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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">En diciembre de 2019 apareci&#243; en China una enfermedad desconocida secundaria a un nuevo virus de la familia <span class="elsevierStyleItalic">Coronaviridae</span> &#40;SARS-CoV-2&#41;&#46; En marzo de 2020&#44; la Organizaci&#243;n Mundial de la Salud declar&#243; la pandemia mundial debido a su r&#225;pida progresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46; En Espa&#241;a&#44; hasta la fecha se han notificado 13&#46;614&#46;807 casos confirmados de COVID-19 y 116&#46;108 fallecidos<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#46; Un n&#250;mero importante de pacientes desarroll&#243; s&#237;ndrome de distr&#233;s respiratorio agudo &#40;SDRA&#41;&#44; necesitando ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41; en una unidad de cuidados intensivos &#40;UCI&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El SDRA se caracteriza por da&#241;o pulmonar inflamatorio agudo y difuso&#44; que produce aumento de la permeabilidad vascular y del peso pulmonar&#44; con disminuci&#243;n de la distensibilidad<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a>&#46; En pacientes con SDRA severo&#44; la utilizaci&#243;n temprana de la posici&#243;n en dec&#250;bito prono &#40;DP&#41; durante al menos 16<span class="elsevierStyleHsp" style=""></span>h consecutivas&#44; asociada a ventilaci&#243;n protectora&#44; ha demostrado reducir la mortalidad precoz<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> debido a la mejora de la diferencia de presi&#243;n transpulmonar ventral-dorsal y del cociente ventilaci&#243;n&#47;perfusi&#243;n&#44; entre otros mecanismos<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#46; Esta maniobra precisa personal experimentado y presenta riesgos&#44; como desplazamiento de dispositivos invasivos &#40;tubo orotraqueal &#91;TOT&#93;&#44; vasculares&#44; sondas&#44; drenajes&#44; etc&#46;&#41; o inestabilidad hemodin&#225;mica<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; Actualmente&#44; se recomienda en pacientes con SDRA severo durante al menos 16<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Durante la pandemia&#44; el n&#250;mero de pacientes que requirieron VMI y DP se increment&#243;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a>&#44; y bien por sobrecarga asistencial o por su mayor gravedad&#44; algunos pacientes se mantuvieron en DP durante periodos m&#225;s prolongados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A diferencia del DP hasta 24<span class="elsevierStyleHsp" style=""></span>h&#44; los datos sobre el uso del DP prolongado &#40;&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#59; DPP&#41; son limitados&#46; Mientras que hay evidencia de que mantener DP durante menos de 24<span class="elsevierStyleHsp" style=""></span>h es seguro y eficaz<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a>&#44; los datos sobre la eficacia y seguridad de mantener la maniobra 36-48<span class="elsevierStyleHsp" style=""></span>h se basan en series descriptivas<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#8211;16</span></a>&#46; El objetivo de este trabajo es describir las caracter&#237;sticas de los pacientes intubados con neumon&#237;a bilateral secundaria a COVID-19 con DPP en comparaci&#243;n con los pacientes en los que se mantuvo la postura de prono<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo descriptivo de pacientes consecutivos ingresados desde el 15&#47;03&#47;2020 hasta el 31&#47;12&#47;2021 en el Servicio de Medicina Intensiva &#40;SMI&#41; del Hospital General Universitario de Elche&#44; con 548 camas &#40;2021&#41;&#46; El SMI pas&#243; de 12 camas a atender simult&#225;neamente hasta 25 pacientes ubicados en diferentes espacios en el momento de pico asistencial&#46; No todos los pacientes en VMI por neumon&#237;a por SARS-CoV-2 del departamento de salud fueron atendidos por el SMI&#59; parte de los pacientes fueron atendidos por el Servicio de Anestesiolog&#237;a en funci&#243;n de la disponibilidad de espacios&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron de modo retrospectivo pacientes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#44; con infecci&#243;n por SARS-CoV-2 confirmada por reacci&#243;n en cadena de la polimerasa&#44; ingresados en el SMI&#44; en VMI por SDRA debido a neumon&#237;a bilateral por SARS-CoV-2&#46; Se excluyeron aquellos pacientes con SARS-CoV-2 intubados por otra causa o contraindicaci&#243;n para el uso del DP&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El SMI no cuenta con un sistema de registro electr&#243;nico de la informaci&#243;n&#44; por tanto&#44; los datos de recogieron de los registros cl&#237;nicos&#46; Se recogieron variables sociodemogr&#225;ficas &#40;edad&#44; sexo&#41;&#59; tratamiento para la COVID-19 &#40;inmunosupresores&#44; antirretrovirales&#41;&#59; comorbilidades &#40;diabetes mellitus&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; enfermedad cardiovascular&#44; etc&#46;&#41;&#59; escala Simplified Acute Phisiologic Score 3 al ingreso<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a>&#44; y uso de VMI y de maniobras de DP&#44; consider&#225;ndose DPP&#44; adem&#225;s del n&#250;mero total de ciclos requeridos&#46; Tambi&#233;n el intervalo entre la intubaci&#243;n y el primer ciclo de prono&#44; la relaci&#243;n PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> al inicio del primer ciclo como indicador de gravedad&#44; el mismo valor tras la primera maniobra&#44; el valor m&#225;ximo de PEEP requerido y la tolerancia posterior a la ventilaci&#243;n en dec&#250;bito supino &#40;DS&#41;&#44; considerada como la capacidad de mantener PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> en DS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#46; La decisi&#243;n de mantener en DPP no fue protocolizada&#44; sino que dependi&#243; de la situaci&#243;n del paciente y las posibilidades del equipo de realizar la maniobra a tiempo y con seguridad&#46; El resto del tratamiento&#44; tanto m&#233;dico como respecto a los protocolos adaptados de prevenci&#243;n de infecci&#243;n nosocomial y los par&#225;metros de ventilaci&#243;n protectora&#44; se realiz&#243; de acuerdo a los protocolos habituales &#40;VT 6-8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg peso ideal&#44; P meseta<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#41;&#44; que incluyen la maniobra de DP en pacientes con relaci&#243;n PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150 con FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60&#37; tras optimizar los niveles de PEEP<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&#46; Todos los pacientes fueron ventilados con sistemas de aspiraci&#243;n cerrados y sistemas de humidificaci&#243;n pasiva&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los resultados analizados fueron&#58; estancia hospitalaria y en UCI&#44; d&#237;as de VMI&#44; mortalidad en UCI&#44; uso de sedantes&#44; analg&#233;sicos y bloqueantes neuromusculares &#40;BNM&#41;&#44; necesidad de medicaci&#243;n vasoactiva&#44; traqueotom&#237;a&#44; p&#233;rdida de dispositivos &#40;cat&#233;teres&#44; tubos&#44; sondas&#44; etc&#46;&#41;&#44; obstrucci&#243;n del TOT&#44; parada cardiorrespiratoria durante el DP&#44; intolerancia a nutrici&#243;n enteral&#44; definida por un residuo g&#225;strico<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#44; y desarrollo de infecciones asociadas a la asistencia sanitaria &#40;IAAS&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&#46; Tambi&#233;n se tuvieron en cuenta los diferentes periodos de la pandemia<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica e Investigaci&#243;n con medicamentos del Hospital General Universitario de Elche&#44; con c&#243;digo de registro PI 103&#47;2021&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el an&#225;lisis estad&#237;stico descriptivo se calcularon las proporciones para las variables categ&#243;ricas y las medianas&#44; con percentiles 25 y 75 en el caso de variables continuas&#46; Se compararon los resultados de los pacientes con DP respecto a los que recibieron DPP&#46; Los contrastes de hip&#243;tesis sobre proporciones se realizaron mediante el test Ji al cuadrado&#46; Las variables cuantitativas se contrastaron mediante pruebas no param&#233;tricas &#40;test de Mann-Whitney para 2 variables&#44; test de Kruskal-Wallis en caso de 3 variables&#41;&#44; con contrastes bilaterales&#44; con un nivel de significaci&#243;n alfa del 5&#37;&#46; Se utiliz&#243; el software estad&#237;stico StatsDirect v 3&#46;3&#46;5 &#40;StatsDirect Ltd&#46;&#44; Wirral&#44; Reino Unido&#44; <a href="https://www.statsdirect.com/">https&#58;&#47;&#47;www&#46;statsdirect&#46;com&#47;</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se analizaron 134 pacientes consecutivos atendidos en el SMI durante 2020 y 2021&#46; El diagrama de flujo de los pacientes atendidos se resume en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; De ellos&#44; 86 pacientes requirieron VMI&#46; Fueron mayoritariamente varones &#40;73&#44;26&#37;&#44; 63 pacientes&#41;&#44; con una mediana de edad de 65 a&#241;os &#40;p25-p75&#58; 57-71 a&#241;os&#41;&#46; En total&#44; 51 pacientes &#40;60&#37;&#41; precisaron DP&#44; todos ellos con SDRA severo&#44; con ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Sus caracter&#237;sticas&#44; en funci&#243;n de la duraci&#243;n del periodo en DP&#44; se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La situaci&#243;n respiratoria inicial fue similar&#44; con par&#225;metros de SDRA grave &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> inicial de 103 en los pacientes con DP vs&#46; 96 en los pacientes con DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;885&#41;&#46; Los pacientes con DPP recibieron m&#225;s ciclos &#40;hasta 3 ciclos&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; de modo precoz en ambos grupos&#46; La mayor&#237;a de estas maniobras se llevaron a cabo durante la tercera ola de la pandemia &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Del total de pacientes&#44; 31 requirieron&#44; al menos&#44; un ciclo de DPP &#40;36&#37; de 86 pacientes con VMI&#41;&#46; Comparados con los que requirieron ciclos de DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; no se encontraron diferencias significativas en edad&#44; comorbilidad&#44; gravedad al ingreso ni tratamiento antiinflamatorio o antiviral administrado&#46; Sin embargo&#44; presentaron menor tolerancia a la ventilaci&#243;n en DS en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de un ciclo de prono &#40;61&#44;29 vs&#46; 89&#44;47&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46; A pesar de una respuesta inicial al DP favorable similar en ambos grupos&#44; 4 pacientes con DPP &#40;12&#44;90&#37; de 31 pacientes&#41; no mejoraron pese a extender la maniobra&#46; Comparados con los pacientes que se trataron con ciclos de DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; los pacientes con DPP presentaron mayor estancia hospitalaria &#40;41 vs&#46; 30 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; m&#225;s d&#237;as de VMI &#40;32 vs&#46; 20 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; y mayor duraci&#243;n del uso de BNM &#40;10&#44;5 vs 3 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#41;&#46; En cuanto a las complicaciones&#44; cabe destacar la mayor frecuencia de episodios de obstrucci&#243;n del TOT &#40;48&#44;39 vs&#46; 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; en los pacientes con DPP comparados con los pacientes con DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Comparando las 3 situaciones &#40;DS&#44; DP y DPP&#41;&#44; los pacientes que recibieron DPP tuvieron m&#225;s complicaciones&#58; aumento del residuo g&#225;strico &#40;5&#44;88&#37; en DS&#44; 15&#37; en DP y 32&#44;26&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; obstrucci&#243;n