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El retraso en la intubaci&#243;n orotraqueal de los pacientes en que fracasa la VNI aumenta la mortalidad&#44; por lo que detectar de forma precoz los pacientes susceptibles de fracaso resultar&#237;a interesante y podr&#237;a relacionarse con una reducci&#243;n de la mortalidad&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo principal del estudio es conocer factores de riesgo de fracaso de VNI en el paciente que ingresa en UCI por neumon&#237;a grave por influenza A &#40;H1N1&#41;pdm09&#46; Adem&#225;s&#44; tratamos de demostrar que los pacientes en que fracasa la VNI tienen mayor mortalidad y estancias tanto en UCI como hospitalarias m&#225;s prolongadas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se incluy&#243; a los pacientes que ingresaron en la UCI del Hospital Universitario Doctor Peset de Valencia desde junio de 2010 hasta diciembre de 2018 por insuficiencia respiratoria&#44; con el diagn&#243;stico confirmado al alta de neumon&#237;a por virus influenza A &#40;H1N1&#41;pdm09 y que requirieron ventilaci&#243;n mec&#225;nica&#46; Previamente se obtuvo la aprobaci&#243;n de este trabajo por el Comit&#233; de &#201;tica de nuestro centro&#46; Se consider&#243; caso confirmado de neumon&#237;a por virus influenza A &#40;H1N1&#41;pdm09 aquel en el que se positiviz&#243; la prueba molecular de amplificaci&#243;n de &#225;cidos nucleicos &#40;rt-PCR&#41;&#46; Para ello se obtuvieron muestras de exudado nasofar&#237;ngeo en todos los pacientes y de secreciones respiratorias mediante aspirado bronquial en los que estaban intubados&#46; Se defini&#243; neumon&#237;a comunitaria como la presencia de signos cl&#237;nicos compatibles &#40;tos&#44; expectoraci&#243;n&#44; fiebre<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>38<span class="elsevierStyleHsp" style=""></span>&#778;C&#44; leucocitosis&#44; elevaci&#243;n de PCR y PCT&#41; y aparici&#243;n de infiltrados alveolares en la radiograf&#237;a de t&#243;rax&#46; Se consider&#243; insuficiencia respiratoria atendiendo a criterios gasom&#233;tricos&#44; PaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mmHg y&#47;o PaCO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mmHg&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se excluyeron los pacientes menores de 18 a&#241;os y en los que se decidi&#243; limitar el tratamiento de soporte vital al ingreso o durante su evoluci&#243;n&#44; en sesi&#243;n cl&#237;nica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los equipos de VNI utilizados fueron BiPAP Vision&#174; &#40;Respironics Inc&#46;&#44; Pennsylvania&#44; Estados Unidos&#41; y V60&#174; &#40;Respironics Inc&#46;&#44; Pennsylvania&#44; Estados Unidos&#41;&#44; tanto en su modo BiPAP como CPAP&#44; conectados a interfaces oronasal o facial total &#40;Respironics Inc&#46;&#44; Pennsylvania&#44; Estados Unidos&#41; y a sistema de humidificaci&#243;n activa &#40;Fisher and Paykel Healthcare Auckland&#44; New Zealand&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se consider&#243; fracaso de la VNI la necesidad de intubaci&#243;n orotraqueal y conexi&#243;n a ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41;&#46; Para proceder a ello se atend&#237;a principalmente a una decisi&#243;n cl&#237;nica seg&#250;n el protocolo local&#44; no solo basado en criterios gasom&#233;tricos &#40;imposibilidad para mantener SatO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#37; con FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;60&#41;&#44; sino tambi&#233;n por la persistencia de signos de aumento de trabajo respiratorio&#44; presencia de secreciones copiosas&#44; acidosis metab&#243;lica&#44; fracaso multiorg&#225;nico&#44; encefalopat&#237;a o agitaci&#243;n con rechazo a la terapia con VNI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogieron datos demogr&#225;ficos&#44; informaci&#243;n relacionada con enfermedades previas&#44; el lugar de procedencia&#44; datos anal&#237;ticos al ingreso en nuestra unidad&#44; el soporte ventilatorio recibido a su llegada&#44; as&#237; como puntuaciones de gravedad como el Sequential Organ Failure Assessment &#40;SOFA&#41; al ingreso y el Acute Physiology and Chronic Health Evaluation II &#40;APACHE II&#41; a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Se definieron los antecedentes respiratorios como enfermedad respiratoria cr&#243;nica &#40;asma&#44; EPOC y fibrosis pulmonar&#41;&#46; Se identific&#243; el fracaso hemodin&#225;mico&#44; definido como la necesidad de iniciar soporte con f&#225;rmacos vasoactivos antes o durante la VNI&#44; y la necesidad de terapia de depuraci&#243;n extrarrenal durante la evoluci&#243;n&#46; A su vez&#44; se registr&#243; si hab&#237;a recibido corticoides antes