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o P&#47;FPe<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Debido a las diferencias entre el SDRA &#171;cl&#225;sico&#187; y el SDRA secundario a la COVID-19 &#40;C-SDRA&#41; como la causa subyacente&#44; mecanismo de lesi&#243;n pulmonar&#44; presentaci&#243;n cl&#237;nica y manejo terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#44; consideramos la hip&#243;tesis de que la utilidad del P&#47;FPe para predecir la mortalidad en el C-SDRA no es igual que el obtenido para los pacientes con SDRA &#171;cl&#225;sico&#187;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se evalu&#243; una cohorte de 507 pacientes con C-SDRA atendidos en el Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#44; Espa&#241;a&#44; y otra de 217 con SDRA &#171;cl&#225;sico&#187; previamente publicada por Martos-Ben&#237;tez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> se utilizaron los criterios de inclusi&#243;n y exclusi&#243;n descritos por ellos&#46; En ambos casos los registros utilizados contaban con la aceptaci&#243;n del Comit&#233; de &#201;tica de Investigaci&#243;n local de cada centro&#59; En el caso espa&#241;ol fue necesaria la concesi&#243;n del consentimiento de los pacientes&#47;representantes &#40;escrito y&#47;o telef&#243;nico&#41;&#44; no se precis&#243; en el caso cubano atendiendo a la retrospectividad de los datos recogidos&#46; La gravedad del SDRA se evalu&#243; en las primeras 24 h de iniciada la ventilaci&#243;n mec&#225;nica invasiva con el paciente en posici&#243;n supina&#46; Todos los sujetos fueron estratificados en SDRA leve&#44; moderado o grave&#44; de acuerdo con la definici&#243;n de Berl&#237;n<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Seg&#250;n el &#237;ndice P&#47;FPe&#44; los pacientes fueron clasificados como SDRA leve &#40;40 &#60;<span class="elsevierStyleHsp" style=""></span>&#237;ndice P&#47;FPe &#8804; 60&#41;&#44; moderado &#40;20 &#60;<span class="elsevierStyleHsp" style=""></span>&#237;ndice P&#47;FPe &#8804; 40&#41; o grave &#40;&#237;ndice P&#47;FPe &#8804; 20&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se presenta una estad&#237;stica descriptica&#44; as&#237; como un an&#225;lisis de regresi&#243;n log&#237;stica multivariado para explorar el impacto de las configuraciones ventilatorias e &#237;ndices respiratorios sobre la mortalidad hospitalaria&#46; El &#225;rea bajo la curva de las caracter&#237;sticas operativas del receptor &#40;AROC&#41; se utiliz&#243; para evaluar el rendimiento de los &#237;ndices respiratorios&#46; Se utiliz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica multivariado para explorar el impacto de los &#237;ndices respiratorios con el resultado primario&#58; mortalidad a 28 d&#237;as&#46; Para interpretar los resultados se incluyeron como covariables&#44; las caracter&#237;sticas que mostrando diferencias significativas en el an&#225;lisis bivariante&#44; no evidenciasen problemas de muticolinealidad &#40;valorado con un factor de inflaci&#243;n de la varianza menor de 3&#41;&#46; Los modelos analizados se presentan como odds ratio &#40;OR&#41; con su intervalo de confianza del 95&#37; &#40;IC95&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los 506 pacientes de la cohorte de pacientes con C-SDRA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La mediana de PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> en la cohorte C-SDRA fue de 110<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p25-75&#58; 90-134<span class="elsevierStyleHsp" style=""></span>mmHg&#41; frente a 187<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p25-75&#58; 117-221<span class="elsevierStyleHsp" style=""></span>mmHg&#41; en la cohorte de SDRA &#171;cl&#225;sico&#187;&#46; La mediana de P&#47;FPe fue de 9&#44;5 &#40;p25-75&#58; 7&#44;2-12&#44;16&#41; en el grupo C-SDRA frente a 21&#44;6 &#40;p25-75&#58; 10&#44;2-33&#44;2&#41; en el SDRA &#171;cl&#225;sico&#187;&#46; Como ocurri&#243; en la cohorte de pacientes con SDRA &#171;cl&#225;sico&#187; descrita por Martos-Ben&#237;tez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#44; en los pacientes con C-SDRA&#44; el &#237;ndice P&#47;FPe reclasific&#243; a la mayor&#237;a de los pacientes en una categor&#237;a diferente de gravedad&#44; respecto a la clasificaci&#243;n de Berl&#237;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En el an&#225;lisis multivariado de regresi&#243;n log&#237;stica&#44; el P&#47;FPe no se relacion&#243; con la mortalidad hospitalaria en la cohorte C-SDRA &#40;odds ratio &#91;OR&#93;&#58; 0&#44;97&#59; 95&#37; IC&#58; 0&#44;93-1&#46;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;187&#41;&#59; pero s&#237; con una menor mortalidad en la cohorte SDRA &#171;cl&#225;sico&#187; &#40;OR&#58; 0&#44;93&#59; 95&#37; IC&#58; 0&#44;89-0&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Al igual que en el SDRA &#171;cl&#225;sico&#187; la presi&#243;n de conducci&#243;n &#40;OR&#58; 