del TOT &#40;11&#44;43&#37; en DS&#44; 15&#37; en DP y 48&#44;39&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0016&#41;&#44; m&#225;s uso de BNM &#40;54&#44;29&#37; en DS&#44; 95&#37; en DP y 96&#44;77&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; en periodos m&#225;s prolongados&#44; sobre todo aquellos con DPP &#40;2 d&#237;as en DS&#44; 3 en DP y 10&#44;5 d&#237;as en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; mayor duraci&#243;n de la VMI y de los d&#237;as de hospitalizaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Respecto a las IAAS&#44; fueron m&#225;s frecuentes entre los pacientes que requirieron DP y DPP comparados con los que se ventilaron en DS&#58; las bacteriemias &#40;37&#44;14&#37; en DS&#44; 70&#37; en DP&#44; 74&#44;19&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y las infecciones del tracto urinario &#40;14&#44;71&#37; en DS&#44; 30&#37; en DP&#44; 45&#44;16&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En conjunto&#44; la mortalidad en UCI de todos los pacientes con COVID-19 fue del 21&#44;66&#37; &#40;29&#47;134&#41;&#46; La mortalidad de los pacientes con neumon&#237;a bilateral ingresados en el SMI fue del 22&#44;22&#37; &#40;24&#47;108&#41;&#59; todos ellos precisaron VMI&#46; Finalmente&#44; la mortalidad de los pacientes que se ventilaron en DP y DPP fue del 30 y el 38&#44;61&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;525&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las circunstancias especiales que se dieron durante la pandemia en las UCI dieron lugar a modificaciones en el tipo de atenci&#243;n prestada a los pacientes&#44; entre las que destaca el uso de la ventilaci&#243;n en DP en periodos prolongados&#46; Este hecho ha suscitado gran inter&#233;s sobre sus resultados&#44; como el impacto en la oxigenaci&#243;n de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12&#44;14&#44;15</span></a>&#44; la carga de trabajo<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15&#44;16</span></a>&#44; el desarrollo de &#250;lceras por presi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11&#44;14&#44;16</span></a>&#44; las lesiones neurop&#225;ticas a largo plazo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> y la p&#233;rdida o disfunci&#243;n accidental de dispositivos invasivos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudio describe los desenlaces de 108 pacientes ingresados por SARS-CoV-2 atendidos por el SMI desde marzo de 2020 a diciembre de 2021&#46; Como en otros estudios&#44; la mayor&#237;a de los pacientes con VMI por neumon&#237;a bilateral secundaria a la COVID-19 fueron varones &#40;73&#37;&#41; en la sexta d&#233;cada &#40;mediana de 63&#44;5 a&#241;os&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#8211;16</span></a>&#46; Hasta un 60&#37; requirieron DP&#44; en contraste con estudios publicados antes de la pandemia&#44; donde el uso del DP se situaba en torno al 16&#37; en el SDRA grave<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a>&#46; El n&#250;mero de ciclos de prono requerido por los pacientes fue similar a otros estudios<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11&#44;13&#44;14</span></a> &#40;mediana de 2 ciclos&#41;&#44; aunque los pacientes con DPP recibieron un n&#250;mero significativamente mayor de ciclos&#46; Con respecto a la gravedad&#44; considerando la ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> previa al inicio del primer ciclo de DP&#44; los pacientes presentaron similar nivel de gravedad&#44; y similar respuesta inicial&#46; Los pacientes que recibieron ciclos de DPP presentaron peor tolerancia al DS &#40;posibilidad de mantener PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en supino en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h tras la maniobra de prono&#41;&#44; mayor duraci&#243;n de la VMI&#44; m&#225;s ciclos de DP&#44; mayor estancia hospitalaria y en UCI&#44; y mayor prevalencia de complicaciones &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; pero no mayor n&#250;mero de IAAS&#46; Comparados con los pacientes ventilados en DS&#44; se mantuvieron estas diferencias&#44; y se asoci&#243; tambi&#233;n con un mayor n&#250;mero de infecciones urinarias y bacteriemias &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Se observa un efecto progresivamente m&#225;s acusado &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; en estos desenlaces entre los pacientes ventilados en DS&#44; DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h y DPP&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En la literatura existe mucha variabilidad en cuanto al uso de la ventilaci&#243;n en DPP durante la pandemia&#44; en periodos de hasta 5 d&#237;as y en uno<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> o varios ciclos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;15&#44;16</span></a>&#46; Entre los beneficios descritos destaca la mejor&#237;a sostenida en la oxigenaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12&#44;14&#44;15</span></a> y la posibilidad de reducir las cargas de trabajo del personal<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;12&#44;15&#44;16</span></a>&#46; En este estudio destaca el mayor uso de recursos como el BNM o la necesidad de traqueotom&#237;a&#44; mayor periodo en VMI&#44; mayor estancia hospitalaria&#44; y la incidencia&#44; progresivamente mayor en funci&#243;n de la necesidad de DP prolongado&#44; de eventos adversos como la obstrucci&#243;n del TOT y las IAAS &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Respecto al uso de BNM&#44; se ha descrito un mayor uso en relaci&#243;n con los pacientes ventilados con SDRA grave inducido por COVID-19<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;21</span></a>&#46; Las directrices de tratamiento actuales evidencian su uso s&#243;lo en pacientes en los que no se puede aplicar un protocolo de ventilaci&#243;n de protecci&#243;n pulmonar&#44; debido a la asincron&#237;a o aumento de los esfuerzos respiratorios&#44; en periodos no superiores a 48<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a>&#46; En nuestros pacientes ventilados en DP tambi&#233;n se utilizaron en mayor proporci&#243;n comparado con datos prepandemia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> y en duraci&#243;n mayor a lo recomendado en las gu&#237;as de pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a>&#44; pero no en los pacientes ventilados en DS&#46; En los pacientes ventilados en DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; este tratamiento se prolong&#243; 24<span class="elsevierStyleHsp" style=""></span>h m&#225;s de lo recomendado &#40;hasta 3 d&#237;as&#44; <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#44; pero fue en los pacientes ventilados en DPP en los que se alarg&#243; de modo significativo este tratamiento &#40;3 vs&#46; 10&#44;5 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Una posibilidad es que la mayor duraci&#243;n de la VMI se relacione con este uso prolongado m&#225;s que por el DPP o el n&#250;mero total de ciclos de DP&#44; aunque pueden haber influido muchos otros factores de confusi&#243;n no considerados en este estudio&#44; como otros datos de fracaso org&#225;nico&#44; o pautas de sedaci&#243;n m&#225;s profundas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En cuanto al resto de las complicaciones asociadas al DP&#44; destaca la obstrucci&#243;n del TOT&#44; sobre todo en los pacientes que recibieron DPP &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; Se observ&#243; un aumento progresivo del riesgo &#40;11&#44;43&#37; en pacientes ventilados en DS&#44; 15&#37; en pacientes ventilados en ciclos de DP&#44; 48&#44;39&#37; en pacientes ventilados en DPP&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0016&#41;&#46; Ese hecho ya est&#225; descrito como potencial complicaci&#243;n asociada a la VMI en DP&#44; aunque en menor porcentaje &#40;hasta un 6&#44;4&#37; en el estudio de Gonz&#225;lez-Seguel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> y hasta un 5&#37; en el estudio PROSEVA<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a>&#41;&#46; La obstrucci&#243;n del TOT por material mucosanguinolento es una complicaci&#243;n que se ha asociado a los pacientes con neumon&#237;a por SARS-CoV-2&#44; en el contexto del estado de hipercoagulabilidad caracter&#237;stico de esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a>&#44; y se ha descrito en los pacientes ventilados en DP una mayor retenci&#243;n de secreciones respiratorias&#44; hasta en el 12&#37; de los pacientes<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a>&#46; Cabe destacar que en todos los pacientes analizados se utiliz&#243; el mismo tipo de dispositivo de humidificaci&#243;n &#40;pasivo&#41;&#44; que no parece afectar a la prevalencia de oclusi&#243;n de la v&#237;a a&#233;rea comparado con los sistemas de humidificaci&#243;n activa de acuerdo con la evidencia actual<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46; Estas 3 circunstancias han podido influir en el elevado n&#250;mero de complicaciones en los pacientes con DPP&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En cuanto a la dificultad para la nutrici&#243;n enteral&#44; se ha descrito un incremento del volumen residual g&#225;strico en DP<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46; Se ha postulado que el uso de BNM podr&#237;a influir&#44; pero se ha visto que estos f&#225;rmacos no tienen un efecto paralizante en la musculatura intestinal&#44; por lo que este hecho se relaciona con la enfermedad subyacente y el uso concomitante de vasopresores o altas dosis de sedaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46; En este estudio&#44; se observa tambi&#233;n el mismo efecto&#44; progresivamente mayor en los pacientes ventilados en DS&#44; DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h y DPP &#40;5&#44;88&#37; en DS&#44; 15&#37; en DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; 32&#44;26&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; aunque cabe destacar que se utiliz&#243; un volumen de residuo g&#225;strico inferior a los valores actualmente recomendados de 500<span class="elsevierStyleHsp" style=""></span>ml<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las IAAS&#44; fueron m&#225;s frecuentes en los pacientes que requirieron DP comparados con los que se ventilaron en DS &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; pero no se encontraron diferencias en funci&#243;n de la duraci&#243;n de la maniobra &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; en probable relaci&#243;n con la maniobra y no con la duraci&#243;n de la misma&#46; Los protocolos adaptados de prevenci&#243;n de infecci&#243;n nosocomial<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> se llevaron a cabo dentro de las dificultades que el gran recambio de personal de enfermer&#237;a supuso y dentro de las posibilidades de entrenamiento que el contexto permiti&#243;&#46; Como en otro estudio espa&#241;ol&#44; las infecciones m&#225;s frecuentes fueron las bacteriemias y las infecciones del tracto urinario&#44; y tambi&#233;n los pacientes que precisaron DP y mayor uso de BNM presentaron mayor porcentaje de IAAS<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Estos resultados deben ser interpretados dentro de las limitaciones de un estudio retrospectivo y de tama&#241;o limitado&#46; No es un estudio de intervenci&#243;n&#44; sino descriptivo de las caracter&#237;sticas y desenlaces de los pacientes de un &#250;nico centro&#46; Las caracter&#237;sticas basales y su punto de partida al inicio de la enfermedad &#40;Simplified Acute Phisiologic Score 3 3&#41; y la ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> de los pacientes fueron similares&#44; lo que nos hace pensar que fue la sobrecarga asistencial la que impidi&#243; realizar los cuidados habituales de enfermer&#237;a &#40;higiene&#44; cambio de sistemas de humidificaci&#243;n&#41; o los cambios posturales