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al igual que la hidroxicloroquina<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Por su parte el remdesivir podr&#237;a tener alg&#250;n beneficio en la reducci&#243;n de la duraci&#243;n de los s&#237;ntomas en la enfermedad m&#225;s leve&#44; pero no parece alterar significativamente el curso de la enfermedad grave o reducir la mortalidad<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; M&#225;s controvertidos son los resultados con el tocilizumab en t&#233;rminos de reducci&#243;n de la mortalidad o la gravedad de la enfermedad por COVID-19<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Por otro lado&#44; cuando hablamos del impacto que los corticoides pueden tener en la evoluci&#243;n de los enfermos con infecci&#243;n por SARS-CoV-2&#44; el ensayo RECOVERY<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> es uno de los estudios m&#225;s consistentes que podemos analizar&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; 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el soporte ventilatorio requerido y la medicaci&#243;n administrada &#40;el uso de corticoides se registr&#243; como una variable binaria &#91;S&#237; o No&#93; si al menos los pacientes recib&#237;an 40<span class="elsevierStyleHsp" style=""></span>mg de metilprednisolona&#44; o su equivalencia&#44; durante un per&#237;odo de al menos 5 d&#237;as con el fin de tratar la inflamaci&#243;n asociada con la neumon&#237;a viral&#41;&#44; la estancia y la mortalidad a los 28 d&#237;as&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los datos se obtuvieron a trav&#233;s del registro de enfermos COVID del SMI&#44; previa aceptaci&#243;n por el comit&#233; de &#233;tica de investigaci&#243;n local y la concesi&#243;n del consentimiento de los pacientes&#47;representante &#40;escrito y&#47;o telef&#243;nico&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la muestra&#46; Los resultados se presentan en forma de porcentaje para las variables categ&#243;ricas&#44; y como media y desviaci&#243;n est&#225;ndar para las variables cuantitativas continuas&#46; La comparaci&#243;n entre grupos se llev&#243; a cabo mediante el empleo del chi cuadrado de Pearson o el test exacto de Fisher para la comparaci&#243;n de proporciones&#44; y mediante la t de Student para muestras independientes&#44; con o sin correcci&#243;n de Welch&#44; para la comparaci&#243;n de medias&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ingresaron un total de 254 enfermos en el per&#237;odo descrito&#46; Fueron excluidos 28 pacientes en los que no se confirm&#243; la presencia de SARS-CoV-2&#46; Se analizaron 228 enfermos&#44; de los cuales 68 ingresaron en la primera oleada y 160 en la segunda&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los enfermos de la primera ola eran significativamente m&#225;s j&#243;venes que los enfermos de la segunda ola &#40;dif&#58; 6 a&#241;os &#40;IC95&#37;&#58; 2&#44;20-9&#44;80&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; 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las razones de las diferencias entre los 2 per&#237;odos a&#250;n no se conocen&#46; En nuestro entorno&#44; se postula que una nueva variante del SARS-CoV-2 surgi&#243; a principios del verano de 2020 en Espa&#241;a&#44; una variante que estaba vinculada a brotes entre j&#243;venes agricultores del noreste del pa&#237;s&#46; Este dato&#44; sumado al mal cumplimiento de las directrices de distanciamiento social por parte de los j&#243;venes podr&#237;a haber facilitado el contagio en adultos y ni&#241;os j&#243;venes&#44; facilitando as&#237; la posterior infecci&#243;n de pacientes m&#225;s a&#241;osos&#44; grupo m&#225;s expuesto a desarrollar una enfermedad por SARS-CoV-2 m&#225;s grave&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Un estudio de similares caracter&#237;sticas realizado en Francia evidenci&#243; que&#44; en comparaci&#243;n con la primera oleada&#44; en la segunda oleada exist&#237;a una menor proporci&#243;n de pacientes que requer&#237;an ventilaci&#243;n mec&#225;nica invasiva y una menor tasa de eventos tromb&#243;ticos&#46; Asimismo&#44; el retraso entre la admisi&#243;n de la UCI y la intubaci&#243;n traqueal fue mayor durante la segunda oleada&#44; no encontrando diferencias en la mortalidad intra-UCI &#40;50 frente a 52&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;96&#41; y la duraci&#243;n de la estancia en la UCI<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; la mortalidad de los pacientes que requieren ventilaci&#243;n mec&#225;nica fue del 57 vs&#46; 