1&#44;09&#59; IC95&#37;&#58;1&#44;00-1&#44;20&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; y el valor SOFA &#40;OR&#58; 1&#44;75&#59; IC95&#37;&#58; 1&#44;26-2&#44;43&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; presentaron asociaci&#243;n significativa con la mortalidad&#46; En la cohorte C-SDRA&#44; el AROC del P&#47;FPe fue de 0&#44;54 &#40;95&#37; IC&#58; 0&#44;49-0&#44;58&#41;&#44; frente a 0&#44;52 &#40;95&#37; IC&#58; 0&#44;47-0&#44;56&#41; del &#237;ndice PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46; En la cohorte SDRA &#171;cl&#225;sico&#187;&#44; el AROC del P&#47;FPe fue de 0&#44;72 &#40;95&#37; IC&#58; 0&#44;65-0&#44;78&#41;&#44; frente a 0&#44;63 &#40;95&#37; IC&#58; 0&#44;54-0&#44;69&#41; del &#237;ndice PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Estos resultados muestran que el &#237;ndice P&#47;FPe tiene un comportamiento diferente en la predicci&#243;n de mortalidad entre pacientes con SDRA &#171;cl&#225;sico&#187; y aquellos con C-SDRA&#46; Adem&#225;s de las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas de ambos grupos&#44; las razones de esta diferencia se pueden explicar por la gravedad de la hipoxemia &#40;mal llamada &#171;hipoxemia feliz&#187;&#41; y por la heterogeneidad de la afectaci&#243;n pulmonar en pacientes con C-SDRA&#44; en comparaci&#243;n con los pacientes con SDRA &#171;cl&#225;sico&#187;&#44; debido al componente microtromb&#243;tico de la COVID-19 y al predominio de alteraci&#243;n del reflejo de vasoconstricci&#243;n pulmonar hip&#243;xica<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; Esta heterogeneidad podr&#237;a llevar a valores m&#225;s bajos del &#237;ndice P&#47;FPe en pacientes con C-ARDS<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La incorporaci&#243;n del valor de la PEEP al cociente PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> resulta atractiva&#44; puesto que considera la <span class="elsevierStyleItalic">compliance</span> del sistema respiratorio y el reclutamiento pulmonar<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; En consecuencia&#44; puede ser &#250;til en la identificaci&#243;n de pacientes con SDRA que podr&#237;an beneficiarse de terapias personalizadas<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; No obstante&#44; en los pacientes con C-SDRA&#44; los &#237;ndices PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> y P&#47;FPe no tienen un buen rendimiento para predecir la mortalidad hospitalaria&#46; Se deben redoblar los esfuerzos para identificar mejores predictores en este grupo de pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">El presente manuscrito no ha recibido financiaci&#243;n alguna&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicto de intereses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">C-ARDS n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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">Edad&#44; a&#241;os&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">65 &#40;56-72&#41;&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">Sexo&#44; var&#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">352 &#40;69&#44;6&#37;&#41;&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">Obesidad&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">88 &#40;17&#44;3&#37;&#41;&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">HTA&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">235 &#40;46&#44;4&#37;&#41;&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">DM&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">101 &#40;19&#44;9&#37;&#41;&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">D&#237;as de estancia hospitalaria previo al 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">0 &#40;0-2&#41;&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">Motivo de ingreso insuficiencia respiratoria&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">500 &#40;98&#44;8&#37;&#41;&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="elsevierStyleBold">&#205;ndices de gravedad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SOFA&#44; puntos&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;4-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&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">110 &#40;90-134&#41;&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">P&#47;FPE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7-12&#41;&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="elsevierStyleBold">Principales par&#225;metros ventilatorios en las primeras 24 horas de</span><span class="elsevierStyleBold">VM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VC&#47;kg&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&#44;1 &#40;5&#44;9-6&#44;4&#41;&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">PEEP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;10-12&#41;&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">Frecuencia respiratoria&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;16-18&#41;&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">Presi&#243;n