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e incluye an&#225;lisis comparativo entre unidades colombianas &#40;COL&#41; y unidades latinoamericanas &#40;LA&#41;&#46; Se destaca que en la mayor&#237;a de los casos no se encontraron comorbilidades&#44; y para el grupo COL se observ&#243; un menor n&#250;mero de comorbilidades no respiratorias &#40;15&#44;7 vs&#46; 24&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; sin detectar diferencias estad&#237;sticamente significativas por tipo de comorbilidad&#44; aunque con bajo poder para detectar diferencias relativas mayores al 25&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Al evaluar la gravedad&#44; se encontr&#243; una baja mediana de probabilidad de mortalidad por puntaje PIM3 &#40;0&#44;36&#37;&#59; RIQ 0&#44;39&#41; y puntajes de dificultad respiratoria moderados M-WCAS &#40;M-WCAS 4&#44;5&#59; RIQ 2&#41;&#44; aunque al compararlos&#44; estos fueron mayores en COL&#46; En los casos que se pudo evaluar la oxigenaci&#243;n &#40;uso de sistemas de FiO<span class="elsevierStyleInf">2</span> definida&#41;&#44; se observ&#243; que en el grupo COL la afectaci&#243;n fue mayor &#40;SaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> mediana 100&#59; RIQ 79&#41; vs&#46; grupo LA &#40;SaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> mediana 202&#59; RIQ 88&#41; con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Al ingres&#243; en la UCIP&#44; el soporte respiratorio de traslado utilizado fue variado&#46; El 51&#44;4&#37; ingres&#243; en la unidad con soporte respiratorio basado en oxigenoterapia convencional&#44; 37&#44;9&#37; con c&#225;nulas nasales de alto flujo &#40;CNAF&#41;&#44; el 2&#44;4&#37; en presi&#243;n positiva continua en la v&#237;a a&#233;rea &#40;CPAP&#44; por sus siglas en ingl&#233;s&#41; o presi&#243;n positiva de 2 niveles &#40;BiPAP&#44; por sus siglas en ingl&#233;s&#41; y un 7&#44;0&#37; en ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41;&#46; Al comparar de forma individual cada tipo de terapia&#44; solo fue estad&#237;sticamente menor para Colombia el uso de c&#225;nulas nasales convencionales &#40;10&#44;6 vs&#46; 54&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0004&#41;&#59; para los dem&#225;s sistemas&#44; aunque se observan diferencias relativas mayores al 25&#37;&#44; el bajo poder estad&#237;stico no permiti&#243; detectarlas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se encontr&#243; una gran frecuencia de virus sincitial respiratorio &#40;VSR&#41; con algunas diferencias significativas entre las regiones&#44; con una mayor frecuencia de VSR y metapneumovirus en el grupo LA&#44; mientras que en Colombia fueron m&#225;s frecuentes los paneles virales negativos y el virus parainfluenza&#46; El uso de antibi&#243;ticos &#40;56&#44;3&#37;&#41; fue elevado a pesar de una baja sospecha declarada de infecci&#243;n bacteriana 70 casos &#40;9&#44;3&#37;&#41; y&#44; aun menos confirmaci&#243;n por cultivos o pruebas serol&#243;gicas&#59; al analizar el uso de terapias farmacol&#243;gicas coadyuvantes tambi&#233;n encontramos alto uso y gran variabilidad&#58; mientras en COL se utilizaron de forma significativa m&#225;s antibi&#243;ticos &#40;66&#44;7 vs&#46; 46&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; adrenalina &#40;14&#44;3 vs&#46; 2&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0007&#41; y terapias hipert&#243;nicas &#40;27&#44;5 vs&#46; 10&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#44; en LA se usaron m&#225;s antivirales &#40;0&#44;3 vs&#46; 2&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; esteroides &#40;3&#44;4 vs&#46; 17&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y broncodilatadores &#40;9&#44;0 vs&#46; 68&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se observ&#243; una diferencia significativa en la frecuencia de VMI como soporte inicial y soporte m&#225;ximo en COL &#40;inicial&#58; 52&#44;7&#37;&#59; m&#225;ximo&#58; 56&#44;9&#37;&#41; y