75&#37;&#46; Otros autores afirman que los pacientes de los 2 per&#237;odos no presentaron diferencias en la edad y el sexo&#44; pero que los marcadores de gravedad fueron sin duda menos prevalentes en la segunda oleada&#44; asoci&#225;ndose a una disminuci&#243;n de 10 veces en la tasa de letalidad <a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Por otro lado&#44; un estudio espa&#241;ol puso de manifiesto que los pacientes hospitalizados de la segunda ola fueron tratados m&#225;s a menudo con ventilaci&#243;n mec&#225;nica no invasiva y corticoides&#44; y con menos frecuencia con ventilaci&#243;n mec&#225;nica invasiva&#44; oxigenoterapia convencional y anticoagulantes&#44; observando diferencias en los factores de riesgo de mortalidad<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En resumen&#44; nuestro trabajo pone de manifiesto diferencias en las terapias utilizadas en los 2 per&#237;odos de tiempo estudiados&#44; sin concretarse en diferencias significativas en las mortalidades analizadas&#46; Consideramos importante la realizaci&#243;n de estudios de una mayor potencia que corroboren el verdadero papel de las estrategias utilizadas en las diferentes oleadas por SARS-CoV-2&#44; y esclarecer si estas se basan en un diferente perfil de enfermo&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los autores reconocen no presentar conflicto de intereses en la realizaci&#243;n del presente trabajo&#46;</p></span></span>"
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                  \t\t\t\t">59 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tocilizumab&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Corticoide&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Suero hiperinmune&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;24&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interfer&#243;n beta &#40;LPV&#47;RTV-IFNb&#41;&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> al ingreso en UCI&#59; media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Datos de laboratorio al ingreso en UCI</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CK&#59; media&#40;DE&#41; &#40;46-171<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;mero D&#59; media &#40;DE&#41; &#40;0-500<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IL6&#59; media &#40;DE&#41; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>pg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;137&#41;<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;112&#41;<span class="elsevierStyleSup">9</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PCR&#59; media &#40;DE&#41; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;8&#41;<span class="elsevierStyleSup">4</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH&#59; media &#40;DE&#41; &#40;120-246<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">589 &#40;390&#41;<span class="elsevierStyleSup">5</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">419 &#40;549&#41;<span class="elsevierStyleSup">11</span>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ferritina&#59; media &#40;DE&#41; &#40;22-322<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1506 &#40;1082&#41;<span class="elsevierStyleSup">6</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1082 &#40;855&#41;<span class="elsevierStyleSup">12</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento VMI al ingreso &#40;primeras 24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h de estancia en la UCI&#41;&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">47 &#40;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Necesidad de VMI durante el ingreso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56 &#40;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">110 &#40;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Par&#225;metros iniciales de VMI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;3&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frecuencia respiratoria<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compliancia<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento HFNO al ingreso&#59; n &#40;&#37;&#41;</span>&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