pico&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 &#40;26-31&#41;&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">Presi&#243;n meseta&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;20-25&#41;&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">Driving pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;9-14&#41;&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="elsevierStyleBold">Variables evolutivas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uso de drogas vasoactivas&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">286 &#40;56&#44;5&#37;&#41;&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">Empleo posici&#243;n de PRONO&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">268 &#40;52&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Duraci&#243;n VM&#44; d&#237;as&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">10 &#40;7-18&#41;&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">Estancia UCI&#44; d&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;9-23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mortalidad a 28 d&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mortalidad hospitalaria&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 con SDRA acorde a criterios de Berl&#237;n en d&#237;a 1 de ventilaci&#243;n mec&#225;nican<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506</th></tr><tr title="table-row"><th class="td" title="\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">SDRA graven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>135 &#40;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Leven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderadon<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;&#60;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de la cohorte de pacientes estudiadas atendiendo a su gravedad seg&#250;n la clasificaci&#243;n de Berl&#237;n y el &#237;ndice P&#47;FPE en las primeras 24 horas de VM</p>"
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                      "titulo" => "Acute respiratory distress syndrome&#58; a definition on the line"
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                      "doi" => "10.1016/j.medine.2023.01.001"
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                      "titulo" => "A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome&#58; age&#44; plateau pressure&#44; and P&#40;aO&#40;2&#41;&#41;&#47;F&#40;IO&#40;2&#41;&#41; at ARDS onset can predict mortality"
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                      "doi" => "10.4187/respcare.01113"
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                    0 => array:2 [
                      "titulo" => "COVID-19 Does Not Lead to a &#8220;Typical&#8221; Acute Respiratory Distress Syndrome"
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                      "titulo" => "Clinical features of patients infected with 2019 novel coronavirus in Wuhan China"
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                      "doi" => "10.1016/S0140-6736(20)30183-5"
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CARTA CIENTÍFICA
Validación del índice P/FPe en una cohorte de enfermos con SDRA secundario a SARS-CoV-2
Validation of the P/FPe index in a cohort of patients with ARDS secondary to SARS-CoV-2
Alejandro González-Castroa,
Autor para correspondencia
e409@humv.es

Autor para correspondencia.
, Frank Daniel Martos Benítezb, Alba Fernández-Rodrígueza, Versis Orama-Requejoc, Raquel Ferrero-Francod, Yhivian Peñascoa
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
b Unidad de Cuidados Intensivos, Instituto de Neurología y Neurocirugía «Dr. Rafael Estrada González», La Habana, Cuba
c Unidad de Cuidados Intermedios, Hospital de Palamós, Palamós, España
d DUE Servicio Cántabro de Salud, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bas&#225;ndose en las limitaciones que el cociente entre la presi&#243;n parcial de ox&#237;geno arterial &#40;PaO<span class="elsevierStyleInf">2</span>&#41; y la fracci&#243;n inspirada de ox&#237;geno &#40;FiO<span class="elsevierStyleInf">2</span>&#41; presenta en la clasificaci&#243;n de la gravedad de los enfermos con s&#237;ndrome de distr&#233;s respiratorio agudo &#40;SDRA&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#44; recientemente Martos-Ben&#237;tez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> evaluaron la gravedad del SDRA mediante la PaO<span class="elsevierStyleInf">2</span> ajustada por la FiO<span class="elsevierStyleInf">2</span> y la presi&#243;n positiva al final de la espiraci&#243;n &#40;PEEP&#41;&#58; PaO2&#47;&#40;FiO<span class="elsevierStyleInf">2</span> x PEEP&#41; o P&#47;FPe<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Debido a las diferencias entre el SDRA &#171;cl&#225;sico&#187; y el SDRA secundario a la COVID-19 &#40;C-SDRA&#41; como la causa subyacente&#44; mecanismo de lesi&#243;n