a tiempo&#46; Tambi&#233;n pudieron haber influido en los peores desenlaces de los pacientes ventilados en DPP otros factores &#40;como sedaci&#243;n m&#225;s profunda&#41;&#44; adem&#225;s de una mayor gravedad evolutiva de los pacientes que requirieron DPP &#40;peor tolerancia al DS&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n es que no hemos incluido entre las complicaciones las lesiones articulares ni las &#250;lceras por presi&#243;n&#44; hecho extensamente descrito&#46; Tampoco se incluye un seguimiento a largo plazo&#44; que ser&#237;a interesante para valorar con perspectiva temporal estos efectos&#44; sobre todo a nivel neuromuscular&#46; Pese a todo ello&#44; pensamos que se&#241;ala potenciales puntos de mejora en el complejo manejo de estos pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">El DPP se asoci&#243; a mayor consumo de recursos &#40;estancia en UCI&#44; en el hospital&#44; un mayor periodo en VMI&#41; y mayor n&#250;mero de complicaciones y procedimientos &#40;uso de traqueotom&#237;a&#44; BNM&#44; dificultad para la nutrici&#243;n enteral&#41;&#44; pero sin diferencias en la supervivencia de estos pacientes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Autor&#237;a</span><p id="par0125" class="elsevierStylePara elsevierViewall">Eva de Miguel-Balsa&#58; Conceptualizaci&#243;n&#44; an&#225;lisis de datos y revisi&#243;n bibliogr&#225;fica y del manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Teresa Blasco-Ruso&#58; Recogida y an&#225;lisis de datos&#44; redacci&#243;n del manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Norma G&#243;mez-Medrano&#58; Conceptualizaci&#243;n&#44; revisi&#243;n del manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Mar&#237;a Mirabet-Guijarro&#58; Recogida de datos&#44; revisi&#243;n del manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Alba Mart&#237;nez-P&#233;rez&#58; Conceptualizaci&#243;n&#44; revisi&#243;n bibliogr&#225;fica y del manuscrito&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Adoraci&#243;n Alcal&#225;-L&#243;pez&#58; Gesti&#243;n de los datos&#44; revisi&#243;n del manuscrito&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores no tienen ning&#250;n conflicto de intereses que declarar&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas de los pacientes con s&#237;ndrome de distr&#233;s respiratorio agudo por neumon&#237;a bilateral por COVID-19 en ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41; y analizar el efecto del dec&#250;bito prono prolongado<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;DPP&#41; respecto al dec&#250;bito prono<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;DP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo descriptivo&#46; An&#225;lisis uni y bivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Servicio de Medicina Intensiva del Hospital General Universitario de Elche&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pacientes con neumon&#237;a por SARS-CoV-2 &#40;2020-2021&#41; en VMI por s&#237;ndrome de distr&#233;s respiratorio agudo moderado-severo&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Intervenciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VMI&#46; Maniobras de DP&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables de inter&#233;s principales</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Sociodemogr&#225;ficas&#59; analgosedaci&#243;n&#59; bloqueo neuromuscular&#59; DP &#40;duraci&#243;n&#41;&#44; estancia y mortalidad en UCI&#44; d&#237;as de VMI&#59; complicaciones no infecciosas&#59; infecciones asociadas a la asistencia sanitaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cincuenta y un pacientes precisaron DP y de ellos 31 &#40;69&#44;78&#37;&#41; requirieron DPP&#46; No se encontraron diferencias en las caracter&#237;sticas iniciales de los pacientes &#40;sexo&#44; edad&#44; comorbilidades&#44; gravedad inicial&#44; o en el tratamiento antiviral y antiinflamatorio recibido&#41;&#46; Los pacientes con DPP presentaron menor tolerancia a la ventilaci&#243;n en dec&#250;bito supino &#40;61&#44;29 vs&#46; 89&#44;47&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; mayor estancia hospitalaria &#40;41 vs&#46; 30 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; m&#225;s d&#237;as de VMI &#40;32 vs&#46; 20 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;&#44; mayor duraci&#243;n del tratamiento con bloqueo neuromuscular &#40;10&#44;5 vs&#46; 3 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#41;&#44; as&#237; como un mayor porcentaje de episodios de obstrucci&#243;n del tubo orotraqueal &#40;48&#44;39 vs&#46; 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El DPP se asoci&#243; con mayor uso de recursos y complicaciones en pacientes con s&#237;ndrome de distr&#233;s respiratorio agudo moderado-severo por COVID-19&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation &#40;IMV&#41; and analyze the effect of prolonged prone decubitus<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;PPD&#41; compared to prone decubitus<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;PD&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational descriptive study&#46; Uni and bivariate analysis&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Department of Intensive Care Medicine&#46; General University Hospital of Elche&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participants</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patients with SARS-CoV-2 pneumonia &#40;2020&#8211;2021&#41; in VMI for moderate-severe acute respiratory distress syndrome&#44; ventilated in PD&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">IMV&#46; PD maneuvers&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Main variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic&#59; analgo-sedation&#59; neuromuscular blockade&#59; PD &#40;duration&#41;&#44; ICU stay and mortality&#44; days of IMV&#59; non-infectious complications&#59; health care-associated infections&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Fifty-one patients required PD and of these 31 &#40;69&#46;78&#37;&#41; required PPD&#46; No differences were found in patient characteristics &#40;sex&#44; age&#44; comorbidities&#44; initial severity&#44; antiviral and anti-inflammatory treatment received&#41;&#46; Patients on PPD had lower tolerance to supine ventilation &#40;61&#46;29 vs&#46; 89&#46;47&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; longer hospital stay &#40;41 vs&#46; 30 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#44; more days of IMV &#40;32 vs&#46; 20 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#41;&#44; longer duration of neuromuscular blockade &#40;10&#46;5 vs&#46; 3 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41;&#44; as well as a higher percentage of episodes of orotracheal tube obstruction &#40;48&#46;39 vs&#46; 15&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19&#46;</p></span>"
        "secciones" => array:8 [
          0 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Design"
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          2 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Setting"
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          3 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Participants"
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          4 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Interventions"
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          5 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Main variables of interest"
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          6 => array:2 [
            "identificador" => "abst0075"
            "titulo" => "Results"
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          7 => array:2 [
            "identificador" => "abst0080"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Datos expresados como mediana &#40;p25-p75&#41; o n &#40;&#37;&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">BNM&#58; bloqueantes neuromusculares&#59; DP&#58; dec&#250;bito prono&#59; DS&#58; dec&#250;bito supino&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; ITU&#58; infecci&#243;n del tracto urinario&#59; NAVM&#58; neumon&#237;a asociada a ventilaci&#243;n mec&#225;nica&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial arterial de ox&#237;geno&#59; PEEP&#58; positive end-expiratory pressure &#40;&#171;presi&#243;n positiva al final de la espiraci&#243;n&#187;&#41;&#59; SAPS 3&#58; Simplified Acute Physiologic Score&#59; TOT&#58; tubo orotraqueal&#59; UCI&#58; Unidad de Cuidados Intensivos&#59; VMI&#58; ventilaci&#243;n mec&#225;nica invasiva&#46;</p>"
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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">1 &#40;5&#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 &#40;3&#44;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
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                  \t\t\t\t">0&#44;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-2&#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 &#40;0-3&#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">0&#44;575&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>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> previa al primer ciclo de DP&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">103 &#40;75-140&#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">96 &#40;75-137&#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;885&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>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> posprono &#40;siguientes 12<span class="elsevierStyleHsp" style=""></span>h&#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">244 &#40;207-278&#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">238 &#40;172-330&#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;940&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>PEEP m&#225;xima&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">14 &#40;12-15&#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">15 &#40;13-16&#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;145&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>N&#46;<span class="elsevierStyleSup">o</span> de ciclos de DP&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 &#40;1-2&#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">3 &#40;2-5&#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;0004&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>Tolerancia al DS &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> tras DS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#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">17 &#40;89&#44;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">19 &#40;61&#44;29&#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;031&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;as de VMI&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 &#40;9-34&#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">32 &#40;14-52&#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;032&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;as de ingreso en UCI&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">23&#44;5 &#40;11-40&#44;5&#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">32 &#40;16-57&#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;054&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;as de hospitalizaci&#243;n&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">30 &#40;16-54&#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">41 &#40;31-72&#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;023&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;as de sedaci&#243;n&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">18 &#40;8-31&#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">29&#44;5 &#40;14-39&#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;098&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>Uso