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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\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="elsevierStyleItalic">D&#237;as de VMI&#59; media &#40;DE&#41;</span>&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 &#40;12&#41;&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</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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dec&#250;bito prono&#59; n &#40;&#37;&#41;</span>&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">43 &#40;63&#41;&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">77 &#40;48&#41;&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11 &#40;10&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad de enfermos que precisaron VMI durante el ingreso en UCI&#59; n &#40;&#37;&#41;</span>&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
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                  \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">24 &#40;22&#41;&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;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad intra-UCI&#59; n &#40;&#37;&#41;</span>&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
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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</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;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad a 28 d&#237;as&#59; n &#40;&#37;&#41;</span>&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">8 &#40;12&#41;&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">28 &#40;17&#41;&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;32&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="elsevierStyleItalic">Mortalidad a 60 d&#237;as&#59; n &#40;&#37;&#41;</span>&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">13 &#40;19&#41;&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">31 &#40;19&#41;&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Valores de referencia de laboratorio&#46;</p> <p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleSup">1</span>Datos de 65 pacientes&#59; <span class="elsevierStyleSup">2</span>Datos de 65 pacientes&#59; <span class="elsevierStyleSup">3</span>Datos de 31 pacientes&#59; <span class="elsevierStyleSup">4</span>Datos de 65 pacientes&#59; <span class="elsevierStyleSup">5</span>Datos de 65 pacientes&#59; <span class="elsevierStyleSup">6</span>Datos de 64 pacientes&#59; <span class="elsevierStyleSup">7</span>Datos de 145 pacientes&#59; <span class="elsevierStyleSup">8</span>Datos de 154 pacientes&#59; <span class="elsevierStyleSup">9</span>Datos de 84 pacientes&#59; <span class="elsevierStyleSup">10</span>Datosde 150 pacientes&#59; <span class="elsevierStyleSup">11</span>Datosde 153 pacientes&#59; <span class="elsevierStyleSup">12</span>Datos de 134 pacientes&#46;</p>"
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los pacientes ingresados durante las 2 oleadas en UCI por enfermedad secundaria a la infecci&#243;n por SARS-CoV-2 confirmada</p>"
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          "identificador" => "bibs0015"
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                    0 => array:2 [
                      "titulo" => "High risk of thrombosis in patients with severe SARS-CoV-2 infection&#58; A multicenter prospective cohort study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Helms"
                            1 => "C&#46; Tacquard"
                            2 => "F&#46; Severac"
                            3 => "I&#46; Leonard-Lorant"
                            4 => "M&#46; Ohana"
                            5 => "X&#46; Delabranche"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med&#46;"
                        "fecha" => "2020"
                        "volumen" => "46"
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                      "titulo" => "A trial of lopinavirritonavir in adults hospitalized with severe Covid-19"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Cao"
                            1 => "Y&#46; Wang"
                            2 => "D&#46; Wen"
                            3 => "W&#46; Liu"
                            4 => "J&#46; Wang"
                            5 => "G&#46; Fan"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa2001282"
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                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2020"
                        "volumen" => "382"
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Primera y segunda oleada de enfermedad por coronavirus-19: un estudio comparativo en pacientes hospitalizados en una UCI de un hospital universitario de tercer nivel
First and second wave of coronavirus-19 disease: A comparative study in patients hospitalized in an ICU of a third-level university hospital
A. González-Castro
Autor para correspondencia
e409@humv.es

Autor para correspondencia.
