array:25 [
  "pii" => "S0873215913000767"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppneu.2013.06.003"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "aid" => "163"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Pneumol. 2013;19:184-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6817
    "formatos" => array:3 [
      "EPUB" => 270
      "HTML" => 5349
      "PDF" => 1198
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0873215913000378"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2013.03.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "152"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Pneumol. 2013;19:186-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6107
      "formatos" => array:3 [
        "EPUB" => 249
        "HTML" => 4768
        "PDF" => 1090
      ]
    ]
    "pt" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>"
      "titulo" => "Asma al&#233;rgica e omalizumab &#8211; A experi&#234;ncia no Centro Hospitalar da Cova da Beira"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "186"
          "paginaFinal" => "187"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Allergic asthma and omalizumab - The experience at the Centro Hospitalar da Cova da Beira"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Sim&#245;es Saldanha Mendes, M&#46;J&#46; Valente, I&#46; Vicente, E&#46; Magalh&#227;es, S&#46; Valente"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Sim&#245;es Saldanha Mendes"
            ]
            1 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Valente"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Vicente"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Magalh&#227;es"
            ]
            4 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Valente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511513000468"
        "doi" => "10.1016/j.rppnen.2013.03.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000468?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000378?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000378/v2_201509041415/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0873215912001638"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2012.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "129"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Pneumol. 2013;19:179-83"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 22763
      "formatos" => array:3 [
        "EPUB" => 283
        "HTML" => 19350
        "PDF" => 3130
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Dermatomiosite como primeira manifesta&#231;&#227;o de uma neoplasia pulmonar"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "179"
          "paginaFinal" => "183"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Dermatomyositis as the first manifestation of a lung tumor"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 881
              "Ancho" => 693
              "Tamanyo" => 65309
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Manifesta&#231;&#245;es cut&#226;neas da dermatomiosite&#58; edema palpebral e eritema periorbit&#225;rio &#40;eritema heliotr&#243;pico&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;S&#46; Castro, A&#46; Barroso, B&#46; Parente"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;S&#46;"
              "apellidos" => "Castro"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Barroso"
            ]
            2 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Parente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511513000158"
        "doi" => "10.1016/j.rppnen.2013.02.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000158?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912001638?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000004/v2_201509041415/S0873215912001638/v2_201509041415/pt/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S0873215913000159"
      "issn" => "08732159"
      "doi" => "10.1016/j.rppneu.2012.12.001"
      "estado" => "S300"
      "fechaPublicacion" => "2013-07-01"
      "aid" => "132"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "sco"
      "cita" => "Rev Port Pneumol. 2013;19:175-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12597
        "formatos" => array:3 [
          "EPUB" => 265
          "HTML" => 10885
          "PDF" => 1447
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Unexpected death of a ventilator-dependent amyotrophic lateral sclerosis patient"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "175"
            "paginaFinal" => "178"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Morte inesperada de um doente com Esclerose Lateral Amiotr&#243;fica dependente de ventilador"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 667
                "Ancho" => 1000
                "Tamanyo" => 223838
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Pulmonary histological examination&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; di Paolo, L&#46; Evangelisti, N&#46; Ambrosino"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "di Paolo"
              ]
              1 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Evangelisti"
              ]
              2 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Ambrosino"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000159?idApp=UINPBA00004E"
      "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000159/v2_201509041415/en/main.assets"
    ]
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Comment</span>"
    "titulo" => "Mechanically Assisted Invasive Ventilation for ALS patients&#58; Is it the Ultimate Strategy To Improve Survival&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "184"
        "paginaFinal" => "185"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Anabela C&#46; Pinto"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Anabela C&#46;"
            "apellidos" => "Pinto"
            "email" => array:1 [
              0 => "jsanches&#46;apinto&#64;mail&#46;telepac&#46;pt"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Department of PM&#38;R &#40;CHLN&#41;&#44; University Clinics of PM&#38;R&#44; Faculty of Medicine&#44; University of Lisbon&#44; Translational and Clinical Physiology Unit&#44; Instituto de Medicina Molecular&#44; Faculty of Medicine&#44; University of Lisbon&#44; Portugal&#44; Lisboa&#44; Portugal"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "A Ventila&#231;&#227;o Mec&#226;nica Invasiva na Esclerose Lateral Amiotr&#243;fica&#58; a derradeira estrat&#233;gia&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ambrosino and his colleagues from an Italian center at Pisa&#44; describe their experience with a significant impact on the management of home-ventilated ALS patients&#46; This work certainly opens a new era by encouraging new studies on clinical evolution and prognosis&#44; thereby deemed to reduce the uncertainties experienced for all of those responsible for the follow-up of these patients that may improve the palliative care at the end-of-life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent evidence aggregating results from retrospective analysis of autopsies of ALS patients with their respective reported clinical causes&#44; showed that despite the frequent lack of concordance&#44; they found that respiratory infectious conditions were the most prominent features and that pulmonary embolism was observed only in spinal ALS patients&#44; and heart failure as unexplained death was more than two-fold higher in bulbar ALS patients than in the spinal forms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition&#44; bulbar