el resto de LA &#40;inicial&#58; 9&#44;07&#37;&#59; m&#225;ximo&#58; 19&#44;4&#37;&#41;&#46; Con los otros sistemas de soporte respiratorio tambi&#233;n se observ&#243; variabilidad&#44; pero no se detectaron diferencias estad&#237;sticas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En forma global&#44; se observ&#243; una baja mortalidad absoluta y tambi&#233;n estandarizada a PIM3&#46; El grupo COL tuvo mayor tiempo de estancia en la UCIP&#44; mayor uso de terapias de rescate &#40;relajantes neuromusculares&#44; prono&#44; ventilaci&#243;n de alta frecuencia&#41; y mayor morbilidad residual&#44; definida como un aumento de 3 o m&#225;s puntos en la escala Functional Status Score &#40;FSS&#41; al egreso &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que tanto el perfil epidemiol&#243;gico como el tipo de terapias y desenlaces cl&#237;nicos de ni&#241;os admitidos por BG en las UCIP colombianas difiere con respecto a sus pares latinoamericanos&#46; Nuestro an&#225;lisis muestra que la variabilidad de pr&#225;cticas es un fen&#243;meno frecuente en Colombia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Destacamos que el grupo de pacientes colombianos tuvo mayor gravedad al momento de admisi&#243;n&#46; Esto podr&#237;a explicarse por el hecho de estar ubicadas por encima de los 1&#46;500 metros sobre el nivel del mar&#44; donde la altura podr&#237;a jugar un papel preponderante en la hipoxemia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Aunque la sospecha &#40;y confirmaci&#243;n&#41; de coinfecci&#243;n bacteriana fue baja&#44; encontramos un elevado uso de antibi&#243;ticos&#44; lo cual ir&#237;a en contra de las recomendaciones de las gu&#237;as de pr&#225;ctica cl&#237;nica para ni&#241;os con BG<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; La indicaci&#243;n de antibi&#243;ticos en ni&#241;os con BG admitidos en la UCIP es un tema a&#250;n en debate entre intensivistas pedi&#225;tricos&#46; La tasa de indicaci&#243;n antibi&#243;tica en nuestra serie est&#225; por debajo de lo reportado por algunas grandes series de otras regiones del mundo&#44; en los cuales la proporci&#243;n de prescripci&#243;n antibi&#243;tica en ni&#241;os admitidos en las UCIP var&#237;a&#44; casi por defecto por encima del 50&#37; como reportan Shein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Una de las consecuencias de reciente descripci&#243;n es la variabilidad de pr&#225;cticas cl&#237;nicas&#44; de pr&#225;cticas diagn&#243;sticas y terap&#233;uticas en ni&#241;os con BG<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Nuestros hallazgos muestran que este fen&#243;meno es frecuente en Latinoam&#233;rica&#46; Es preocupante la gran variabilidad y la alta frecuencia de uso en las terapias coadyuvantes &#40;nebulizaciones&#44; antibi&#243;ticos&#44; esteroides&#41; observadas en toda la regi&#243;n latinoamericana analizada&#46; Existe una disociaci&#243;n entre las recomendaciones generales de tratamientos respaldados con evidencia cient&#237;fica y la pr&#225;ctica cl&#237;nica&#46; Para muchos profesionales de la salud&#44; la terapia de soporte puede no ser suficiente y la angustia ante el &#171;no hacer&#187; y &#171;dejar evolucionar con vigilancia&#187; induce al sobreuso de terapias f&#250;tiles y&#44; en ocasiones&#44; iatrog&#233;nicas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En las UCIP colombianas hubo un mayor uso de VMI y un menor uso de terapias no invasivas &#40;como CNAF y BiPAP&#41; comparadas con LA&#46; El uso de terapias de rescate &#40;como VMI en posici&#243;n prono y VAFO&#41; en el grupo de pacientes que recibieron VMI fue mayor en COL&#46; Esto puede relacionarse con una mayor gravedad al momento del ingreso o un llamado de atenci&#243;n de eventual sobreuso &#40;sobre indicaci&#243;n&#41; de estas terapias invasivas y de rescate&#44; especialmente considerando que un abordaje menos invasivo lleva a resultados similares en ni&#241;os con