, E. Cuenca Fito, A. Fernandez, P. Escudero Acha, J.C. Rodríguez Borregán, Y. Peñasco
Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Durante la primera oleada por SARS-CoV-2 se pudo comprender el curso de esta enfermedad previamente desconocida con sus propias especificidades&#44; incluyendo un s&#237;ndrome de distr&#233;s respiratorio agudo de una gravedad muy elevada y antes no conocida con la necesidad de sedaci&#243;n profunda y bloqueo neuromuscular&#44; la realizaci&#243;n de maniobras de dec&#250;bito prono&#44; el mayor riesgo de eventos tromb&#243;ticos&#44; y la duraci&#243;n prolongada de la ventilaci&#243;n mec&#225;nica<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Los resultados de diferentes trabajos realizados durante este per&#237;odo han podido modificar las actitudes terap&#233;uticas posteriores en pacientes con COVID-19 en estado cr&#237;tico&#46; En este sentido&#44; parece probada la ineficacia de antivirales como el lopinavir y el ritonavir&#44; al igual que la hidroxicloroquina<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Por su parte el remdesivir podr&#237;a tener alg&#250;n beneficio en la reducci&#243;n de la duraci&#243;n de los s&#237;ntomas en la enfermedad m&#225;s leve&#44; pero no parece alterar significativamente el curso de la enfermedad grave o reducir la mortalidad<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; M&#225;s controvertidos son los resultados con el tocilizumab en t&#233;rminos de reducci&#243;n de la mortalidad o la gravedad de la enfermedad por COVID-19<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Por otro lado&#44; cuando hablamos del impacto que los corticoides pueden tener en la evoluci&#243;n de los enfermos con infecci&#243;n por SARS-CoV-2&#44; el ensayo RECOVERY<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> es uno de los estudios m&#225;s consistentes que podemos analizar&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por lo tanto&#44; parece razonable suponer que la experiencia adquirida durante la primera oleada&#44; as&#237; como disponer de los resultados de la evaluaci&#243;n de diferentes tratamientos utilizados de forma experimental durante la primera oleada&#44; puede haber contribuido a un manejo diferente de los pacientes COVID-19 en estado cr&#237;tico admitidos durante la segunda ola y modificar el resultado cl&#237;nico de los mismos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">De manera retrospectiva&#44; registramos las caracter&#237;sticas de todos los casos hospitalizados de infecci&#243;n por SARS-CoV-2 en la UCI de un hospital universitario de tercer nivel de Espa&#241;a&#44; ingresados entre el 15 de marzo y el 5 de diciembre de 2020&#46; Todos los pacientes ingresados hasta el 7 de junio fueron considerados en la primera ola y todos los ingresados a partir del 21 de julio en la segunda ola&#46; Se evalu&#243; la edad&#44; el sexo&#44; las comorbilidades&#44; datos de laboratorio&#44; el soporte ventilatorio requerido y la medicaci&#243;n administrada &#40;el uso de corticoides se registr&#243; como una variable binaria &#91;S&#237; o No&#93; si al menos los pacientes recib&#237;an 40<span class="elsevierStyleHsp" style=""></span>mg de metilprednisolona&#44; o su equivalencia&#44; durante un per&#237;odo de al menos 5 d&#237;as con el fin de tratar la inflamaci&#243;n asociada con la neumon&#237;a viral&#41;&#44; la estancia y la mortalidad a los 28 d&#237;as&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los datos se obtuvieron a trav&#233;s del registro de enfermos COVID del SMI&#44; previa aceptaci&#243;n por el comit&#233; de &#233;tica de investigaci&#243;n local y la concesi&#243;n del consentimiento de los pacientes&#47;representante &#40;escrito y&#47;o telef&#243;nico&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de la muestra&#46; Los resultados se presentan en forma de porcentaje para las variables categ&#243;ricas&#44; y como media y desviaci&#243;n est&#225;ndar para las variables cuantitativas continuas&#46; La comparaci&#243;n entre grupos se llev&#243; a cabo mediante el empleo del chi cuadrado de Pearson o el test exacto de Fisher para la comparaci&#243;n de proporciones&#44; y mediante la t de Student para muestras independientes&#44; con o sin correcci&#243;n de Welch&#44; para la comparaci&#243;n de medias&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ingresaron un total de 254 enfermos en el per&#237;odo descrito&#46; Fueron excluidos 28 pacientes en los que no se confirm&#243; la presencia de SARS-CoV-2&#46; Se analizaron 228 enfermos&#44; de los cuales 68 ingresaron en la primera oleada y 160 en la segunda&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los enfermos de la primera ola eran significativamente m&#225;s j&#243;venes que los enfermos de la segunda ola &#40;dif&#58; 6 a&#241;os &#40;IC95&#37;&#58; 2&#44;20-9&#44;80&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Se evidenciaron diferencias significativas en la medicaci&#243;n especifica anti-COVID suministrada&#44; con un aumento en la aplicaci&#243;n de corticoterapia &#40;22 frente a 67&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y la administraci&#243;n de plasma hiperinmune &#40;3 frente a 24&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; en la segunda oleada &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> al ingreso en UCI fue significativamente m&#225;s baja en los enfermos de la primera oleada &#40;113 &#91;49&#93; frente a 157 &#91;74&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; El uso de la ventilaci&#243;n mec&#225;nica invasiva al ingreso fue tambi&#233;n significativamente mayor &#40;83 frente al 69&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nuestros datos ratifican la hip&#243;tesis expuesta&#44; ya que se han encontrado diferencias en el