o durante la VNI y si hab&#237;a recibido oseltamivir dentro de las primeras 72<span class="elsevierStyleHsp" style=""></span>h desde el comienzo de la sintomatolog&#237;a&#44; as&#237; como la mortalidad en UCI&#44; a los 30 d&#237;as y hospitalaria&#44; y la estancia en UCI y hospitalaria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; mediante el paquete de software SPSS&#174; 17&#46;0 &#40;Chicago&#44; IL&#44; Estados Unidos&#41;&#46; Se evalu&#243; la normalidad de las variables cuantitativas mediante el test de Kolmogorov-Smirnov&#46; Las variables cuantitativas se expresaron mediante media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE o mediana &#40;RIC&#41;&#44; mientras que las cualitativas se expresaron como frecuencia &#40;porcentaje&#41;&#46; Las variables cuantitativas se compararon mediante los test t de Student o U de Mann-Whitney&#44; mientras que las cualitativas se compararon mediante Chi-cuadrado o test exacto de Fisher&#46; Se analizaron los factores de riesgo mediante regresi&#243;n log&#237;stica y se expresan mediante OR &#40;IC 95&#37;&#41;&#46; Se incluyeron en el an&#225;lisis multivariante aquellas variables que presentaron una p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 en el an&#225;lisis univariante&#46; Se consideraron diferencias estad&#237;sticamente significativas si p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">En total ingresaron 54 pacientes en nuestra unidad con el diagn&#243;stico confirmado&#44; de los que 49 fueron ventilados&#46; Principalmente procedieron del servicio de urgencias hospitalarias &#40;26 pacientes&#59; 53&#44;1&#37;&#41;&#46; La edad de los ingresados fue de 66&#44;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;77 a&#241;os y 29 &#40;59&#44;2&#37;&#41; fueron mujeres&#46; Entre los antecedentes&#44; 28 &#40;57&#44;1&#37;&#41; eran hipertensos&#44; 19 &#40;38&#44;8&#37;&#41; ten&#237;an diabetes mellitus&#44; 17 &#40;34&#44;7&#37;&#41; eran fumadores&#47;as y 19 &#40;38&#44;8&#37;&#41; ten&#237;an alguna enfermedad respiratoria cr&#243;nica&#44; trat&#225;ndose de EPOC en 11 de ellos &#40;22&#44;4&#37;&#41;&#46; A su ingreso tuvieron una puntuaci&#243;n en el SOFA de 5&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5 y un APACHE II de 16 &#40;11-22&#41;&#46; Tuvieron 4 &#40;2-7&#41; d&#237;as de sintomatolog&#237;a previa&#46; Al ingreso&#44; 21 pacientes &#40;42&#44;9&#37;&#41; no hab&#237;an recibido soporte mec&#225;nico respiratorio&#44; en 22 &#40;40&#44;7&#37;&#41; se inici&#243; VNI y 6 &#40;11&#44;1&#37;&#41; fueron intubados directamente&#46; En total&#44; a lo largo del ingreso&#44; 43 &#40;87&#44;75&#37;&#41; recibieron VNI&#44; con una duraci&#243;n de 48 &#40;40&#41; h&#44; de los cuales fracasaron 18 &#40;41&#44;9&#37;&#41;&#44; requiriendo VMI&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra la distribuci&#243;n de los pacientes en funci&#243;n del soporte ventilatorio recibido&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Los pacientes en que fracas&#243; la VNI tuvieron puntuaciones en el SOFA superiores al ingreso &#40;7 vs&#46; 4&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; eran m&#225;s j&#243;venes &#40;63 vs&#46; 74 a&#241;os&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#44; hab&#237;an recibido m&#225;s corticoides &#40;55&#44;6 vs&#46; 12&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#44; desarrollaron m&#225;s fracaso hemodin&#225;mico precoz &#40;61&#44;1 vs&#46; 8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y requirieron m&#225;s frecuentemente terapia de reemplazo renal &#40;27&#44;8 vs&#46; 4&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; No se objetivaron diferencias significativas entre los pacientes con EPOC &#40;16&#44;7 vs&#46; 32&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;31&#41;&#46; El fracaso de la VNI se tradujo en superiores estancias en la UCI &#40;26&#44;28 vs&#46; 6&#44;88 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y hospitalarias &#40;32&#44;78 vs&#46; 18&#44;8 d&#237;as&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; as&#237; como en una mayor mortalidad en la UCI &#40;38&#44;9 vs&#46; 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; a los 30 d&#237;as y hospitalaria &#40;44&#44;4 vs&#46; 0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Se identificaron como factores de riesgo de fracaso de VNI el haber administrado precozmente corticoides &#40;OR 7&#44;08&#59; IC 95&#37; 1&#44;23-40&#44;50&#41; y haber desarrollado precozmente fracaso hemodin&#225;mico &#40;OR 14&#44;77&#59; IC 95&#37; 2&#44;34-92&#44;97&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">A d&#237;a de hoy&#44; existen dudas de la utilidad de la VNI en pacientes con fracaso respiratorio