BG<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; observamos diferencias significativas en el perfil epidemiol&#243;gico y en los resultados asistenciales en Colombia&#44; donde se observ&#243; una gravedad mayor al ingreso y los pacientes fueron tratados con m&#233;todos de soporte respiratorio m&#225;s invasivos&#44; presentaron mayor estad&#237;a en la UCIP y morbilidad residual superior&#46; Esta variabilidad debe motivar iniciativas colaborativas para disminuirla y mejorar la calidad de asistencia&#44; as&#237; como la optimizaci&#243;n de recursos&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaramos que este proyecto ha sido financiado por fondos propios&#46;</p></span></span>"
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            "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall">Dra&#46; Anal&#237;a Fern&#225;ndez&#44; Hospital Durand&#44; Buenos Aires&#44; Argentina&#59; Dr&#46; Roberto Jabornisky y Dra&#46; Silvina Muzzio&#44; Hospital Juan Pablo II&#44; Corrientes&#44; Argentina&#59; Dra&#46; Evelin Cidral y Dr&#46; Alejandro Mansur&#44; Hospital Regional Olga Stucky de Rizzi&#44; Reconquista&#44; Argentina&#59; Dr&#46; Miguel C&#233;spedes Lesczinsky y Dra&#46; Zurama Velasco&#44; Hospital Materno Infantil Boliviano Japon&#233;s&#44; Trinidad&#44; Bolivia&#59; Dra&#46; Regina Grigolli Cesar&#44; Hospital Infantil Sabar&#225;&#44; San Pablo&#44; Brasil&#59; Dr&#46; Pablo Cruces y Dr&#46; Tamara Cordova&#44; Hospital El Carmen&#44; Maip&#250;&#44; Santiago&#44; Chile&#59; Dr&#46; Diego Aranguiz Quintanilla&#44; Dr&#46; Juan Sep&#250;lveda y Dra&#46; Ivette Padilla&#44; Complejo Asistencial Dr&#46; V&#237;ctor R&#237;os Ru&#237;z&#44; Los &#193;ngeles&#44; Chile&#59; Dr&#46; Alejandro Donoso&#44; Dra&#46; Mar&#237;a Jos&#233; N&#250;&#241;ez S&#225;nchez&#59; Dra&#46; Adriana Wegner&#44; Complejo Asistencial Dr&#46; Sotero del R&#237;o&#44; Santiago&#44; Chile&#59; Dr&#46; Pietro Pietroboni Fuster&#44; Hospital Regional&#44; Antofagasta&#44; Chile&#59; Dr&#46; Jos&#233; Rosales Fern&#225;ndez y Dra&#46; Silvia Sanabria&#44; Hospital Nacional de ni&#241;os &#171;Dr&#46; Carlos S&#225;enz Herrera&#187;&#44; Costa Rica&#59; Dra&#46; Aran&#237; Ferre&#44; Dra&#46; Magal&#237; Espa&#241;a&#44; Dra&#46; Andrea Iroa y Dr&#46; Raul Navatta&#44; Hospital Policial&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Ema Benech y Dra&#46; M&#243;nica Carro&#44; Sanatorio C&#237;rculo Cat&#243;lico&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Alicia Fern&#225;ndez&#44; Asociaci&#243;n Espa&#241;ola&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Nicol&#225;s Monteverde y Dra&#46; Martha Carbonell&#44; M&#233;dica Uruguaya&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Bernardo Alonso&#44; Dr&#46; Alberto Serra y Lic&#46; F&#225;tima Varela&#44; Sanatorio Casa de Galicia&#44; Montevideo&#44; Uruguay&#59; Lic&#46; Cristina Courtie&#44; Dr&#46; Javier Mart&#237;nez y Dra&#46; Krystel Cantir&#225;n&#44; Hospital Militar&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Loredana Matrai y Dra&#46; Cecilia Mislej&#44; Hospital Evang&#233;lico&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Luis Castro&#44; Sanatorio CAMDEL&#44; Minas&#44; Uruguay&#59; Dra&#46; Soledad Menta&#44; Hospital Tacuaremb&#243;&#44; Uruguay&#59; Dra&#46; Carolina Talasimov y Lic&#46; Mar&#237;a Jos&#233; Caggiano&#44; Sanatorio COMECA&#44; Canelones&#44; Uruguay&#59; Dr&#46; Luis Pedrozo y Dr&#46; Alejandro Franco&#44; Hospital Salto&#44; Uruguay&#59; Dr&#46; Luis Mart&#237;nez Arroyo y Dra&#46; Silvia Dubra&#44; Sanatorio COMEPA&#44; Paysand&#250;&#44; Uruguay&#59; Dra&#46; Ana Inverso&#44; Dra&#46; Nora Mouta&#44; Dra&#46; Mar&#237;a Parada y Lic&#46; Karina Etulain&#44; Sanatorio Semm-Mautone&#44; Maldonado&#44; Uruguay&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">G&#233;nero&#44; n &#37;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#44;9&#37;</td><td class="td" title="\n