ALS patients have more frequently disautonomy and sympathetic hyperactivity&#44; and specifically in ventilated ALS patients these phenomena have already been for many years described and recognized as possible cause of unexpected death among ventilated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover&#44; it is recognized that diffuse alveolar hemorrhage is also an unspecific feature&#44; both for ARDS with mechanically lung injury produced with higher lung volume&#44; and bronchopneumonia&#46; Indeed&#44; Prost and colleagues found strong and powerful associations between those clinical conditions in multivariate analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; as Diaz and colleagues&#44; reported that diffuse alveolar hemorrhage is the clinical feature that often may not be apparent or its presentation can be mistaken for an alternative disease process&#44; and may be completely unrecognized even in ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Accordingly&#44; we secured it to the so called &#8220;irrelevant data&#8221; on the 2 previous admissions to the emergency room in the last four months described in the text by Ambrosino and colleagues&#44; to draw attention and focus to this critical condition in the emergency room&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Indeed&#44; the presence of an obvious critically ill ALS patient like the one reported on this clinical case&#44; probably with an end-stage disease&#44; the diffuse alveolar hemorrhage was very likely the cause of death&#46; Nevertheless&#44; the etiology attributed to malfunction of the device without discussion of other clinical conditions seemed rather partial especially because of the high frequency of other possible negative events in ALS patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Still&#44; it is not disputable the interest of the present case study and future research should cover these pertinent issues&#44; as it is granted that other causes of death are implicated in the terminal ALS stages&#44; even if properly and adequately invasively ventilated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Overall&#44; though mechanically assisted invasive ventilation &#40;MAIV&#41; is often believed to be a life-prolonging intervention&#44; it is not devoid of serious life-threatening complications&#44; and the long-term medical course of ALS with MAIV has never been tested in a randomized trial with NIV that frequently goes up to 24&#47;24 and also to the point of total locked-in syndrome&#44; meaning that&#44; especially due to the paucity of studies&#44; we may no longer consider MAIV as the ultimate strategy to improve survival but rather it should be more extensively evaluated&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the other hand&#44; as the risk management and safety of the home ventilator dependent patient is impossible to guarantee<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> especially care has to be undertaken by manufacturers when implementing software designs to detect and anticipate possible faulty mechanisms&#46; They should be readily accessible by physicians&#44; providers&#44; patients and carers&#44; and assist immediate responses&#46; However&#44; even in the last generation of ventilators the alarm signs are not easily transmitted&#44; mostly due to the protection of data laws that do not allow a good communication with carers and patients which&#44; once fully educated and familiarized with problems and solutions should be thought as the true experts and team members&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; though the authors could have reported a more detailed clinical case and improved the discussion&#44; this report is very interesting and quite important and possibly may represent a turning point&#44; calling for more detailed studies on durability&#44; reviews and maintenance of devices as well as in imposed demands both on manufacturers and providers and regulatory mechanisms regarding patient safety&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Causes of death in a post-mortem series of ALS patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Corcia"
                            1 => "P&#46;F&#46; Pradat"
                            2 => "F&#46; Salachas"
                            3 => "G&#46; Bruneteau"
                            4 => "N&#46; Forestier"
                            5 => "D&#46; Seilhean"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Amyotrophic Lateral Sclerosis&#58; official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "59"
                        "paginaFinal" => "62"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulatory collapse and sudden death in respirator-dependent amyotrophic lateral sclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Shimizu"
                            1 => "H&#46; Hayashi"
                            2 => "S&#46; Kato"
                            3 => "M&#46; Hayashi"
                            4 => "H&#46; Tanabe"
                            5 => "M&#46; Oda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Journal of the Neurological Sciences"
                        "fecha" => "1994"
                        "volumen" => "124"
                        "paginaInicial" => "45"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7931421"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827807006575"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse alveolar hemorrhage in immunocompetent patients&#58; etiologies and prognosis revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; de Prost"
                            1 => "A&#46; Parrot"
                            2 => "E&#46; Cuquemelle"
                            3 => "C&#46; Picard"
                            4 => "M&#46; Antoine"
                            5 => "J&#46; Fleury-Feith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2012.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiratory Medicine"
                        "fecha" => "2012"
                        "volumen" => "106"
                        "paginaInicial" => "1021"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary vasculitis in the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Diaz"
                            1 => "K&#46;T&#46; Calamia"
                            2 => "A&#46;S&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066610384551"
                      "Revista" => array:6 [
                        "tituloSerie" => "Journal of Intensive Care Medicine"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "88"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21464063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk management of the home ventilator dependent patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;K&#46; Simonds"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.055566"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "369"
                        "paginaFinal" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16648349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000767/v2_201509041415/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9596"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Coment&#225;rio"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001900000004/v2_201509041415/S0873215913000767/v2_201509041415/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000767?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Comment
Mechanically Assisted Invasive Ventilation for ALS patients: Is it the Ultimate Strategy To Improve Survival?