pulmonar&#44; presentaci&#243;n cl&#237;nica y manejo terap&#233;utico<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#44; consideramos la hip&#243;tesis de que la utilidad del P&#47;FPe para predecir la mortalidad en el C-SDRA no es igual que el obtenido para los pacientes con SDRA &#171;cl&#225;sico&#187;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se evalu&#243; una cohorte de 507 pacientes con C-SDRA atendidos en el Hospital Universitario Marqu&#233;s de Valdecilla&#44; Santander&#44; Espa&#241;a&#44; y otra de 217 con SDRA &#171;cl&#225;sico&#187; previamente publicada por Martos-Ben&#237;tez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> se utilizaron los criterios de inclusi&#243;n y exclusi&#243;n descritos por ellos&#46; En ambos casos los registros utilizados contaban con la aceptaci&#243;n del Comit&#233; de &#201;tica de Investigaci&#243;n local de cada centro&#59; En el caso espa&#241;ol fue necesaria la concesi&#243;n del consentimiento de los pacientes&#47;representantes &#40;escrito y&#47;o telef&#243;nico&#41;&#44; no se precis&#243; en el caso cubano atendiendo a la retrospectividad de los datos recogidos&#46; La gravedad del SDRA se evalu&#243; en las primeras 24 h de iniciada la ventilaci&#243;n mec&#225;nica invasiva con el paciente en posici&#243;n supina&#46; Todos los sujetos fueron estratificados en SDRA leve&#44; moderado o grave&#44; de acuerdo con la definici&#243;n de Berl&#237;n<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Seg&#250;n el &#237;ndice P&#47;FPe&#44; los pacientes fueron clasificados como SDRA leve &#40;40 &#60;<span class="elsevierStyleHsp" style=""></span>&#237;ndice P&#47;FPe &#8804; 60&#41;&#44; moderado &#40;20 &#60;<span class="elsevierStyleHsp" style=""></span>&#237;ndice P&#47;FPe &#8804; 40&#41; o grave &#40;&#237;ndice P&#47;FPe &#8804; 20&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se presenta una estad&#237;stica descriptica&#44; as&#237; como un an&#225;lisis de regresi&#243;n log&#237;stica multivariado para explorar el impacto de las configuraciones ventilatorias e &#237;ndices respiratorios sobre la mortalidad hospitalaria&#46; El &#225;rea bajo la curva de las caracter&#237;sticas operativas del receptor &#40;AROC&#41; se utiliz&#243; para evaluar el rendimiento de los &#237;ndices respiratorios&#46; Se utiliz&#243; un an&#225;lisis de regresi&#243;n log&#237;stica multivariado para explorar el impacto de los &#237;ndices respiratorios con el resultado primario&#58; mortalidad a 28 d&#237;as&#46; Para interpretar los resultados se incluyeron como covariables&#44; las caracter&#237;sticas que mostrando diferencias significativas en el an&#225;lisis bivariante&#44; no evidenciasen problemas de muticolinealidad &#40;valorado con un factor de inflaci&#243;n de la varianza menor de 3&#41;&#46; Los modelos analizados se presentan como odds ratio &#40;OR&#41; con su intervalo de confianza del 95&#37; &#40;IC95&#37;&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas de los 506 pacientes de la cohorte de pacientes con C-SDRA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La mediana de PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> en la cohorte C-SDRA fue de 110<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p25-75&#58; 90-134<span class="elsevierStyleHsp" style=""></span>mmHg&#41; frente a 187<span class="elsevierStyleHsp" style=""></span>mmHg &#40;p25-75&#58; 117-221<span class="elsevierStyleHsp" style=""></span>mmHg&#41; en la cohorte de SDRA &#171;cl&#225;sico&#187;&#46; La mediana de P&#47;FPe fue de 9&#44;5 &#40;p25-75&#58; 7&#44;2-12&#44;16&#41; en el grupo C-SDRA frente a 21&#44;6 &#40;p25-75&#58; 10&#44;2-33&#44;2&#41; en el SDRA &#171;cl&#225;sico&#187;&#46; Como ocurri&#243; en la cohorte de pacientes con SDRA &#171;cl&#225;sico&#187; descrita por Martos-Ben&#237;tez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#44; en los pacientes con C-SDRA&#44; el &#237;ndice P&#47;FPe reclasific&#243; a la mayor&#237;a de los pacientes en una categor&#237;a diferente de gravedad&#44; respecto a la clasificaci&#243;n de Berl&#237;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En el an&#225;lisis multivariado de regresi&#243;n log&#237;stica&#44; el P&#47;FPe no se relacion&#243; con la mortalidad hospitalaria en la cohorte C-SDRA &#40;odds ratio &#91;OR&#93;&#58; 0&#44;97&#59; 95&#37; IC&#58; 0&#44;93-1&#46;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;187&#41;&#59; pero s&#237; con una menor mortalidad en la cohorte SDRA &#171;cl&#225;sico&#187; &#40;OR&#58; 0&#44;93&#59; 95&#37; IC&#58; 0&#44;89-0&#44;97&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Al igual que en el SDRA &#171;cl&#225;sico&#187; la presi&#243;n de conducci&#243;n &#40;OR&#58; 1&#44;09&#59; IC95&#37;&#58;1&#44;00-1&#44;20&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#41; y el valor SOFA &#40;OR&#58; 1&#44;75&#59; IC95&#37;&#58; 1&#44;26-2&#44;43&#59; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; presentaron asociaci&#243;n significativa con la