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                  \t\t\t\t">33&#44;1&#37;</td><td class="td" title="\n
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                  \t\t\t\t">38&#44;5&#37;</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">64&#44;1&#37;</td><td class="td" title="\n
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                  \t\t\t\t">66&#44;9&#37;</td><td class="td" title="\n
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                  \t\t\t\t">61&#44;5&#37;</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">166&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#44;0&#37;</td><td class="td" title="\n
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                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;2&#37;</td><td class="td" title="\n
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                  \t\t\t\t">101&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#44;4&#37;</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades respiratorias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;4&#37;</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Otras comorbilidades &#40;no respiratorias&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;9&#37;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prematuridad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desnutrici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Genopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;2&#37;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#233;ficit neurol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Puntajes gravedad&#44; n</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">med RIQ</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Probabilidad muerte PIM3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de admisi&#243;n&#44; n &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuidado intensivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuidado intermedio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#44;6&#37;</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">D&#237;as VMI&#44; med RIQ</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esperada&#44; n IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;6-7&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Observada&#44; n &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;13&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;0&#44;25&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>REM&#44; n IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2-0&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;1-0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asociadas a la VMI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;411&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asociadas a la VMNI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecciones asociadas al cuidado de salud&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapias de rescate<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">14&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">24&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cambio &#60;<span class="elsevierStyleHsp" style=""></span>3 en FSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">92&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">99&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cambio &#8805;<span class="elsevierStyleHsp" style=""></span>3 en FSS&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.1097/PCC.0000000000001839"
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Carta científica
Ingreso en cuidados intensivos debido a bronquiolitis grave en Colombia: ¿dónde nos encontramos en relación con el resto de Latinoamérica?
Admission to intensive care due to severe bronchiolitis in Colombia: How are we with respect to the rest of Latin America?
P. Vásquez-Hoyosa,
Autor para correspondencia
pvasquez@fucsalud.edu.co

Autor para correspondencia.