hipox&#233;mico por gripe A&#46; Pese a ello&#44; en nuestra unidad&#44; el uso de VNI es una herramienta frecuentemente utilizada como soporte inicial en los pacientes con IRA&#44; en contraposici&#243;n a otros estudios<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#44;8</span></a>&#46; Uno de los motivos que cl&#225;sicamente apoya evitar el uso de VNI&#44; como es la posibilidad de contagio del personal sanitario<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; no se observ&#243; en nuestra cohorte&#44; en la que no se notific&#243; ning&#250;n caso&#46; La Sociedad Europea de Cuidados Intensivos tambi&#233;n se manifiesta en este sentido&#44; consider&#225;ndolo un procedimiento de alto riesgo de contagio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a>&#46; En nuestra unidad se coloca un filtro antibacteriano&#47;viral a la salida del ventilador<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestra cohorte de pacientes el fracaso a VNI fue del 41&#44;9&#37;&#44; menor que lo referido en otros estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13&#8211;15</span></a>&#46; Nuestros resultados podr&#237;an equipararse a los del trabajo de Mar&#237;n-Corral et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a>&#44; en el que se objetivaba fracaso en el 35&#44;3&#37;&#44; menor que en nuestra cohorte&#44; pero con mayor mortalidad en UCI &#40;18&#44;4 vs&#46; 24&#44;2&#37;&#41;&#46; Por el contrario&#44; en el trabajo de Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> la tasa de fracasos fue mayor &#40;56&#44;8&#37;&#41;&#44; pero se obtuvo una mortalidad similar a la de nuestra cohorte&#46; Esto &#250;ltimo llama la atenci&#243;n&#44; teniendo en cuenta que presentaban similar gravedad y que el fracaso a VNI se ha asociado a mayor mortalidad y peor pron&#243;stico<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a>&#46; En nuestro caso hubo diferencias significativas de mortalidad cuando se compararon los pacientes que fracasaban y los que no&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las variables que se asociaron con un aumento del fracaso fueron el uso de corticoides y la presencia de fallo hemodin&#225;mico precoz&#46; Teniendo esto en cuenta&#44; la menor mortalidad en nuestra cohorte puede deberse a un menor uso de corticoides con respecto al trabajo de Masclans et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> &#40;32&#44;65 vs&#46; 39&#44;7&#37;&#41;&#46; El uso de corticoides se ha relacionado con un aumento de la mortalidad<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">16&#44;17</span></a> y en este sentido se manifiestan las conclusiones de un metaan&#225;lisis publicado<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a>&#46; Las de otro metaan&#225;lisis m&#225;s reciente&#44; que eval&#250;a el uso de corticoides en pacientes con neumon&#237;a&#44; tambi&#233;n van en contra de su uso&#44; aunque el bajo porcentaje de pacientes con neumon&#237;a por influenza A &#40;H1N1&#41;pdm09 incluidos debe hacernos ser cautelosos con sus conclusiones<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a>&#46; Pese a ello&#44; existe consenso en que el uso de corticoides en pacientes con neumon&#237;a por gripe A debe evitarse&#44; lo cual en nuestra unidad es una de las piedras angulares del manejo de estos pacientes&#46; Las recomendaciones de 2012 no lo inclu&#237;an como parte del tratamiento<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a>&#46; Como aspecto a discutir quedar&#237;a la discrepancia de su uso en pacientes que tienen shock asociado en los que se valorar&#237;a inicio de tratamiento corticoideo sustitutorio como parte de tratamiento integral del shock&#46; En nuestro trabajo&#44; los pacientes que desarrollaron fracaso hemodin&#225;mico precoz recibieron m&#225;s corticoides &#40;54&#44;5 vs&#46; 18&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Esto &#250;ltimo podr&#237;a apoyar la sospecha de que el uso de corticoides en estos pacientes se debe en gran medida a la aparici&#243;n de shock&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En cuanto al beneficio del soporte con VNI en el grupo de pacientes con EPOC<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a>&#44; en nuestra serie no se objetivaron diferencias en el &#233;xito de VNI entre estos pacientes y no se asoci&#243; de forma independiente con el fracaso de VNI&#46; Este hecho puede ir en consonancia con los resultados de Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#44; seg&#250;n los cuales el efecto beneficioso de VNI en estos pacientes se perd&#237;a al presentar un SOFA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Uno de los aspectos importantes que tambi&#233;n puede crear controversia es la evoluci&#243;n de