perfil de enfermo&#44; as&#237; como en las terapias utilizadas &#40;ventilatorias y farmacol&#243;gicas&#41; entre los enfermos de la primera oleada de la pandemia del COVID-19 y la segunda oleada&#44; sin que esto tradujese diferencias significativas en la mortalidad intra-UCI&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El n&#250;mero de admitidos en la UCI durante la segunda ola fue mayor&#44; fueron de mayor edad y hubo menos fallecimientos&#46; Estos datos son acordes con los resultados reportados por investigaciones previas en varios pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sin embargo&#44; las razones de las diferencias entre los 2 per&#237;odos a&#250;n no se conocen&#46; En nuestro entorno&#44; se postula que una nueva variante del SARS-CoV-2 surgi&#243; a principios del verano de 2020 en Espa&#241;a&#44; una variante que estaba vinculada a brotes entre j&#243;venes agricultores del noreste del pa&#237;s&#46; Este dato&#44; sumado al mal cumplimiento de las directrices de distanciamiento social por parte de los j&#243;venes podr&#237;a haber facilitado el contagio en adultos y ni&#241;os j&#243;venes&#44; facilitando as&#237; la posterior infecci&#243;n de pacientes m&#225;s a&#241;osos&#44; grupo m&#225;s expuesto a desarrollar una enfermedad por SARS-CoV-2 m&#225;s grave&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Un estudio de similares caracter&#237;sticas realizado en Francia evidenci&#243; que&#44; en comparaci&#243;n con la primera oleada&#44; en la segunda oleada exist&#237;a una menor proporci&#243;n de pacientes que requer&#237;an ventilaci&#243;n mec&#225;nica invasiva y una menor tasa de eventos tromb&#243;ticos&#46; Asimismo&#44; el retraso entre la admisi&#243;n de la UCI y la intubaci&#243;n traqueal fue mayor durante la segunda oleada&#44; no encontrando diferencias en la mortalidad intra-UCI &#40;50 frente a 52&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;96&#41; y la duraci&#243;n de la estancia en la UCI<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Sin embargo&#44; la mortalidad de los pacientes que requieren ventilaci&#243;n mec&#225;nica fue del 57 vs&#46; 75&#37;&#46; Otros autores afirman que los pacientes de los 2 per&#237;odos no presentaron diferencias en la edad y el sexo&#44; pero que los marcadores de gravedad fueron sin duda menos prevalentes en la segunda oleada&#44; asoci&#225;ndose a una disminuci&#243;n de 10 veces en la tasa de letalidad <a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Por otro lado&#44; un estudio espa&#241;ol puso de manifiesto que los pacientes hospitalizados de la segunda ola fueron tratados m&#225;s a menudo con ventilaci&#243;n mec&#225;nica no invasiva y corticoides&#44; y con menos frecuencia con ventilaci&#243;n mec&#225;nica invasiva&#44; oxigenoterapia convencional y anticoagulantes&#44; observando diferencias en los factores de riesgo de mortalidad<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En resumen&#44; nuestro trabajo pone de manifiesto diferencias en las terapias utilizadas en los 2 per&#237;odos de tiempo estudiados&#44; sin concretarse en diferencias significativas en las mortalidades analizadas&#46; Consideramos importante la realizaci&#243;n de estudios de una mayor potencia que corroboren el verdadero papel de las estrategias utilizadas en las diferentes oleadas por SARS-CoV-2&#44; y esclarecer si estas se basan en un diferente perfil de enfermo&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los autores reconocen no presentar conflicto de intereses en la realizaci&#243;n del presente trabajo&#46;</p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DM&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;22&#41;&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"><span class="elsevierStyleHsp" style=""></span>Obesidad&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fumador&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">46 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;34&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">Tratamiento frente SARS-CoV-2</span>&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lopinavir&#47;ritonavir&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>Hidroxicloroquina&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tocilizumab&#59; n &#40;&#37;&#41;&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">58 &#40;85&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;29&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Corticoide&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">107 &#40;67&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>Suero hiperinmune&#59; n &#40;&#37;&#41;&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">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;24&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>Interfer&#243;n beta &#40;LPV&#47;RTV-IFNb&#41;&#59; n &#40;&#37;&#41;&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">12 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> al ingreso en UCI&#59; media &#40;DE&#41;&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">113 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;74&#37;&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Datos de laboratorio al ingreso en UCI</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \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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                  \t\t\t\t">&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="" valign="\n