, R. Pardo-Carrerob, J.C. Jaramillo-Bustamantec, S. González-Dambrauskasd, C. Carvajale, F. Diazf,g, Red Pediátrica de Latinoamérica (LARed) Network
a Hospital de San José, FUCS, Universidad Nacional de Colombia, Bogotá, Colombia
b Clínica Infantil de Colsubsidio, Bogotá, Colombia
c Hospital General de Medellín, Medellín, Colombia
d Unidad de Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia, Montevideo, Uruguay
e Universidad de Los Andes, Región Metropolitana, Chile
f Hospital El Carmen de Maipú, Santiago, Chile
g Instituto de Ciencias Biomédicas, Universidad del Desarrollo, Santiago, Chile
Colaboradores de la Red Pediátrica de Latinoamérica (LARed) Network
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        "titulo" => "Admission to intensive care due to severe bronchiolitis in Colombia&#58; How are we with respect to the rest of Latin America&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La bronquiolitis &#40;BG&#41; es la causa con mayor n&#250;mero de ingresos hospitalarios y de admisi&#243;n en las unidades de cuidados intensivos pedi&#225;tricos &#40;UCIP&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Aunque no contamos con recomendaciones espec&#237;ficas para los ni&#241;os en estado cr&#237;tico&#44; las principales gu&#237;as de pr&#225;ctica cl&#237;nica recomiendan que su tratamiento es de soporte&#44; y consideran a la mayor&#237;a de las intervenciones diagn&#243;sticas y farmacol&#243;gicas f&#250;tiles<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; En pa&#237;ses en v&#237;as de desarrollo&#44; como Colombia&#44; la informaci&#243;n epidemiol&#243;gica sobre BG admitidas a las UCI es precaria&#46; El objetivo de este estudio fue comparar las caracter&#237;sticas&#44; intervenciones y desenlaces cl&#237;nicos de lactantes con BG admitidos en 3 UCIP colombianas pertenecientes a una red colaborativa latinoamericana&#44; y comparar sus resultados asistenciales en el contexto latinoamericano&#46; Para ello nos comparamos con otras 23 unidades de la regi&#243;n &#40;5 pa&#237;ses&#41;&#44; utilizando el registro prospectivo de LARed Network &#40;red colaborativa pedi&#225;trica de Latinoam&#233;rica&#41; que integramos<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Durante el periodo del 1 de enero y 31 de diciembre de 2018 ingresaron al registro 886 ni&#241;os con BG&#46; Para nuestro an&#225;lisis se excluyeron 132 por presentar diagn&#243;sticos de egresos distintos a BG o por tener enfermedad bronco pulmonar previa&#46; En total se analizaron 754 pacientes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> re&#250;ne las caracter&#237;sticas demogr&#225;ficas y comorbilidades no respiratorias&#44; e incluye an&#225;lisis comparativo entre unidades colombianas &#40;COL&#41; y unidades latinoamericanas &#40;LA&#41;&#46; Se destaca que en la mayor&#237;a de los casos no se encontraron comorbilidades&#44; y para el grupo COL se observ&#243; un menor n&#250;mero de comorbilidades no respiratorias &#40;15&#44;7 vs&#46; 24&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#44; sin detectar diferencias estad&#237;sticamente significativas por tipo de comorbilidad&#44; aunque con bajo poder para detectar diferencias relativas mayores al 25&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Al evaluar la gravedad&#44; se encontr&#243; una baja mediana de probabilidad de mortalidad por puntaje PIM3 &#40;0&#44;36&#37;&#59; RIQ 0&#44;39&#41; y puntajes de dificultad respiratoria moderados M-WCAS &#40;M-WCAS 4&#44;5&#59; RIQ 2&#41;&#44; aunque al compararlos&#44; estos fueron mayores en COL&#46; En los casos que se pudo evaluar la oxigenaci&#243;n &#40;uso de sistemas de FiO<span class="elsevierStyleInf">2</span> definida&#41;&#44; se observ&#243; que en el grupo COL la afectaci&#243;n fue mayor &#40;SaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> mediana 100&#59; RIQ 79&#41; vs&#46; grupo LA &#40;SaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> mediana 202&#59; RIQ 88&#41; con p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Al ingres&#243; en la UCIP&#44; el soporte respiratorio de traslado utilizado fue variado&#46; El 51&#44;4&#37; ingres&#243; en la unidad con soporte respiratorio basado en oxigenoterapia convencional&#44; 37&#44;9&#37; con c&#225;nulas nasales de alto flujo &#40;CNAF&#41;&#44; el 2&#44;4&#37; en presi&#243;n positiva continua en la v&#237;a a&#233;rea &#40;CPAP&#44; por sus siglas en ingl&#233;s&#41; o presi&#243;n