los pacientes que reciben VMI&#44; y si existen diferencias entre los que son intubados a su ingreso y los que la requieren tras el fracaso de la VNI&#46; En nuestra serie&#44; con puntuaciones de gravedad superiores a las de Rello et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a>&#44; la incidencia de VMI al ingreso fue menor&#46; Sin embargo&#44; en la serie de Rodr&#237;guez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> el porcentaje de pacientes que recib&#237;an inicialmente soporte con VMI fue superior &#40;57&#44;5 vs&#46; 12&#44;24&#37;&#41; y presentaron menor mortalidad en la UCI &#40;31&#44;3 vs&#46; 50&#37;&#41;&#44; a pesar del escaso n&#250;mero de pacientes&#46; Destaca la marcada gravedad de estos pacientes en nuestra cohorte&#46; La comparaci&#243;n entre los pacientes que recib&#237;an VMI al ingreso y los que la recibieron tras presentar fracaso de VNI no revel&#243; diferencias en cuanto a estancias y mortalidad tanto en la UCI como hospitalarias&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Con respecto al tiempo que se mantiene el soporte con VNI y su asociaci&#243;n con el fracaso de la misma&#44; debemos hacer referencia a los trabajos publicados que demuestran que una demora en la intubaci&#243;n aumenta la mortalidad en pacientes con fracaso respiratorio hipox&#233;mico<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a>&#46; Sin embargo&#44; en nuestro trabajo se observ&#243; que los pacientes que fracasaban necesitaban ser intubados m&#225;s precozmente y&#44; por lo tanto&#44; recib&#237;an menos horas de VNI&#46; Esto puede deberse a que la gravedad de estos pacientes era mayor&#44; y adem&#225;s presentaban m&#225;s fracaso hemodin&#225;mico&#44; criterios que probablemente contribuyeron a que se decidiese iniciar VMI m&#225;s tempranamente&#46; Adem&#225;s&#44; los pacientes que fracasaban requer&#237;an a lo largo de la evoluci&#243;n m&#225;s terapia de reemplazo renal&#44; a pesar de que no hab&#237;a diferencias en los par&#225;metros de funci&#243;n renal al ingreso&#46; Con estos hallazgos podr&#237;amos plantear mantener el soporte respiratorio con VNI en el caso de que no se sume un segundo fallo de &#243;rgano&#44; especialmente hemodin&#225;mico&#44; pudiendo plantearlo y limitarlo &#250;nicamente para aquellos que presenten fallo respiratorio&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Las principales limitaciones de nuestro estudio radican en el dise&#241;o observacional retrospectivo&#46; Es probable que pacientes con el mismo diagn&#243;stico y con necesidad de soporte con VNI no llegaran a ingresar en nuestra unidad por desestimar su ingreso en la misma&#46; Evidentemente&#44; estos pacientes no forman parte del an&#225;lisis&#46; A su vez&#44; no fue posible la recogida de variables importantes como todos los datos gasom&#233;tricos&#46; Su inclusi&#243;n posibilitar&#237;a clasificar el tipo de insuficiencia respiratoria aguda &#40;por ejemplo&#44; PaO<span class="elsevierStyleInf">2</span>&#44; SatO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; y analizar su papel como posible factor pron&#243;stico de fracaso de la VNI&#46; El sesgo de selecci&#243;n que existe al incluir los pacientes gravemente enfermos hospitalizados en la UCI hace que estos resultados no sean extrapolables a otras poblaciones&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; podr&#237;a considerarse el uso de VNI en casos de neumon&#237;a por virus influenza A &#40;H1N1&#41;pdm09 como primer sistema de soporte respiratorio&#44; sobre todo en personas j&#243;venes con bajos niveles de gravedad y que no hayan recibido corticoides ni desarrollado fracaso hemodin&#225;mico precoz&#46; La presencia de cualquiera de estos 2 &#250;ltimos aspectos se asociar&#237;a con un aumento de la probabilidad de fracaso del soporte con VNI&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Autor&#237;a</span><p id="par0105" class="elsevierStylePara elsevierViewall">H&#46; Hern&#225;ndez&#44; A&#46; Navarro y L&#46; Lizama participaron en la confecci&#243;n de la base de datos&#44; as&#237; como en la recopilaci&#243;n&#46; H&#46; Hern&#225;ndez realiz&#243; el an&#225;lisis de los datos&#44; as&#237; como la redacci&#243;n y la correcci&#243;n del art&#237;culo&#46; R&#46; Zaragoza supervis&#243; el an&#225;lisis estad&#237;stico y revis&#243; cr&#237;ticamente el art&#237;culo en cuanto a contenido intelectual&#46; Todos aprobaron la &#250;ltima versi&#243;n del art&#237;culo&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0110" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        1 => array:2 [
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          "titulo" => "Palabras clave"
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          "titulo" => "Abstract"