mortalidad&#46; En la cohorte C-SDRA&#44; el AROC del P&#47;FPe fue de 0&#44;54 &#40;95&#37; IC&#58; 0&#44;49-0&#44;58&#41;&#44; frente a 0&#44;52 &#40;95&#37; IC&#58; 0&#44;47-0&#44;56&#41; del &#237;ndice PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46; En la cohorte SDRA &#171;cl&#225;sico&#187;&#44; el AROC del P&#47;FPe fue de 0&#44;72 &#40;95&#37; IC&#58; 0&#44;65-0&#44;78&#41;&#44; frente a 0&#44;63 &#40;95&#37; IC&#58; 0&#44;54-0&#44;69&#41; del &#237;ndice PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Estos resultados muestran que el &#237;ndice P&#47;FPe tiene un comportamiento diferente en la predicci&#243;n de mortalidad entre pacientes con SDRA &#171;cl&#225;sico&#187; y aquellos con C-SDRA&#46; Adem&#225;s de las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas de ambos grupos&#44; las razones de esta diferencia se pueden explicar por la gravedad de la hipoxemia &#40;mal llamada &#171;hipoxemia feliz&#187;&#41; y por la heterogeneidad de la afectaci&#243;n pulmonar en pacientes con C-SDRA&#44; en comparaci&#243;n con los pacientes con SDRA &#171;cl&#225;sico&#187;&#44; debido al componente microtromb&#243;tico de la COVID-19 y al predominio de alteraci&#243;n del reflejo de vasoconstricci&#243;n pulmonar hip&#243;xica<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; Esta heterogeneidad podr&#237;a llevar a valores m&#225;s bajos del &#237;ndice P&#47;FPe en pacientes con C-ARDS<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La incorporaci&#243;n del valor de la PEEP al cociente PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> resulta atractiva&#44; puesto que considera la <span class="elsevierStyleItalic">compliance</span> del sistema respiratorio y el reclutamiento pulmonar<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; En consecuencia&#44; puede ser &#250;til en la identificaci&#243;n de pacientes con SDRA que podr&#237;an beneficiarse de terapias personalizadas<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a>&#46; No obstante&#44; en los pacientes con C-SDRA&#44; los &#237;ndices PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> y P&#47;FPe no tienen un buen rendimiento para predecir la mortalidad hospitalaria&#46; Se deben redoblar los esfuerzos para identificar mejores predictores en este grupo de pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0040" class="elsevierStylePara elsevierViewall">El presente manuscrito no ha recibido financiaci&#243;n alguna&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicto de intereses</span><p id="par0045" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Frecuencia respiratoria&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;16-18&#41;&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">Presi&#243;n pico&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 &#40;26-31&#41;&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">Presi&#243;n meseta&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;20-25&#41;&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">Driving pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;9-14&#41;&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="elsevierStyleBold">Variables evolutivas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uso de drogas vasoactivas&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">286 &#40;56&#44;5&#37;&#41;&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">Empleo posici&#243;n de PRONO&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">268 &#40;52&#44;9&#37;&#41;&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">Duraci&#243;n VM&#44; d&#237;as&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;7-18&#41;&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">Estancia UCI&#44; d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;9-23&#41;&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">Mortalidad a 28 d&#237;as&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">74 &#40;14&#44;6&#37;&#41;&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">Mortalidad hospitalaria&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">109 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Principales variables cl&#237;nico-demogr&#225;ficas&#44; &#237;ndices de gravedad&#44; par&#225;metros ventilatorios y evolutivos&#44; de la cohorte de enfermos analizados&#44; C-ARDS</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Enfermos con C-ARDS</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&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 con SDRA acorde a criterios de Berl&#237;n en d&#237;a 1 de ventilaci&#243;n mec&#225;nican<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506</th></tr><tr title="table-row"><th class="td" title="\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