positiva de 2 niveles &#40;BiPAP&#44; por sus siglas en ingl&#233;s&#41; y un 7&#44;0&#37; en ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41;&#46; Al comparar de forma individual cada tipo de terapia&#44; solo fue estad&#237;sticamente menor para Colombia el uso de c&#225;nulas nasales convencionales &#40;10&#44;6 vs&#46; 54&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0004&#41;&#59; para los dem&#225;s sistemas&#44; aunque se observan diferencias relativas mayores al 25&#37;&#44; el bajo poder estad&#237;stico no permiti&#243; detectarlas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se encontr&#243; una gran frecuencia de virus sincitial respiratorio &#40;VSR&#41; con algunas diferencias significativas entre las regiones&#44; con una mayor frecuencia de VSR y metapneumovirus en el grupo LA&#44; mientras que en Colombia fueron m&#225;s frecuentes los paneles virales negativos y el virus parainfluenza&#46; El uso de antibi&#243;ticos &#40;56&#44;3&#37;&#41; fue elevado a pesar de una baja sospecha declarada de infecci&#243;n bacteriana 70 casos &#40;9&#44;3&#37;&#41; y&#44; aun menos confirmaci&#243;n por cultivos o pruebas serol&#243;gicas&#59; al analizar el uso de terapias farmacol&#243;gicas coadyuvantes tambi&#233;n encontramos alto uso y gran variabilidad&#58; mientras en COL se utilizaron de forma significativa m&#225;s antibi&#243;ticos &#40;66&#44;7 vs&#46; 46&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; adrenalina &#40;14&#44;3 vs&#46; 2&#44;0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0007&#41; y terapias hipert&#243;nicas &#40;27&#44;5 vs&#46; 10&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#44; en LA se usaron m&#225;s antivirales &#40;0&#44;3 vs&#46; 2&#44;5&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; esteroides &#40;3&#44;4 vs&#46; 17&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y broncodilatadores &#40;9&#44;0 vs&#46; 68&#44;8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se observ&#243; una diferencia significativa en la frecuencia de VMI como soporte inicial y soporte m&#225;ximo en COL &#40;inicial&#58; 52&#44;7&#37;&#59; m&#225;ximo&#58; 56&#44;9&#37;&#41; y el resto de LA &#40;inicial&#58; 9&#44;07&#37;&#59; m&#225;ximo&#58; 19&#44;4&#37;&#41;&#46; Con los otros sistemas de soporte respiratorio tambi&#233;n se observ&#243; variabilidad&#44; pero no se detectaron diferencias estad&#237;sticas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En forma global&#44; se observ&#243; una baja mortalidad absoluta y tambi&#233;n estandarizada a PIM3&#46; El grupo COL tuvo mayor tiempo de estancia en la UCIP&#44; mayor uso de terapias de rescate &#40;relajantes neuromusculares&#44; prono&#44; ventilaci&#243;n de alta frecuencia&#41; y mayor morbilidad residual&#44; definida como un aumento de 3 o m&#225;s puntos en la escala Functional Status Score &#40;FSS&#41; al egreso &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que tanto el perfil epidemiol&#243;gico como el tipo de terapias y desenlaces cl&#237;nicos de ni&#241;os admitidos por BG en las UCIP colombianas difiere con respecto a sus pares latinoamericanos&#46; Nuestro an&#225;lisis muestra que la variabilidad de pr&#225;cticas es un fen&#243;meno frecuente en Colombia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Destacamos que el grupo de pacientes colombianos tuvo mayor gravedad al momento de admisi&#243;n&#46; Esto podr&#237;a explicarse por el hecho de estar ubicadas por encima de los 1&#46;500 metros sobre el nivel del mar&#44; donde la altura podr&#237;a jugar un papel preponderante en la hipoxemia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Aunque la sospecha &#40;y confirmaci&#243;n&#41; de coinfecci&#243;n bacteriana fue baja&#44; encontramos un elevado uso de antibi&#243;ticos&#44; lo cual ir&#237;a en contra de las recomendaciones de las gu&#237;as de pr&#225;ctica cl&#237;nica para ni&#241;os con BG<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; La indicaci&#243;n de antibi&#243;ticos en ni&#241;os con BG admitidos en la UCIP es un tema a&#250;n en debate entre intensivistas pedi&#225;tricos&#46; La tasa de indicaci&#243;n antibi&#243;tica en nuestra serie est&#225; por debajo de lo reportado por algunas grandes series de otras regiones del mundo&#44; en los cuales la proporci&#243;n de prescripci&#243;n antibi&#243;tica en ni&#241;os admitidos en las UCIP var&#237;a&#44; casi por defecto por encima del 50&#37; como reportan