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              "identificador" => "abst0060"
              "titulo" => "Measurements"
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              "identificador" => "abst0065"
              "titulo" => "Results"
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          "titulo" => "Keywords"
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          "titulo" => "Resultados"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "tienePdf" => true
    "fechaRecibido" => "2019-09-14"
    "fechaAceptado" => "2019-11-19"
    "PalabrasClave" => array:2 [
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1401098"
          "palabras" => array:6 [
            0 => "Influenza A"
            1 => "Ventilaci&#243;n no invasiva"
            2 => "Neumon&#237;a"
            3 => "Factores de riesgo"
            4 => "Fracaso"
            5 => "Mortalidad"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Influenza A"
            1 => "Noninvasive ventilation"
            2 => "Pneumonia"
            3 => "Risk factors"
            4 => "Failure"
            5 => "Mortality"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar factores de riesgo de fracaso de la ventilaci&#243;n no invasiva &#40;VNI&#41; en pacientes que ingresan en una unidad de cuidados intensivos &#40;UCI&#41; por neumon&#237;a primaria por virus influenza A &#40;H1N1&#41;pdm09&#46; Demostrar que los pacientes que fracasan con la VNI tienen mayor mortalidad y estancias m&#225;s largas&#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 de cohorte&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">&#193;mbito</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">UCI polivalente de un hospital universitario de 16 camas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Pacientes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Pacientes adultos que ingresaron en la UCI en los que se confirm&#243; el diagn&#243;stico de neumon&#237;a por influenza A &#40;H1N1&#41;pdm09 y que recibieron ventilaci&#243;n mec&#225;nica&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Edad&#44; sexo&#44; puntuaciones de gravedad&#44; administraci&#243;n de corticoides&#44; oseltamivir dentro de las 72<span class="elsevierStyleHsp" style=""></span>h de la sintomatolog&#237;a&#44; d&#237;as de sintomatolog&#237;a previos al ingreso&#44; cuadrantes afectados&#44; fracaso hemodin&#225;mico&#44; renal y datos anal&#237;ticos al ingreso&#44; mortalidad y estancia en UCI y hospitalaria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Ingresaron 54 pacientes y 49 fueron ventilados&#46; Sexo femenino&#44; 29 &#40;59&#44;2&#37;&#41; y una edad media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar de 66&#44;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;77 a&#241;os&#46; Fueron ventilados con VNI 43 &#40;87&#44;75&#37;&#41;&#44; de los que fracasaron 18 &#40;41&#44;9&#37;&#41;&#46; Los pacientes que fracasaron presentaron menor edad &#40;63 vs&#46; 74 a&#241;os&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#44; mayor puntuaci&#243;n SOFA &#40;7 vs&#46; 4&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y mayor fracaso hemodin&#225;mico &#40;61&#44;1 vs&#46; 8&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Adem&#225;s&#44; presentaron estancias m&#225;s largas tanto en UCI &#40;26&#44;28 vs&#46; 6&#44;88 d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; como hospitalarias &#40;32&#44;78 vs&#46; 18&#44;8 d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; y mayor mortalidad en UCI &#40;38&#44;9 vs&#46; 0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; Se identificaron como factores de riesgo de fracaso a VNI recibir corticoides &#40;OR 7&#44;08&#59; IC 95&#37; 1&#44;23-40&#44;50&#41; y el fallo hemodin&#225;mico precoz &#40;OR 14&#44;77&#59; IC 95&#37; 2&#44;34-92&#44;97&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con corticoides y el fracaso hemodin&#225;mico precoz se asociaron con el fracaso de la VNI en pacientes con neumon&#237;a primaria por virus influenza A &#40;H1N1&#41;pdm09&#46; Estos tienen una mortalidad superior&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Dise&#241;o"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "&#193;mbito"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Pacientes"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Variables"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Resultados"
          ]