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SDRA leven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SDRA moderado n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>327 &#40;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SDRA graven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>135 &#40;26&#37;&#41;&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">Gravedad por &#237;ndice P&#47;FPE</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>Leven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;&#60;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderadon<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13 &#40;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;&#60;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Graven<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>488 &#40;96&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">318 &#40;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">132 &#40;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de la cohorte de pacientes estudiadas atendiendo a su gravedad seg&#250;n la clasificaci&#243;n de Berl&#237;n y el &#237;ndice P&#47;FPE en las primeras 24 horas de VM</p>"
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      "titulo" => "Bibliograf&#237;a"
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        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute respiratory distress syndrome&#58; a definition on the line"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Gonz&#225;lez-Castro"
                            1 => "E&#46; Cuenca Fito"
                            2 => "C&#46; Gonzalez"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medine.2023.01.001"
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva &#40;Engl Ed&#41;&#46;"
                        "fecha" => "2023"
                        "volumen" => "3"
                        "paginaInicial" => "00001"
                        "paginaFinal" => "2"
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              "identificador" => "bib0060"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic value of the novel P&#47;FPE index to classify ARDS severity&#58; A cohort study"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;D&#46; Martos-Ben&#237;tez"
                            1 => "R&#46; Est&#233;vez-Muguercia"
                            2 => "V&#46; Orama-Requejo"
                            3 => "T&#46; del Toro-Simoni"
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                    0 => array:2 [
                      "doi" => "10.1016/j.medine.2022.06.023"
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              "identificador" => "bib0065"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome&#58; age&#44; plateau pressure&#44; and P&#40;aO&#40;2&#41;&#41;&#47;F&#40;IO&#40;2&#41;&#41; at ARDS onset can predict mortality"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Villar"
                            1 => "L&#46; P&#233;rez-M&#233;ndez"
                            2 => "S&#46; Basald&#250;a"
                            3 => "J&#46; Blanco"
                            4 => "G&#46; Aguilar"
                            5 => "D&#46; Toral"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.01113"
                      "Revista" => array:5 [
                        "tituloSerie" => "Respir Care&#46;"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "1774"
                        "paginaFinal" => "1779"
                      ]
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            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COVID-19 Does Not Lead to a &#8220;Typical&#8221; Acute Respiratory Distress Syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Gattinoni"
                            1 => "S&#46; Coppola"
                            2 => "M&#46; Cressoni"
                            3 => "M&#46; Busana"
                            4 => "S&#46; Rossi"
                            5 => "D&#46; Chiumello"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.202003-0817LE"
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                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2020"
                        "volumen" => "201"
                        "paginaInicial" => "1299"
                        "paginaFinal" => "1300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32228035"
                            "web" => "Medline"
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              "identificador" => "bib0075"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ARDS Definition Task Force"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;M&#46; Ranieri"
                            1 => "G&#46;D&#46; Rubenfeld"
                            2 => "B&#46;T&#46; Thompson"
                            3 => "N&#46;D&#46; Ferguson"
                            4 => "E&#46; Caldwell"
                            5 => "E&#46; Fan"
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                  "host" => array:1 [
                    0 => array:2 [
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ISSN: 02105691
Idioma original: Español
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