de BNM&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">19 &#40;95&#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">30 &#40;96&#44;77&#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;750&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;as de BNM&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">3 &#40;3-5&#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&#44;5 &#40;5-19&#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">0&#44;0002&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>Mortalidad en UCI&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 &#40;30&#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">12 &#40;38&#44;61&#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;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones</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>Traqueotom&#237;a&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;50&#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">20 &#40;64&#44;52&#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;303&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>Aumento del residuo g&#225;strico &#40;&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#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">3 &#40;15&#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;32&#44;26&#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;167&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>Parada cardiorrespiratoria&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 &#40;5&#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 &#40;0&#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;208&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>Obstrucci&#243;n del TOT&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">3 &#40;15&#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\ttop\n
                  \t\t\t\t">19 &#40;61&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;886&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;42&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;35&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;711&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;42&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;19&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;118&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>Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;16&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;148&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>Asma&#47;EPOC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;22&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;6&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;146&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Enfermedad coronaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;8&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;841&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Evoluci&#243;n</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>D&#237;as de VMI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;6-13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;9-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;14-52&#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;0001&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>D&#237;as de ingreso en UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;9-17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&#44;5 &#40;11-40&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;16-57&#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;0001&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;as de hospitalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;5 &#40;17-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;16-54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;31-72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as de sedaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5-11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;8-31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#44;5 &#40;14-39&#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;0001&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>Uso de BNM&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">19 &#40;54&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;96&#44;77&#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;0001&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;as de BNM&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;0-2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3-5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;5 &#40;5-19&#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;0001&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>Mortalidad en UCI&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">6 &#40;17&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;38&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;140&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones</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>Traqueotom&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;14&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;64&#44;52&#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">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&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>Aumento del residuo g&#225;strico &#40;&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#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">2 &#40;5&#44;88&#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">3 &#40;15&#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;32&#44;26&#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;023&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>Parada cardiorrespiratoria&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 &#40;2&#44;94&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#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 &#40;0&#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;704&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>Obstrucci&#243;n del TOT&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">4 &#40;11&#44;43&#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">3 &#40;15&#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">15 &#40;48&#44;39&#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;0016&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>P&#233;rdida de dispositivos&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 &#40;2&#44;86&#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 &#40;5&#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">5 &#40;16&#44;13&#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;148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Infecciones nosocomiales</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>Bacteriemia&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">13 &#40;37&#44;14&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;70&#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">23 &#40;74&#44;19&#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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;005&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>ITU&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 &#40;14&#44;71&#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  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;30&#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">14 &#40;45&#44;16&#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;027&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>NAVM&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">5 &#40;14&#44;71&#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">6 &#40;30&#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  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;38&#44;71&#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">0&#44;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento COVID-19</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>Remdesivir&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">17 &#40;51&#44;52&#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">13 &#40;65&#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">18 &#40;58&#44;06&#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;639&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>Tocilizumab&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;68&#44;57&#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">15 &#40;75&#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">22 &#40;70&#44;97&#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;930&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>Metilprednisolona&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 &#40;17&#44;65&#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">3 &#40;15&#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">6 &#40;19&#44;35&#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;922&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>Dexametasona&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">26 &#40;86&#44;67&#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">17 &#40;89&#44;5&#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;82&#44;76&#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;844&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3456172.png"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y desenlaces de los pacientes con neumon&#237;a por SARS-CoV-2 en ventilaci&#243;n mec&#225;nica invasiva</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Centro de Coordinaci&#243;n de Alertas y Emergencias Sanitarias&#46; Enfermedad por coronavirus&#44; COVID-19 &#91;consultado 5 Dic 2022&#93;&#46; Disponible en https&#58;&#47;&#47;www&#46;sanidad&#46;gob&#46;es&#47;profesionales&#47;saludPublica&#47;ccayes&#47;alertasActual&#47;nCov&#47;documentos&#47;ITCoronavirus&#46;pdf"
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              "identificador" => "bib0145"
              "etiqueta" => "2"
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                0 => array:1 [
                  "referenciaCompleta" => "Centro de Coordinaci&#243;n de Alertas y Emergencias Sanitarias&#46; Actualizaci&#243;n n&#46;<span class="elsevierStyleSup">o</span> 648&#46; Enfermedad por el coronavirus &#40;COVID-19&#41;&#46; 02&#46;12&#46;2022 &#91;consultado 5 Dic 2022&#93;&#46; Disponible en https&#58;&#47;&#47;www&#46;sanidad&#46;gob&#46;es&#47;profesionales&#47;saludPublica&#47;ccayes&#47;alertasActual&#47;nCov&#47;documentos&#47;Actualizacion&#95;648&#95;COVID-19&#46;pdf"
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            2 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region&#44; Italy"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "COVID-19 Lombardy ICU Network"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Grasselli"
                            1 => "A&#46; Zangrillo"
                            2 => "A&#46; Zanella"
                            3 => "M&#46; Antonelli"
                            4 => "L&#46; Cabrini"
                            5 => "A&#46; Castelli"
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                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2020.5394"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2020"
                        "volumen" => "323"
                        "paginaInicial" => "1574"
                        "paginaFinal" => "1581"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32250385"
                            "web" => "Medline"
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                        ]
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ORIGINAL
Efecto de la duración del decúbito prono en pacientes con SDRA durante la pandemia por SARS-CoV-2
Effect of duration of prone position in ARDS patients during SARS-CoV-2 pandemic
Eva de Miguel-Balsaa,b,
Autor para correspondencia
eva.miguelb@umh.es

Autor para correspondencia.