          6 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To evaluate the risk factors associated to noninvasive mechanical ventilation &#40;NIV&#41; failure in patients with primary pneumonia due to influenza A &#40;H1N1&#41;pdm09 virus admitted to the intensive care unit &#40;ICU&#41;&#44; and to demonstrate the association of NIV failure to increased mortality and longer stays&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A cohort study was carried out&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Scope</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A mixed ICU &#40;16 beds&#41; in a teaching hospital&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Patients</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Adult patients admitted to the ICU with a diagnosis of pneumonia due to influenza A &#40;H1N1&#41;pdm09 virus requiring mechanical ventilation&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Measurements</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Age&#44; sex&#44; severity scores&#44; administration of corticosteroids&#44; oseltamivir within 72<span class="elsevierStyleHsp" style=""></span>h of symptoms onset&#44; days of symptoms prior to admission&#44; affected quadrants&#44; hemodynamic parameters&#44; renal failure&#44; laboratory test data on admission&#44; mortality and stay in ICU and in hospital&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A total of 54 patients were admitted to the ICU and 49 were ventilated&#59; 29 were females &#40;59&#46;2&#37;&#41;&#44; and the mean age<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation was 66&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;77 years&#46; Forty-three patients &#40;87&#46;75&#37;&#41; were ventilated with NIV&#44; and 18 &#40;41&#46;9&#37;&#41; of them failed&#46; Patients with NIV failure were younger &#40;63 vs&#46; 74 years&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41;&#44; with a higher SOFA score &#40;7 vs&#46; 4&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; and greater early hemodynamic failure &#40;61&#46;1 vs&#46; 8&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; In addition&#44; they presented longer ICU &#40;26&#46;28 vs&#46; 6&#46;88 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; and hospital stay &#40;32&#46;78 vs&#46; 18&#46;8 days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; The ICU mortality rate was also higher in the NIV failure group &#40;38&#46;9 vs&#46; 0&#37;&#59; P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#46; In the multivariate analysis&#44; corticosteroid therapy &#40;OR 7&#46;08&#59; 95&#37; <span class="elsevierStyleSmallCaps">C</span>I 1&#46;23-40&#46;50&#41; and early hemodynamic failure &#40;OR 14&#46;77&#59; 95&#37; CI 2&#46;34-92&#46;97&#41; were identified as independent risk factors for NIV failure&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Treatment with corticosteroids and early hemodynamic failure were associated to NIV failure in patients with primary pneumonia due to influenza A &#40;H1N1&#41;pdm09 virus infection admitted to the ICU&#46; The failure of NIV was associated to increased mortality&#46;</p></span>"
        "secciones" => array:7 [
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            "titulo" => "Design"
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            "titulo" => "Scope"
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          3 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Patients"
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            "identificador" => "abst0060"
            "titulo" => "Measurements"
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            "identificador" => "abst0065"
            "titulo" => "Results"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Flujograma de pacientes con neumon&#237;a por influenza A &#40;H1N1&#41;pdm09 ingresados en una unidad de cuidados intensivos&#46;IOT&#58; intubaci&#243;n orotraqueal&#59; VNI&#58; ventilaci&#243;n mec&#225;nica no invasiva&#46;</p>"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#58; Acute Physiology and Chronic Health Evaluation II&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; SOFA&#58; Sequential Organ Failure Assessment scoring al ingreso en UCI&#59; VNI&#58; ventilaci&#243;n no invasiva&#59; VMI&#58; ventilaci&#243;n mec&#225;nica invasiva&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Datos expresados como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#44; mediana &#40;rango intercuart&#237;lico P25-P75&#41; o n &#40;porcentaje&#41;&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Los datos anal&#237;ticos corresponden a los de admisi&#243;n en la UCI&#46;</p>"