A Ventilação Mecânica Invasiva na Esclerose Lateral Amiotrófica: a derradeira estratégia?
Anabela C. Pinto
Department of PM&R (CHLN), University Clinics of PM&R, Faculty of Medicine, University of Lisbon, Translational and Clinical Physiology Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal, Lisboa, Portugal
Read
11013
Times
was read the article
2855
Total PDF
8158
Total HTML
Share statistics
 array:25 [
  "pii" => "S0873215913000767"
  "issn" => "08732159"
  "doi" => "10.1016/j.rppneu.2013.06.003"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "aid" => "163"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Pneumol. 2013;19:184-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6817
    "formatos" => array:3 [
      "EPUB" => 270
      "HTML" => 5349
      "PDF" => 1198
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0873215913000378"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2013.03.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "152"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Rev Port Pneumol. 2013;19:186-7"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6107
      "formatos" => array:3 [
        "EPUB" => 249
        "HTML" => 4768
        "PDF" => 1090
      ]
    ]
    "pt" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>"
      "titulo" => "Asma al&#233;rgica e omalizumab &#8211; A experi&#234;ncia no Centro Hospitalar da Cova da Beira"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "186"
          "paginaFinal" => "187"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Allergic asthma and omalizumab - The experience at the Centro Hospitalar da Cova da Beira"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Sim&#245;es Saldanha Mendes, M&#46;J&#46; Valente, I&#46; Vicente, E&#46; Magalh&#227;es, S&#46; Valente"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Sim&#245;es Saldanha Mendes"
            ]
            1 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Valente"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Vicente"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Magalh&#227;es"
            ]
            4 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Valente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511513000468"
        "doi" => "10.1016/j.rppnen.2013.03.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000468?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000378?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000378/v2_201509041415/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0873215912001638"
    "issn" => "08732159"
    "doi" => "10.1016/j.rppneu.2012.11.002"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "129"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Pneumol. 2013;19:179-83"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 22763
      "formatos" => array:3 [
        "EPUB" => 283
        "HTML" => 19350
        "PDF" => 3130
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
      "titulo" => "Dermatomiosite como primeira manifesta&#231;&#227;o de uma neoplasia pulmonar"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "179"
          "paginaFinal" => "183"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Dermatomyositis as the first manifestation of a lung tumor"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 881
              "Ancho" => 693
              "Tamanyo" => 65309
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Manifesta&#231;&#245;es cut&#226;neas da dermatomiosite&#58; edema palpebral e eritema periorbit&#225;rio &#40;eritema heliotr&#243;pico&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46;S&#46; Castro, A&#46; Barroso, B&#46; Parente"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "A&#46;S&#46;"
              "apellidos" => "Castro"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Barroso"
            ]
            2 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Parente"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2173511513000158"
        "doi" => "10.1016/j.rppnen.2013.02.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000158?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215912001638?idApp=UINPBA00004E"
    "url" => "/08732159/0000001900000004/v2_201509041415/S0873215912001638/v2_201509041415/pt/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S0873215913000159"
      "issn" => "08732159"
      "doi" => "10.1016/j.rppneu.2012.12.001"
      "estado" => "S300"
      "fechaPublicacion" => "2013-07-01"
      "aid" => "132"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "article"
      "crossmark" => 0
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "sco"
      "cita" => "Rev Port Pneumol. 2013;19:175-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 12597
        "formatos" => array:3 [
          "EPUB" => 265
          "HTML" => 10885
          "PDF" => 1447
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
        "titulo" => "Unexpected death of a ventilator-dependent amyotrophic lateral sclerosis patient"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "175"
            "paginaFinal" => "178"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Morte inesperada de um doente com Esclerose Lateral Amiotr&#243;fica dependente de ventilador"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 667
                "Ancho" => 1000
                "Tamanyo" => 223838
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Pulmonary histological examination&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; di Paolo, L&#46; Evangelisti, N&#46; Ambrosino"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "di Paolo"
              ]
              1 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Evangelisti"