, Teresa Blasco-Rusob, Norma Gómez-Medranoa, María Mirabet-Guijarroa, Alba Martínez-Péreza, Adoración Alcalá-Lópeza
a Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, España
b Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández de Elche, Elche, Alicante, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">En diciembre de 2019 apareci&#243; en China una enfermedad desconocida secundaria a un nuevo virus de la familia <span class="elsevierStyleItalic">Coronaviridae</span> &#40;SARS-CoV-2&#41;&#46; En marzo de 2020&#44; la Organizaci&#243;n Mundial de la Salud declar&#243; la pandemia mundial debido a su r&#225;pida progresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46; En Espa&#241;a&#44; hasta la fecha se han notificado 13&#46;614&#46;807 casos confirmados de COVID-19 y 116&#46;108 fallecidos<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>&#46; Un n&#250;mero importante de pacientes desarroll&#243; s&#237;ndrome de distr&#233;s respiratorio agudo &#40;SDRA&#41;&#44; necesitando ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41; en una unidad de cuidados intensivos &#40;UCI&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El SDRA se caracteriza por da&#241;o pulmonar inflamatorio agudo y difuso&#44; que produce aumento de la permeabilidad vascular y del peso pulmonar&#44; con disminuci&#243;n de la distensibilidad<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a>&#46; En pacientes con SDRA severo&#44; la utilizaci&#243;n temprana de la posici&#243;n en dec&#250;bito prono &#40;DP&#41; durante al menos 16<span class="elsevierStyleHsp" style=""></span>h consecutivas&#44; asociada a ventilaci&#243;n protectora&#44; ha demostrado reducir la mortalidad precoz<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> debido a la mejora de la diferencia de presi&#243;n transpulmonar ventral-dorsal y del cociente ventilaci&#243;n&#47;perfusi&#243;n&#44; entre otros mecanismos<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#46; Esta maniobra precisa personal experimentado y presenta riesgos&#44; como desplazamiento de dispositivos invasivos &#40;tubo orotraqueal &#91;TOT&#93;&#44; vasculares&#44; sondas&#44; drenajes&#44; etc&#46;&#41; o inestabilidad hemodin&#225;mica<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46; Actualmente&#44; se recomienda en pacientes con SDRA severo durante al menos 16<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Durante la pandemia&#44; el n&#250;mero de pacientes que requirieron VMI y DP se increment&#243;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a>&#44; y bien por sobrecarga asistencial o por su mayor gravedad&#44; algunos pacientes se mantuvieron en DP durante periodos m&#225;s prolongados&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A diferencia del DP hasta 24<span class="elsevierStyleHsp" style=""></span>h&#44; los datos sobre el uso del DP prolongado &#40;&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#59; DPP&#41; son limitados&#46; Mientras que hay evidencia de que mantener DP durante menos de 24<span class="elsevierStyleHsp" style=""></span>h es seguro y eficaz<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a>&#44; los datos sobre la eficacia y seguridad de mantener la maniobra 36-48<span class="elsevierStyleHsp" style=""></span>h se basan en series descriptivas<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#8211;16</span></a>&#46; El objetivo de este trabajo es describir las caracter&#237;sticas de los pacientes intubados con neumon&#237;a bilateral secundaria a COVID-19 con DPP en comparaci&#243;n con los pacientes en los que se mantuvo la postura de prono<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional retrospectivo descriptivo de pacientes consecutivos ingresados desde el 15&#47;03&#47;2020 hasta el 31&#47;12&#47;2021 en el Servicio de Medicina Intensiva &#40;SMI&#41; del Hospital General Universitario de Elche&#44; con 548 camas &#40;2021&#41;&#46; El SMI pas&#243; de 12 camas a atender simult&#225;neamente hasta 25 pacientes ubicados en diferentes espacios en el momento de pico asistencial&#46; No todos los pacientes en VMI por neumon&#237;a por SARS-CoV-2 del departamento de salud fueron atendidos por el SMI&#59; parte de los pacientes fueron atendidos por el Servicio de Anestesiolog&#237;a en funci&#243;n de la disponibilidad de espacios&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron de modo retrospectivo pacientes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#44; con infecci&#243;n por SARS-CoV-2 confirmada por reacci&#243;n en cadena de la polimerasa&#44; ingresados en el SMI&#44; en VMI por SDRA debido a neumon&#237;a bilateral por SARS-CoV-2&#46; Se excluyeron aquellos pacientes con SARS-CoV-2 intubados por otra causa o contraindicaci&#243;n para el uso del DP&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El SMI no cuenta con un sistema de registro electr&#243;nico de la informaci&#243;n&#44; por tanto&#44; los datos de recogieron de los registros cl&#237;nicos&#46; Se recogieron variables sociodemogr&#225;ficas &#40;edad&#44; sexo&#41;&#59; tratamiento para la COVID-19 &#40;inmunosupresores&#44; antirretrovirales&#41;&#59; comorbilidades &#40;diabetes mellitus&#44; hipertensi&#243;n arterial&#44; dislipidemia&#44; enfermedad cardiovascular&#44; etc&#46;&#41;&#59; escala Simplified Acute Phisiologic Score 3 al ingreso<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a>&#44; y uso de VMI y de maniobras de DP&#44; consider&#225;ndose DPP&#44; adem&#225;s del n&#250;mero total de ciclos requeridos&#46; Tambi&#233;n el intervalo entre la intubaci&#243;n y el primer ciclo de prono&#44; la relaci&#243;n PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> al inicio del primer ciclo como indicador de gravedad&#44; el mismo valor tras la primera maniobra&#44; el valor m&#225;ximo de PEEP requerido y la tolerancia posterior a la ventilaci&#243;n en dec&#250;bito supino &#40;DS&#41;&#44; considerada como la capacidad de mantener PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> en DS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#46; La decisi&#243;n de mantener en DPP no fue protocolizada&#44; sino que dependi&#243; de la situaci&#243;n del paciente y las posibilidades del equipo de realizar la maniobra a tiempo y con seguridad&#46; El resto del tratamiento&#44; tanto m&#233;dico como respecto a los protocolos adaptados de prevenci&#243;n de infecci&#243;n nosocomial y los par&#225;metros de ventilaci&#243;n protectora&#44; se realiz&#243; de acuerdo a los protocolos habituales &#40;VT 6-8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg peso ideal&#44; P meseta<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#41;&#44; que incluyen la maniobra de DP en pacientes con relaci&#243;n PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150 con FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60&#37; tras optimizar los niveles de PEEP<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a>&#46; Todos los pacientes fueron ventilados con sistemas de aspiraci&#243;n cerrados y sistemas de humidificaci&#243;n pasiva&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los resultados analizados fueron&#58; estancia hospitalaria y en UCI&#44; d&#237;as de VMI&#44; mortalidad en UCI&#44; uso de sedantes&#44; analg&#233;sicos y bloqueantes neuromusculares &#40;BNM&#41;&#44; necesidad de medicaci&#243;n vasoactiva&#44; traqueotom&#237;a&#44; p&#233;rdida de dispositivos &#40;cat&#233;teres&#44; tubos&#44; sondas&#44; etc&#46;&#41;&#44; obstrucci&#243;n del TOT&#44; parada cardiorrespiratoria durante el DP&#44; intolerancia a nutrici&#243;n enteral&#44; definida por un residuo g&#225;strico<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#44; y desarrollo de infecciones asociadas a la asistencia sanitaria &#40;IAAS&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a>&#46; Tambi&#233;n se tuvieron en cuenta los diferentes periodos de la pandemia<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica e Investigaci&#243;n con medicamentos del Hospital General Universitario de Elche&#44; con c&#243;digo de registro PI 103&#47;2021&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el an&#225;lisis estad&#237;stico descriptivo se calcularon las proporciones para las variables categ&#243;ricas y las medianas&#44; con percentiles 25 y 75 en el caso de variables continuas&#46; Se compararon los resultados de los pacientes con DP respecto a los que recibieron DPP&#46; Los contrastes de hip&#243;tesis sobre proporciones se realizaron mediante el test Ji al cuadrado&#46; Las variables cuantitativas se contrastaron mediante pruebas no param&#233;tricas &#40;test de Mann-Whitney para 2 variables&#44; test de Kruskal-Wallis en caso de 3 variables&#41;&#44; con contrastes bilaterales&#44; con un nivel de significaci&#243;n alfa del 5&#37;&#46; Se utiliz&#243; el software estad&#237;stico StatsDirect v 3&#46;3&#46;5 &#40;StatsDirect Ltd&#46;&#44; Wirral&#44; Reino Unido&#44; <a href="https://www.statsdirect.com/">https&#58;&#47;&#47;www&#46;statsdirect&#46;com&#47;</a>&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se analizaron 134 pacientes consecutivos atendidos en el SMI durante 2020 y 2021&#46; El diagrama de flujo de los pacientes atendidos se resume en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; De ellos&#44; 86 pacientes requirieron VMI&#46; Fueron mayoritariamente varones &#40;73&#44;26&#37;&#44; 63 pacientes&#41;&#44; con una mediana de edad de 65 a&#241;os &#40;p25-p75&#58; 57-71 a&#241;os&#41;&#46; En total&#44; 51 pacientes &#40;60&#37;&#41; precisaron DP&#44; todos ellos con SDRA severo&#44; con ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Sus caracter&#237;sticas&#44; en funci&#243;n de la duraci&#243;n del periodo en DP&#44; se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La situaci&#243;n respiratoria inicial fue similar&#44; con par&#225;metros de SDRA grave &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> inicial de 103 en los pacientes con DP vs&#46; 96 en los pacientes con DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;885&#41;&#46; Los pacientes con DPP recibieron m&#225;s ciclos &#40;hasta 3 ciclos&#44; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; de modo precoz en ambos grupos&#46; La mayor&#237;a de estas maniobras se llevaron a cabo durante la tercera ola de la pandemia &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Del total de pacientes&#44; 31 requirieron&#44; al menos&#44; un ciclo de DPP &#40;36&#37; de 86 pacientes con VMI&#41;&#46; Comparados con los que requirieron ciclos de DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; no se encontraron diferencias significativas en edad&#44; comorbilidad&#44; gravedad al ingreso ni tratamiento antiinflamatorio o antiviral administrado&#46; Sin embargo&#44; presentaron menor tolerancia a la ventilaci&#243;n en DS en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de un ciclo de prono &#40;61&#44;29 vs&#46; 89&#44;47&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46; A pesar de una respuesta inicial al DP favorable similar en ambos grupos&#44; 4 pacientes con DPP &#40;12&#44;90&#37; de 31 pacientes&#41; no mejoraron pese a extender la maniobra&#46; Comparados con los pacientes que se trataron con ciclos de DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; los pacientes con DPP presentaron mayor estancia hospitalaria &#40;41 vs&#46; 30 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; m&#225;s d&#237;as de VMI &#40;32 vs&#46; 20 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41; y mayor duraci&#243;n del uso de BNM &#40;10&#44;5 vs 3 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#41;&#46; En cuanto a las complicaciones&#44; cabe destacar la mayor frecuencia de episodios de obstrucci&#243;n del TOT &#40;48&#44;39 vs&#46; 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; en