Shein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Una de las consecuencias de reciente descripci&#243;n es la variabilidad de pr&#225;cticas cl&#237;nicas&#44; de pr&#225;cticas diagn&#243;sticas y terap&#233;uticas en ni&#241;os con BG<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Nuestros hallazgos muestran que este fen&#243;meno es frecuente en Latinoam&#233;rica&#46; Es preocupante la gran variabilidad y la alta frecuencia de uso en las terapias coadyuvantes &#40;nebulizaciones&#44; antibi&#243;ticos&#44; esteroides&#41; observadas en toda la regi&#243;n latinoamericana analizada&#46; Existe una disociaci&#243;n entre las recomendaciones generales de tratamientos respaldados con evidencia cient&#237;fica y la pr&#225;ctica cl&#237;nica&#46; Para muchos profesionales de la salud&#44; la terapia de soporte puede no ser suficiente y la angustia ante el &#171;no hacer&#187; y &#171;dejar evolucionar con vigilancia&#187; induce al sobreuso de terapias f&#250;tiles y&#44; en ocasiones&#44; iatrog&#233;nicas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En las UCIP colombianas hubo un mayor uso de VMI y un menor uso de terapias no invasivas &#40;como CNAF y BiPAP&#41; comparadas con LA&#46; El uso de terapias de rescate &#40;como VMI en posici&#243;n prono y VAFO&#41; en el grupo de pacientes que recibieron VMI fue mayor en COL&#46; Esto puede relacionarse con una mayor gravedad al momento del ingreso o un llamado de atenci&#243;n de eventual sobreuso &#40;sobre indicaci&#243;n&#41; de estas terapias invasivas y de rescate&#44; especialmente considerando que un abordaje menos invasivo lleva a resultados similares en ni&#241;os con BG<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; observamos diferencias significativas en el perfil epidemiol&#243;gico y en los resultados asistenciales en Colombia&#44; donde se observ&#243; una gravedad mayor al ingreso y los pacientes fueron tratados con m&#233;todos de soporte respiratorio m&#225;s invasivos&#44; presentaron mayor estad&#237;a en la UCIP y morbilidad residual superior&#46; Esta variabilidad debe motivar iniciativas colaborativas para disminuirla y mejorar la calidad de asistencia&#44; as&#237; como la optimizaci&#243;n de recursos&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaramos que este proyecto ha sido financiado por fondos propios&#46;</p></span></span>"
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            "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall">Dra&#46; Anal&#237;a Fern&#225;ndez&#44; Hospital Durand&#44; Buenos Aires&#44; Argentina&#59; Dr&#46; Roberto Jabornisky y Dra&#46; Silvina Muzzio&#44; Hospital Juan Pablo II&#44; Corrientes&#44; Argentina&#59; Dra&#46; Evelin Cidral y Dr&#46; Alejandro Mansur&#44; Hospital Regional Olga Stucky de Rizzi&#44; Reconquista&#44; Argentina&#59; Dr&#46; Miguel C&#233;spedes Lesczinsky y Dra&#46; Zurama Velasco&#44; Hospital Materno Infantil Boliviano Japon&#233;s&#44; Trinidad&#44; Bolivia&#59; Dra&#46; Regina Grigolli Cesar&#44; Hospital Infantil Sabar&#225;&#44; San Pablo&#44; Brasil&#59; Dr&#46; Pablo Cruces y Dr&#46; Tamara Cordova&#44; Hospital El Carmen&#44; Maip&#250;&#44; Santiago&#44; Chile&#59; Dr&#46; Diego Aranguiz Quintanilla&#44; Dr&#46; Juan Sep&#250;lveda y Dra&#46; Ivette Padilla&#44; Complejo Asistencial Dr&#46; V&#237;ctor R&#237;os Ru&#237;z&#44; Los &#193;ngeles&#44; Chile&#59; Dr&#46; Alejandro Donoso&#44; Dra&#46; Mar&#237;a Jos&#233; N&#250;&#241;ez S&#225;nchez&#59; Dra&#46; Adriana Wegner&#44; Complejo Asistencial Dr&#46; Sotero del R&#237;o&#44; Santiago&#44; Chile&#59; Dr&#46; Pietro Pietroboni Fuster&#44; Hospital Regional&#44; Antofagasta&#44; Chile&#59; Dr&#46; Jos&#233; Rosales Fern&#225;ndez y Dra&#46; Silvia Sanabria&#44; Hospital Nacional de ni&#241;os &#171;Dr&#46; Carlos S&#225;enz Herrera&#187;&#44; Costa Rica&#59; Dra&#46; Aran&#237; Ferre&#44; Dra&#46; Magal&#237; Espa&#241;a&#44; Dra&#46; Andrea Iroa y Dr&#46; Raul Navatta&#44; Hospital Policial&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Ema Benech y Dra&#46; M&#243;nica Carro&#44; Sanatorio C&#237;rculo Cat&#243;lico&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Alicia Fern&#225;ndez&#44; Asociaci&#243;n Espa&#241;ola&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Nicol&#225;s Monteverde y Dra&#46; Martha Carbonell&#44; M&#233;dica Uruguaya&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Bernardo Alonso&#44; Dr&#46; Alberto Serra y Lic&#46; F&#225;tima