              ]
              2 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Ambrosino"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000159?idApp=UINPBA00004E"
      "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000159/v2_201509041415/en/main.assets"
    ]
  ]
  "en" => array:11 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Comment</span>"
    "titulo" => "Mechanically Assisted Invasive Ventilation for ALS patients&#58; Is it the Ultimate Strategy To Improve Survival&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "184"
        "paginaFinal" => "185"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Anabela C&#46; Pinto"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Anabela C&#46;"
            "apellidos" => "Pinto"
            "email" => array:1 [
              0 => "jsanches&#46;apinto&#64;mail&#46;telepac&#46;pt"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Department of PM&#38;R &#40;CHLN&#41;&#44; University Clinics of PM&#38;R&#44; Faculty of Medicine&#44; University of Lisbon&#44; Translational and Clinical Physiology Unit&#44; Instituto de Medicina Molecular&#44; Faculty of Medicine&#44; University of Lisbon&#44; Portugal&#44; Lisboa&#44; Portugal"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "A Ventila&#231;&#227;o Mec&#226;nica Invasiva na Esclerose Lateral Amiotr&#243;fica&#58; a derradeira estrat&#233;gia&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ambrosino and his colleagues from an Italian center at Pisa&#44; describe their experience with a significant impact on the management of home-ventilated ALS patients&#46; This work certainly opens a new era by encouraging new studies on clinical evolution and prognosis&#44; thereby deemed to reduce the uncertainties experienced for all of those responsible for the follow-up of these patients that may improve the palliative care at the end-of-life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent evidence aggregating results from retrospective analysis of autopsies of ALS patients with their respective reported clinical causes&#44; showed that despite the frequent lack of concordance&#44; they found that respiratory infectious conditions were the most prominent features and that pulmonary embolism was observed only in spinal ALS patients&#44; and heart failure as unexplained death was more than two-fold higher in bulbar ALS patients than in the spinal forms&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition&#44; bulbar ALS patients have more frequently disautonomy and sympathetic hyperactivity&#44; and specifically in ventilated ALS patients these phenomena have already been for many years described and recognized as possible cause of unexpected death among ventilated patients&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover&#44; it is recognized that diffuse alveolar hemorrhage is also an unspecific feature&#44; both for ARDS with mechanically lung injury produced with higher lung volume&#44; and bronchopneumonia&#46; Indeed&#44; Prost and colleagues found strong and powerful associations between those clinical conditions in multivariate analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; as Diaz and colleagues&#44; reported that diffuse alveolar hemorrhage is the clinical feature that often may not be apparent or its presentation can be mistaken for an alternative disease process&#44; and may be completely unrecognized even in ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Accordingly&#44; we secured it to the so called &#8220;irrelevant data&#8221; on the 2 previous admissions to the emergency room in the last four months described in the text by Ambrosino and colleagues&#44; to draw attention and focus to this critical condition in the emergency room&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Indeed&#44; the presence of an obvious critically ill ALS patient like the one reported on this clinical case&#44; probably with an end-stage disease&#44; the diffuse alveolar hemorrhage was very likely the cause of death&#46; Nevertheless&#44; the etiology attributed to malfunction of the device without discussion of other clinical conditions seemed rather partial especially because of the high frequency of other possible negative events in ALS patients&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Still&#44; it is not disputable the interest of the present case study and future research should cover these pertinent issues&#44; as it is granted that other causes of death are implicated in the terminal ALS stages&#44; even if properly and adequately invasively ventilated&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Overall&#44; though mechanically assisted invasive ventilation &#40;MAIV&#41; is often believed to be a life-prolonging intervention&#44; it is not devoid of serious life-threatening complications&#44; and the long-term medical course of ALS with MAIV has never been tested in a randomized trial with NIV that frequently goes up to 24&#47;24 and also to the point of total locked-in syndrome&#44; meaning that&#44; especially due to the paucity of studies&#44; we may no longer consider MAIV as the ultimate strategy to improve survival but rather it should be more extensively evaluated&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">On the other hand&#44; as the risk management and safety of the home ventilator dependent patient is impossible to guarantee<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> especially care has to be undertaken by manufacturers when implementing software designs to detect and anticipate possible faulty mechanisms&#46; They should be readily accessible by physicians&#44; providers&#44; patients and carers&#44; and