los pacientes con DPP comparados con los pacientes con DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Comparando las 3 situaciones &#40;DS&#44; DP y DPP&#41;&#44; los pacientes que recibieron DPP tuvieron m&#225;s complicaciones&#58; aumento del residuo g&#225;strico &#40;5&#44;88&#37; en DS&#44; 15&#37; en DP y 32&#44;26&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; obstrucci&#243;n del TOT &#40;11&#44;43&#37; en DS&#44; 15&#37; en DP y 48&#44;39&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0016&#41;&#44; m&#225;s uso de BNM &#40;54&#44;29&#37; en DS&#44; 95&#37; en DP y 96&#44;77&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; en periodos m&#225;s prolongados&#44; sobre todo aquellos con DPP &#40;2 d&#237;as en DS&#44; 3 en DP y 10&#44;5 d&#237;as en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; mayor duraci&#243;n de la VMI y de los d&#237;as de hospitalizaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Respecto a las IAAS&#44; fueron m&#225;s frecuentes entre los pacientes que requirieron DP y DPP comparados con los que se ventilaron en DS&#58; las bacteriemias &#40;37&#44;14&#37; en DS&#44; 70&#37; en DP&#44; 74&#44;19&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41; y las infecciones del tracto urinario &#40;14&#44;71&#37; en DS&#44; 30&#37; en DP&#44; 45&#44;16&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;027&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En conjunto&#44; la mortalidad en UCI de todos los pacientes con COVID-19 fue del 21&#44;66&#37; &#40;29&#47;134&#41;&#46; La mortalidad de los pacientes con neumon&#237;a bilateral ingresados en el SMI fue del 22&#44;22&#37; &#40;24&#47;108&#41;&#59; todos ellos precisaron VMI&#46; Finalmente&#44; la mortalidad de los pacientes que se ventilaron en DP y DPP fue del 30 y el 38&#44;61&#37;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;525&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las circunstancias especiales que se dieron durante la pandemia en las UCI dieron lugar a modificaciones en el tipo de atenci&#243;n prestada a los pacientes&#44; entre las que destaca el uso de la ventilaci&#243;n en DP en periodos prolongados&#46; Este hecho ha suscitado gran inter&#233;s sobre sus resultados&#44; como el impacto en la oxigenaci&#243;n de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12&#44;14&#44;15</span></a>&#44; la carga de trabajo<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15&#44;16</span></a>&#44; el desarrollo de &#250;lceras por presi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11&#44;14&#44;16</span></a>&#44; las lesiones neurop&#225;ticas a largo plazo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> y la p&#233;rdida o disfunci&#243;n accidental de dispositivos invasivos<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudio describe los desenlaces de 108 pacientes ingresados por SARS-CoV-2 atendidos por el SMI desde marzo de 2020 a diciembre de 2021&#46; Como en otros estudios&#44; la mayor&#237;a de los pacientes con VMI por neumon&#237;a bilateral secundaria a la COVID-19 fueron varones &#40;73&#37;&#41; en la sexta d&#233;cada &#40;mediana de 63&#44;5 a&#241;os&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#8211;16</span></a>&#46; Hasta un 60&#37; requirieron DP&#44; en contraste con estudios publicados antes de la pandemia&#44; donde el uso del DP se situaba en torno al 16&#37; en el SDRA grave<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a>&#46; El n&#250;mero de ciclos de prono requerido por los pacientes fue similar a otros estudios<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;11&#44;13&#44;14</span></a> &#40;mediana de 2 ciclos&#41;&#44; aunque los pacientes con DPP recibieron un n&#250;mero significativamente mayor de ciclos&#46; Con respecto a la gravedad&#44; considerando la ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> previa al inicio del primer ciclo de DP&#44; los pacientes presentaron similar nivel de gravedad&#44; y similar respuesta inicial&#46; Los pacientes que recibieron ciclos de DPP presentaron peor tolerancia al DS &#40;posibilidad de mantener PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en supino en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h tras la maniobra de prono&#41;&#44; mayor duraci&#243;n de la VMI&#44; m&#225;s ciclos de DP&#44; mayor estancia hospitalaria y en UCI&#44; y mayor prevalencia de complicaciones &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; pero no mayor n&#250;mero de IAAS&#46; Comparados con los pacientes ventilados en DS&#44; se mantuvieron estas diferencias&#44; y se asoci&#243; tambi&#233;n con un mayor n&#250;mero de infecciones urinarias y bacteriemias &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Se observa un efecto progresivamente m&#225;s acusado &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; en estos desenlaces entre los pacientes ventilados en DS&#44; DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h y DPP&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En la literatura existe mucha variabilidad en cuanto al uso de la ventilaci&#243;n en DPP durante la pandemia&#44; en periodos de hasta 5 d&#237;as y en uno<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a> o varios ciclos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;15&#44;16</span></a>&#46; Entre los beneficios descritos destaca la mejor&#237;a sostenida en la oxigenaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;12&#44;14&#44;15</span></a> y la posibilidad de reducir las cargas de trabajo del personal<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">10&#44;12&#44;15&#44;16</span></a>&#46; En este estudio destaca el mayor uso de recursos como el BNM o la necesidad de traqueotom&#237;a&#44; mayor periodo en VMI&#44; mayor estancia hospitalaria&#44; y la incidencia&#44; progresivamente mayor en funci&#243;n de la necesidad de DP prolongado&#44; de eventos adversos como la obstrucci&#243;n del TOT y las IAAS &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Respecto al uso de BNM&#44; se ha descrito un mayor uso en relaci&#243;n con los pacientes ventilados con SDRA grave inducido por COVID-19<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;21</span></a>&#46; Las directrices de tratamiento actuales evidencian su uso s&#243;lo en pacientes en los que no se puede aplicar un protocolo de ventilaci&#243;n de protecci&#243;n pulmonar&#44; debido a la asincron&#237;a o aumento de los esfuerzos respiratorios&#44; en periodos no superiores a 48<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a>&#46; En nuestros pacientes ventilados en DP tambi&#233;n se utilizaron en mayor proporci&#243;n comparado con datos prepandemia<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> y en duraci&#243;n mayor a lo recomendado en las gu&#237;as de pr&#225;ctica cl&#237;nica<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a>&#44; pero no en los pacientes ventilados en DS&#46; En los pacientes ventilados en DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; este tratamiento se prolong&#243; 24<span class="elsevierStyleHsp" style=""></span>h m&#225;s de lo recomendado &#40;hasta 3 d&#237;as&#44; <a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#44; pero fue en los pacientes ventilados en DPP en los que se alarg&#243; de modo significativo este tratamiento &#40;3 vs&#46; 10&#44;5 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Una posibilidad es que la mayor duraci&#243;n de la VMI se relacione con este uso prolongado m&#225;s que por el DPP o el n&#250;mero total de ciclos de DP&#44; aunque pueden haber influido muchos otros factores de confusi&#243;n no considerados en este estudio&#44; como otros datos de fracaso org&#225;nico&#44; o pautas de sedaci&#243;n m&#225;s profundas&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En cuanto al resto de las complicaciones asociadas al DP&#44; destaca la obstrucci&#243;n del TOT&#44; sobre todo en los pacientes que recibieron DPP &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; Se observ&#243; un aumento progresivo del riesgo &#40;11&#44;43&#37; en pacientes ventilados en DS&#44; 15&#37; en pacientes ventilados en ciclos de DP&#44; 48&#44;39&#37; en pacientes ventilados en DPP&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0016&#41;&#46; Ese hecho ya est&#225; descrito como potencial complicaci&#243;n asociada a la VMI en DP&#44; aunque en menor porcentaje &#40;hasta un 6&#44;4&#37; en el estudio de Gonz&#225;lez-Seguel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a> y hasta un 5&#37; en el estudio PROSEVA<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a>&#41;&#46; La obstrucci&#243;n del TOT por material mucosanguinolento es una complicaci&#243;n que se ha asociado a los pacientes con neumon&#237;a por SARS-CoV-2&#44; en el contexto del estado de hipercoagulabilidad caracter&#237;stico de esta enfermedad<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a>&#44; y se ha descrito en los pacientes ventilados en DP una mayor retenci&#243;n de secreciones respiratorias&#44; hasta en el 12&#37; de los pacientes<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a>&#46; Cabe destacar que en todos los pacientes analizados se utiliz&#243; el mismo tipo de dispositivo de humidificaci&#243;n &#40;pasivo&#41;&#44; que no parece afectar a la prevalencia de oclusi&#243;n de la v&#237;a a&#233;rea comparado con los sistemas de humidificaci&#243;n activa de acuerdo con la evidencia actual<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a>&#46; Estas 3 circunstancias han podido influir en el elevado n&#250;mero de complicaciones en los pacientes con DPP&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En cuanto a la dificultad para la nutrici&#243;n enteral&#44; se ha descrito un incremento del volumen residual g&#225;strico en DP<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46; Se ha postulado que el uso de BNM podr&#237;a influir&#44; pero se ha visto que estos f&#225;rmacos no tienen un efecto paralizante en la musculatura intestinal&#44; por lo que este hecho se relaciona con la enfermedad subyacente y el uso concomitante de vasopresores o altas dosis de sedaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a>&#46; En este estudio&#44; se observa tambi&#233;n el mismo efecto&#44; progresivamente mayor en los pacientes ventilados en DS&#44; DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h y DPP &#40;5&#44;88&#37; en DS&#44; 15&#37; en DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#44; 32&#44;26&#37; en DPP&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#59; <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; aunque cabe destacar que se utiliz&#243; un volumen de residuo g&#225;strico inferior a los valores actualmente recomendados de 500<span class="elsevierStyleHsp" style=""></span>ml<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las IAAS&#44; fueron m&#225;s frecuentes en los pacientes que requirieron DP comparados con los que se ventilaron en DS &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; pero no se encontraron diferencias en funci&#243;n de la duraci&#243;n de la maniobra &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; en probable relaci&#243;n con la maniobra y no con la duraci&#243;n de la misma&#46; Los protocolos adaptados de prevenci&#243;n de infecci&#243;n nosocomial<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> se llevaron a cabo dentro de las dificultades que el gran recambio de personal de enfermer&#237;a supuso y dentro de las posibilidades de entrenamiento que el contexto permiti&#243;&#46; Como en otro estudio espa&#241;ol&#44; las infecciones m&#225;s frecuentes fueron las bacteriemias y las infecciones del tracto urinario&#44; y tambi&#233;n los pacientes que precisaron DP y mayor uso de BNM presentaron mayor porcentaje de