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                  \t\t\t\t">SOFA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Urea &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Alb&#250;mina &#40;g&#47;dl&#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">Sodio &#40;mEq&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Potasio &#40;mEq&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#193;cido l&#225;ctico &#40;mmol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Hemoglobina &#40;g&#47;dl&#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">Oseltamivir primeras 72<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;44&#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;45&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">Tratamiento con corticoides<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></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">3 &#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">3 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;55&#44;6&#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;002&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">Fallo hemodin&#225;mico precoz<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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">6 &#40;100&#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;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;61&#44;1&#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;01&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">Terapia depuraci&#243;n extrarrenal&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;66&#44;7&#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;4&#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;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&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">Horas con VNI&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">-&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">48 &#40;27-88&#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">24 &#40;12-54&#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">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
              "identificador" => "tblfn0010"
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de los pacientes que recibieron soporte con ventilaci&#243;n mec&#225;nica&#46; Comparaci&#243;n de pacientes con fracaso vs&#46; &#233;xito de VNI</p>"
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">VMI&#58; ventilaci&#243;n mec&#225;nica invasiva&#59; VNI&#58; ventilaci&#243;n no invasiva&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Datos expresados como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar o n &#40;porcentaje&#41;&#46;</p>"
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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">GlobalN<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#201;xito VNIn<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fracaso VNI n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Estancia en UCI &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#44;64<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;88<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&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&#44;67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;43&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;47&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 hospitalaria &#40;d&#237;as&#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">23&#44;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;72&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">18&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&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">32&#44;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&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">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;13&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;87&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 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">9 &#40;18&#44;4&#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">7 &#40;38&#44;9&#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;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">0&#44;66&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 30 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">11 &#40;22&#44;4&#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">8 &#40;44&#44;4&#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">4 &#40;66&#44;7&#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;64&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">11 &#40;22&#44;4&#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">8 &#40;44&#44;4&#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">4 &#40;66&#44;7&#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;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2659576.png"
