti"
                            3 => "M&#46; Blaivas"
                            4 => "J&#46;G&#46; Augoustides"
                            5 => "M&#46; Elbarbary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2597-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Landmark versus ultrasound-guided insertion of femoral venous catheters in the pediatric intensive care unit&#58; an efficacy and safety comparison study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Pietroboni"
                            1 => "C&#46; Carvajal"
                            2 => "Y&#46; Zuleta"
                            3 => "Y&#46; Lucero"
                            4 => "P&#46; Ort&#237;z"
                            5 => "M&#46; Drago"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2020"
                        "volumen" => "44"
                        "paginaInicial" => "96"
                        "paginaFinal" => "100"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central venous catheter use in the pediatric patient&#58; mechanical and infectious complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;C&#46; de Jonge"
                            1 => "K&#46;H&#46; Polderman"
                            2 => "R&#46;J&#46; Gemke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.PCC.0000161074.94315.0A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "6"
                        "paginaInicial" => "329"
                        "paginaFinal" => "339"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15857534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An affordable and easily constructed model for training in ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Rippey"
                            1 => "P&#46; Blanco"
                            2 => "P&#46;J&#46; Carr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5301/jva.5000384"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Access"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "422"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26349885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Design and application of model for training ultrasound-guided vascular cannulation in pediatric patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "O&#46; P&#233;rez-Quevedo"
                            1 => "J&#46;M&#46; L&#243;pez-&#193;lvarez"
                            2 => "J&#46;M&#46; Limi&#241;ana-Ca&#241;al"
                            3 => "J&#46;F&#46; Loro-Ferrer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2015.11.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2016"
                        "volumen" => "40"
                        "paginaInicial" => "364"
                        "paginaFinal" => "370"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26746125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;D&#46; Witting"
                            1 => "S&#46;M&#46; Schenkel"
                            2 => "B&#46;J&#46; Lawner"
                            3 => "B&#46;D&#46; Euerle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2009.01.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "39"
                        "paginaInicial" => "70"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19272730"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02105691/0000004400000002/v1_202002230623/S0210569119302311/v1_202002230623/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "443"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02105691/0000004400000002/v1_202002230623/S0210569119302311/v1_202002230623/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569119302311?idApp=WMIE"
]
Información del artículo
ISSN: 02105691
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 3 6 9
2024 Octubre 62 67 129
2024 Septiembre 73 35 108
2024 Agosto 58 46 104
2024 Julio 70 27 97
2024 Junio 90 42 132
2024 Mayo 64 50 114
2024 Abril 70 38 108
2024 Marzo 72 34 106
2024 Febrero 50 34 84
2024 Enero 65 34 99
2023 Diciembre 48 28 76
2023 Noviembre 67 49 116
2023 Octubre 57 28 85
2023 Septiembre 58 36 94
2023 Agosto 38 14 52
2023 Julio 70 31 101
2023 Junio 61 30 91
2023 Mayo 58 35 93
2023 Abril 42 22 64
2023 Marzo 68 30 98
2023 Febrero 62 26 88
2023 Enero 65 23 88
2022 Diciembre 66 39 105
2022 Noviembre 58 40 98
2022 Octubre 69 18 87
2022 Septiembre 55 37 92
2022 Agosto 52 46 98
2022 Julio 52 47 99
2022 Junio 109 29 138
2022 Mayo 54 33 87
2022 Abril 41 33 74
2022 Marzo 69 44 113
2022 Febrero 61 32 93
2022 Enero 69 28 97
2021 Diciembre 42 44 86
2021 Noviembre 61 56 117
2021 Octubre 68 67 135
2021 Septiembre 34 39 73
2021 Agosto 33 48 81
2021 Julio 35 25 60
2021 Junio 40 32 72
2021 Mayo 58 59 117
2021 Abril 133 73 206
2021 Marzo 73 34 107
2021 Febrero 92 27 119
2021 Enero 59 32 91
2020 Diciembre 62 33 95
2020 Noviembre 30 30 60
2020 Octubre 26 10 36
2020 Julio 34 8 42
2020 Junio 34 16 50
2020 Mayo 49 12 61
2020 Abril 112 21 133
2020 Marzo 40 10 50
2020 Febrero 15 4 19
2019 Diciembre 2 2 4
2019 Noviembre 2 2 4
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Medicina Intensiva
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?