IAAS<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Estos resultados deben ser interpretados dentro de las limitaciones de un estudio retrospectivo y de tama&#241;o limitado&#46; No es un estudio de intervenci&#243;n&#44; sino descriptivo de las caracter&#237;sticas y desenlaces de los pacientes de un &#250;nico centro&#46; Las caracter&#237;sticas basales y su punto de partida al inicio de la enfermedad &#40;Simplified Acute Phisiologic Score 3 3&#41; y la ratio PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> de los pacientes fueron similares&#44; lo que nos hace pensar que fue la sobrecarga asistencial la que impidi&#243; realizar los cuidados habituales de enfermer&#237;a &#40;higiene&#44; cambio de sistemas de humidificaci&#243;n&#41; o los cambios posturales a tiempo&#46; Tambi&#233;n pudieron haber influido en los peores desenlaces de los pacientes ventilados en DPP otros factores &#40;como sedaci&#243;n m&#225;s profunda&#41;&#44; adem&#225;s de una mayor gravedad evolutiva de los pacientes que requirieron DPP &#40;peor tolerancia al DS&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Otra limitaci&#243;n es que no hemos incluido entre las complicaciones las lesiones articulares ni las &#250;lceras por presi&#243;n&#44; hecho extensamente descrito&#46; Tampoco se incluye un seguimiento a largo plazo&#44; que ser&#237;a interesante para valorar con perspectiva temporal estos efectos&#44; sobre todo a nivel neuromuscular&#46; Pese a todo ello&#44; pensamos que se&#241;ala potenciales puntos de mejora en el complejo manejo de estos pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusiones</span><p id="par0120" class="elsevierStylePara elsevierViewall">El DPP se asoci&#243; a mayor consumo de recursos &#40;estancia en UCI&#44; en el hospital&#44; un mayor periodo en VMI&#41; y mayor n&#250;mero de complicaciones y procedimientos &#40;uso de traqueotom&#237;a&#44; BNM&#44; dificultad para la nutrici&#243;n enteral&#41;&#44; pero sin diferencias en la supervivencia de estos pacientes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Autor&#237;a</span><p id="par0125" class="elsevierStylePara elsevierViewall">Eva de Miguel-Balsa&#58; Conceptualizaci&#243;n&#44; an&#225;lisis de datos y revisi&#243;n bibliogr&#225;fica y del manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Teresa Blasco-Ruso&#58; Recogida y an&#225;lisis de datos&#44; redacci&#243;n del manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Norma G&#243;mez-Medrano&#58; Conceptualizaci&#243;n&#44; revisi&#243;n del manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Mar&#237;a Mirabet-Guijarro&#58; Recogida de datos&#44; revisi&#243;n del manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Alba Mart&#237;nez-P&#233;rez&#58; Conceptualizaci&#243;n&#44; revisi&#243;n bibliogr&#225;fica y del manuscrito&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Adoraci&#243;n Alcal&#225;-L&#243;pez&#58; Gesti&#243;n de los datos&#44; revisi&#243;n del manuscrito&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores no tienen ning&#250;n conflicto de intereses que declarar&#46;</p></span></span>"
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    "fechaRecibido" => "2022-10-16"
    "fechaAceptado" => "2023-03-06"
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            0 => "Dec&#250;bito prono"
            1 => "Dec&#250;bito prono prolongado"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas de los pacientes con s&#237;ndrome de distr&#233;s respiratorio agudo por neumon&#237;a bilateral por COVID-19 en ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41; y analizar el efecto del dec&#250;bito prono prolongado<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;DPP&#41; respecto al dec&#250;bito prono<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;DP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo descriptivo&#46; An&#225;lisis uni y bivariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Servicio de Medicina Intensiva del Hospital General Universitario de Elche&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pacientes con neumon&#237;a por SARS-CoV-2 &#40;2020-2021&#41; en VMI por s&#237;ndrome de distr&#233;s respiratorio agudo moderado-severo&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Intervenciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">VMI&#46; Maniobras de DP&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables de inter&#233;s principales</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Sociodemogr&#225;ficas&#59; analgosedaci&#243;n&#59; bloqueo neuromuscular&#59; DP &#40;duraci&#243;n&#41;&#44; estancia y mortalidad en UCI&#44; d&#237;as de VMI&#59; complicaciones no infecciosas&#59; infecciones asociadas a la asistencia sanitaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cincuenta y un pacientes precisaron DP y de ellos 31 &#40;69&#44;78&#37;&#41; requirieron DPP&#46; No se encontraron diferencias en las caracter&#237;sticas iniciales de los pacientes &#40;sexo&#44; edad&#44; comorbilidades&#44; gravedad inicial&#44; o en el tratamiento antiviral y antiinflamatorio recibido&#41;&#46; Los pacientes con DPP presentaron menor tolerancia a la ventilaci&#243;n en dec&#250;bito supino &#40;61&#44;29 vs&#46; 89&#44;47&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; mayor estancia hospitalaria &#40;41 vs&#46; 30 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;023&#41;&#44; m&#225;s d&#237;as de VMI &#40;32 vs&#46; 20 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;032&#41;&#44; mayor duraci&#243;n del tratamiento con bloqueo neuromuscular &#40;10&#44;5 vs&#46; 3 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0002&#41;&#44; as&#237; como un mayor porcentaje de episodios de obstrucci&#243;n del tubo orotraqueal &#40;48&#44;39 vs&#46; 15&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El DPP se asoci&#243; con mayor uso de recursos y complicaciones en pacientes con s&#237;ndrome de distr&#233;s respiratorio agudo moderado-severo por COVID-19&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of patients with acute respiratory distress syndrome due to bilateral COVID-19 pneumonia on invasive mechanical ventilation &#40;IMV&#41; and analyze the effect of prolonged prone decubitus<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;PPD&#41; compared to prone decubitus<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h &#40;PD&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Design</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Retrospective observational descriptive study&#46; Uni and bivariate analysis&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Setting</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Department of Intensive Care Medicine&#46; General University Hospital of Elche&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participants</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patients with SARS-CoV-2 pneumonia &#40;2020&#8211;2021&#41; in VMI for moderate-severe acute respiratory distress syndrome&#44; ventilated in PD&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Interventions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">IMV&#46; PD maneuvers&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Main variables of interest</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic&#59; analgo-sedation&#59; neuromuscular blockade&#59; PD &#40;duration&#41;&#44; ICU stay and mortality&#44; days of IMV&#59; non-infectious complications&#59; health care-associated infections&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Fifty-one patients required PD and of these 31 &#40;69&#46;78&#37;&#41; required PPD&#46; No differences were found in patient characteristics &#40;sex&#44; age&#44; comorbidities&#44; initial severity&#44; antiviral and anti-inflammatory treatment received&#41;&#46; Patients on PPD had lower tolerance to supine ventilation &#40;61&#46;29 vs&#46; 89&#46;47&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#41;&#44; longer hospital stay &#40;41 vs&#46; 30 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#41;&#44; more days of IMV &#40;32 vs&#46; 20 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#41;&#44; longer duration of neuromuscular blockade &#40;10&#46;5 vs&#46; 3 days&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41;&#44; as well as a higher percentage of episodes of orotracheal tube obstruction &#40;48&#46;39 vs&#46; 15&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">PPD was associated with higher resource use and complications in patients with moderate-severe acute respiratory distress syndrome by COVID-19&#46;</p></span>"
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;35&#44;5&#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;777&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>Diabetes mellitus&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 &#40;25&#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">6 &#40;19&#44;36&#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;503&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>Enfermedad renal cr&#243;nica&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 &#40;5&#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">5 &#40;16&#44;13&#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;228&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma&#47;EPOC&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">2 &#40;10&#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">2 &#40;6&#44;45&#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;645&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>Enfermedad coronaria&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">1 &#40;5&#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">1 &#40;3&#44;23&#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;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Evoluci&#243;n</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>D&#237;as intubaci&#243;n al primer ciclo de DP&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 &#40;0-2&#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">1 &#40;0-3&#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">0&#44;575&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>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> previa al primer ciclo de DP&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">103 &#40;75-140&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;75-137&#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;885&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>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> posprono &#40;siguientes 12<span class="elsevierStyleHsp" style=""></span>h&#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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">244 &#40;207-278&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">238 &#40;172-330&#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  " align="left" valign="\n