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                  \t\t\t\t">&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>CK&#59; media&#40;DE&#41; &#40;46-171<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&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">838 &#40;1152&#41;<span class="elsevierStyleSup">1</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">214 &#40;490&#41;<span class="elsevierStyleSup">7</span>&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>D&#237;mero D&#59; media &#40;DE&#41; &#40;0-500<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&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">22783 &#40;34128&#41;<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4308 &#40;12841&#41;<span class="elsevierStyleSup">8</span>&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>IL6&#59; media &#40;DE&#41; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>pg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;137&#41;<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;112&#41;<span class="elsevierStyleSup">9</span>&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;04&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>PCR&#59; media &#40;DE&#41; &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22 &#40;8&#41;<span class="elsevierStyleSup">4</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;8&#41;<span class="elsevierStyleSup">10</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>LDH&#59; media &#40;DE&#41; &#40;120-246<span class="elsevierStyleHsp" style=""></span>U&#47;l&#41;&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">589 &#40;390&#41;<span class="elsevierStyleSup">5</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">419 &#40;549&#41;<span class="elsevierStyleSup">11</span>&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>Ferritina&#59; media &#40;DE&#41; &#40;22-322<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41;&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">1506 &#40;1082&#41;<span class="elsevierStyleSup">6</span>&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">1082 &#40;855&#41;<span class="elsevierStyleSup">12</span>&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Tratamiento VMI al ingreso &#40;primeras 24</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h de estancia en la UCI&#41;&#59; n &#40;&#37;&#41;</span>&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">47 &#40;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;38&#37;&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Necesidad de VMI durante el ingreso</span>&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">56 &#40;83&#37;&#41;&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">110 &#40;69&#37;&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Par&#225;metros iniciales de VMI</span>&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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                  \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>Volumen tidal<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&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">470 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">464 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;30&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
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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>PEEP<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&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 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;3&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>Frecuencia respiratoria<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&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">17 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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>P&#46; plateau<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;4&#41;&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;14&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>Compliancia<span class="elsevierStyleItalic">&#59;</span> media &#40;DE&#41;&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">46 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">45 &#40;17&#41;&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;69&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="elsevierStyleItalic">Tratamiento HFNO al ingreso&#59; n &#40;&#37;&#41;</span>&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">17 &#40;25&#41;&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">75 &#40;47&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">D&#237;as de VMI&#59; media &#40;DE&#41;</span>&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">15 &#40;12&#41;&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">10 &#40;8&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Dec&#250;bito prono&#59; n &#40;&#37;&#41;</span>&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">43 &#40;63&#41;&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">77 &#40;48&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Estancia en UCI &#40;d&#237;as&#41;</span>&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">15 &#40;12&#41;&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">11 &#40;10&#41;&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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&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="elsevierStyleItalic">Mortalidad de enfermos que precisaron VMI durante el ingreso en UCI&#59; n &#40;&#37;&#41;</span>&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">13 &#40;23&#41;&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">24 &#40;22&#41;&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;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad intra-UCI&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad a 60 d&#237;as&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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ISSN: 02105691
Idioma original: Español
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