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Estancias y mortalidad de los pacientes con fracaso&#44; no fracaso y VMI&#46; Comparaci&#243;n de los pacientes con fracaso de VNI y los que reciben VMI como primer soporte</p>"
        ]
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      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">APACHE II&#58; Acute Physiology and Chronic Health Evaluation II&#59; DM&#58; diabetes mellitus&#59; EPOC&#58; enfermedad pulmonar obstructiva cr&#243;nica&#59; HTA&#58; hipertensi&#243;n arterial&#59; IC 95&#37;&#58; intervalo de confianza del 95&#37;&#59; OR&#58; odds ratio&#59; SOFA&#58; Sequential Organ Failure Assessment scoring al ingreso en UCI&#59; TDER&#58; terapia de depuraci&#243;n extrarrenal&#59; VMI&#58; ventilaci&#243;n mec&#225;nica invasiva&#59; VNI&#58; ventilaci&#243;n no invasiva&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Antecedentes respiratorios&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</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">Oseltamivir 72<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;18-2&#44;12&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;45&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">Tratamiento con corticoides&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;004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;02&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">Fallo hemodin&#225;mico&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">18&#44;07&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">3&#44;21-101&#44;72&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;001&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">14&#44;77&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">2&#44;34-92&#44;97&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;004&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">SOFA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;18&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;76-13&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;63-3&#44;80&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">0&#44;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">APACHE II<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;17-2&#44;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Cuadrantes<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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                            4 => "I&#46; Dot"
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                            0 => "J&#46;R&#46; Masclans"
                            1 => "M&#46; P&#233;rez"
                            2 => "J&#46; Almirall"
                            3 => "L&#46; Lorente"
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                      "doi" => "10.1111/j.1469-0691.2012.03797.x"
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                          "etal" => true
                          "autores" => array:6 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Kumar"
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                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;D&#46; Ramsey"
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                  "host" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;A&#46; Fowler"
                            1 => "C&#46;B&#46; Guest"
                            2 => "S&#46;E&#46; Lapinsky"
                            3 => "W&#46;J&#46; Sibbald"
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                      "doi" => "10.1164/rccm.200305-715OC"
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                        "volumen" => "169"
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                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Chapter 1&#46; Introduction&#46; Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster"
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                        0 => array:3 [
                          "colaboracion" => "European Society of Intensive Care Medicine&#39;s Task Force for intensive care unit triage during an influenza epidemic or mass disaster"
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Información de la revista
Vol. 45. Núm. 6.
Páginas 347-353 (agosto - septiembre 2021)
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6559
Vol. 45. Núm. 6.
Páginas 347-353 (agosto - septiembre 2021)
ORIGINAL
Acceso a texto completo
Factores de riesgo de fracaso de ventilación no invasiva en neumonía primaria por influenza A en pacientes críticos
Risk factors associated to noninvasive ventilation failure in primary influenza A pneumonia in the critical care setting
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6559
H. Hernández Garcés
Autor para correspondencia