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                  \t\t\t\t">0&#44;940&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>PEEP m&#225;xima&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">14 &#40;12-15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;13-16&#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;145&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>N&#46;<span class="elsevierStyleSup">o</span> de ciclos de DP&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 &#40;1-2&#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">3 &#40;2-5&#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;0004&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>Tolerancia al DS &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> tras DS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150 en las siguientes 24<span class="elsevierStyleHsp" style=""></span>h&#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">17 &#40;89&#44;47&#41;&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">19 &#40;61&#44;29&#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;031&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;as de VMI&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 &#40;9-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;14-52&#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;032&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;as de ingreso en UCI&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">23&#44;5 &#40;11-40&#44;5&#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">32 &#40;16-57&#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;054&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;as de hospitalizaci&#243;n&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">30 &#40;16-54&#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">41 &#40;31-72&#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;023&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;as de sedaci&#243;n&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">18 &#40;8-31&#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">29&#44;5 &#40;14-39&#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;098&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>Uso de BNM&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">19 &#40;95&#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">30 &#40;96&#44;77&#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;750&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;as de BNM&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">3 &#40;3-5&#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&#44;5 &#40;5-19&#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">0&#44;0002&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>Mortalidad en UCI&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">6 &#40;30&#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">12 &#40;38&#44;61&#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;525&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>Traqueotom&#237;a&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;50&#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">20 &#40;64&#44;52&#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;303&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>Aumento del residuo g&#225;strico &#40;&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#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">3 &#40;15&#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;32&#44;26&#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;167&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>Parada cardiorrespiratoria&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 &#40;5&#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 &#40;0&#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;208&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>Obstrucci&#243;n del TOT&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">3 &#40;15&#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">15 &#40;48&#44;39&#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;014&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>P&#233;rdida de dispositivos&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">1 &#40;5&#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">5 &#40;16&#44;13&#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;228&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Infecciones nosocomiales</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>Bacteriemia&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">14 &#40;70&#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">23 &#40;74&#44;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">0&#44;743&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>ITU&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">6 &#40;30&#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">14 &#40;45&#44;16&#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">0&#44;278&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>NAVM&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">6 &#40;30&#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">12 &#40;38&#44;71&#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;525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" 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 ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Remdesivir&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">13 &#40;65&#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">18 &#40;58&#44;06&#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;620&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>Tocilizumab&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;75&#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">22 &#40;70&#44;97&#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;752&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>Metilprednisolona&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">3 &#40;15&#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">6 &#40;19&#44;35&#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;690&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>Dexametasona&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">17 &#40;89&#44;5&#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;82&#44;76&#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;519&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" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes ventilados en DS&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes ventiladosen DP<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&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" scope="col" style="border-bottom: 2px solid black">Pacientes ventilados en DP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo masculino</span>&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">SAPS 3 al ingreso</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;54-73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60 &#40;53-68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;886&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;42&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;35&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;711&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>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;42&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;19&#44;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;118&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>Enfermedad renal cr&#243;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;16&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asma&#47;EPOC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;22&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;6&#44;45&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;146&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>Enfermedad coronaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;8&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#44;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Evoluci&#243;n</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as de VMI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;6-13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;9-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;14-52&#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;0001&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>D&#237;as de ingreso en UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;9-17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&#44;5 &#40;11-40&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;16-57&#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;0001&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>D&#237;as de hospitalizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24&#44;5 &#40;17-34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;16-54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;31-72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;as de sedaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5-11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;8-31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#44;5 &#40;14-39&#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;0001&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"><span class="elsevierStyleHsp" style=""></span>Uso de BNM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;96&#44;77&#41;&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>D&#237;as de BNM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;0-2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;5 &#40;5-19&#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;0001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mortalidad en UCI&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">6 &#40;17&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;38&#44;61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;140&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traqueotom&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;14&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;64&#44;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Aumento del residuo g&#225;strico &#40;&#62;<span class="elsevierStyleHsp" style=""></span>200<span class="elsevierStyleHsp" style=""></span>ml&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;5&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;32&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parada cardiorrespiratoria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#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">0&#44;704&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>Obstrucci&#243;n del TOT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;11&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;48&#44;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0016&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>P&#233;rdida de dispositivos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;16&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;148&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Infecciones nosocomiales</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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bacteriemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;37&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;74&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;005&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>ITU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;14&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;45&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;027&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>NAVM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;14&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;38&#44;71&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;091&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento COVID-19</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>Remdesivir&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;51&#44;52&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;58&#44;06&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;639&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>Tocilizumab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;68&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;75&#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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Información del artículo
ISSN: 02105691
Idioma original: Español
DOI:10.1016/j.medin.2023.03.002
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