Varela&#44; Sanatorio Casa de Galicia&#44; Montevideo&#44; Uruguay&#59; Lic&#46; Cristina Courtie&#44; Dr&#46; Javier Mart&#237;nez y Dra&#46; Krystel Cantir&#225;n&#44; Hospital Militar&#44; Montevideo&#44; Uruguay&#59; Dra&#46; Loredana Matrai y Dra&#46; Cecilia Mislej&#44; Hospital Evang&#233;lico&#44; Montevideo&#44; Uruguay&#59; Dr&#46; Luis Castro&#44; Sanatorio CAMDEL&#44; Minas&#44; Uruguay&#59; Dra&#46; Soledad Menta&#44; Hospital Tacuaremb&#243;&#44; Uruguay&#59; Dra&#46; Carolina Talasimov y Lic&#46; Mar&#237;a Jos&#233; Caggiano&#44; Sanatorio COMECA&#44; Canelones&#44; Uruguay&#59; Dr&#46; Luis Pedrozo y Dr&#46; Alejandro Franco&#44; Hospital Salto&#44; Uruguay&#59; Dr&#46; Luis Mart&#237;nez Arroyo y Dra&#46; Silvia Dubra&#44; Sanatorio COMEPA&#44; Paysand&#250;&#44; Uruguay&#59; Dra&#46; Ana Inverso&#44; Dra&#46; Nora Mouta&#44; Dra&#46; Mar&#237;a Parada y Lic&#46; Karina Etulain&#44; Sanatorio Semm-Mautone&#44; Maldonado&#44; Uruguay&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Peso &#40;kg&#41;&#44; med RIQ</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">G&#233;nero&#44; n &#37;</span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Femenino 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35&#44;9&#37;</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#44;2&#37;</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades respiratorias</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Otras comorbilidades &#40;no respiratorias&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiopat&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prematuridad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desnutrici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;8&#37;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Genopat&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#233;ficit neurol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otras&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Puntajes gravedad&#44; n</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">med RIQ</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Probabilidad muerte PIM3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="11" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de admisi&#243;n&#44; n &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuidado intensivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">87&#44;4&#37;</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">D&#237;as VMI&#44; med RIQ</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Esperada&#44; n IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Observada&#44; n &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;13&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t">0 &#40;0&#44;0&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;0&#44;25&#37;&#41;</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>REM&#44; n IC 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8212;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;1-0&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asociadas a la VMI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;411&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asociadas a la VMNI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infecciones asociadas al cuidado de salud&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terapias de rescate<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">14&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">24&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nueva morbilidad</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleItalic">&#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">523&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cambio &#60;<span class="elsevierStyleHsp" style=""></span>3 en FSS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">508&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">97&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">336&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cambio &#8805;<span class="elsevierStyleHsp" style=""></span>3 en FSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                        "paginaInicial" => "460"
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                            4 => "P&#46; Toltzis"
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ISSN: 02105691
Idioma original: Español
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