assist immediate responses&#46; However&#44; even in the last generation of ventilators the alarm signs are not easily transmitted&#44; mostly due to the protection of data laws that do not allow a good communication with carers and patients which&#44; once fully educated and familiarized with problems and solutions should be thought as the true experts and team members&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; though the authors could have reported a more detailed clinical case and improved the discussion&#44; this report is very interesting and quite important and possibly may represent a turning point&#44; calling for more detailed studies on durability&#44; reviews and maintenance of devices as well as in imposed demands both on manufacturers and providers and regulatory mechanisms regarding patient safety&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Causes of death in a post-mortem series of ALS patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Corcia"
                            1 => "P&#46;F&#46; Pradat"
                            2 => "F&#46; Salachas"
                            3 => "G&#46; Bruneteau"
                            4 => "N&#46; Forestier"
                            5 => "D&#46; Seilhean"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Amyotrophic Lateral Sclerosis&#58; official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "59"
                        "paginaFinal" => "62"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulatory collapse and sudden death in respirator-dependent amyotrophic lateral sclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Shimizu"
                            1 => "H&#46; Hayashi"
                            2 => "S&#46; Kato"
                            3 => "M&#46; Hayashi"
                            4 => "H&#46; Tanabe"
                            5 => "M&#46; Oda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Journal of the Neurological Sciences"
                        "fecha" => "1994"
                        "volumen" => "124"
                        "paginaInicial" => "45"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7931421"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827807006575"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse alveolar hemorrhage in immunocompetent patients&#58; etiologies and prognosis revisited"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; de Prost"
                            1 => "A&#46; Parrot"
                            2 => "E&#46; Cuquemelle"
                            3 => "C&#46; Picard"
                            4 => "M&#46; Antoine"
                            5 => "J&#46; Fleury-Feith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2012.03.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respiratory Medicine"
                        "fecha" => "2012"
                        "volumen" => "106"
                        "paginaInicial" => "1021"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary vasculitis in the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Diaz"
                            1 => "K&#46;T&#46; Calamia"
                            2 => "A&#46;S&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066610384551"
                      "Revista" => array:6 [
                        "tituloSerie" => "Journal of Intensive Care Medicine"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "88"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21464063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk management of the home ventilator dependent patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;K&#46; Simonds"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2005.055566"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2006"
                        "volumen" => "61"
                        "paginaInicial" => "369"
                        "paginaFinal" => "371"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16648349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08732159/0000001900000004/v2_201509041415/S0873215913000767/v2_201509041415/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9596"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Coment&#225;rio"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001900000004/v2_201509041415/S0873215913000767/v2_201509041415/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215913000767?idApp=UINPBA00004E"
]
Article information
ISSN: 08732159
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 13 8 21
2024 October 37 42 79
2024 September 43 35 78
2024 August 61 41 102
2024 July 44 36 80
2024 June 53 42 95
2024 May 47 42 89
2024 April 52 34 86
2024 March 52 31 83
2024 February 53 39 92
2024 January 41 23 64
2023 December 37 19 56
2023 November 31 30 61
2023 October 47 37 84
2023 September 37 30 67
2023 August 30 31 61
2023 July 38 28 66
2023 June 27 14 41
2023 May 34 24 58
2023 April 25 19 44
2023 March 37 22 59
2023 February 32 20 52
2023 January 27 13 40
2022 December 41 22 63
2022 November 49 30 79
2022 October 37 24 61
2022 September 30 37 67
2022 August 39 32 71
2022 July 38 44 82
2022 June 23 27 50
2022 May 48 37 85
2022 April 32 23 55
2022 March 33 53 86
2022 February 43 33 76
2022 January 43 34 77
2021 December 35 32 67
2021 November 32 31 63
2021 October 41 55 96
2021 September 53 28 81
2021 August 45 28 73
2021 July 43 20 63
2021 June 36 33 69
2021 May 55 28 83
2021 April 110 62 172
2021 March 98 22 120
2021 February 81 24 105
2021 January 44 21 65
2020 December 57 33 90
2020 November 62 29 91
2020 October 66 15 81
2020 September 57 27 84
2020 August 68 34 102
2020 July 105 20 125
2020 June 107 16 123
2020 May 87 19 106
2020 April 77 11 88
2020 March 72 11 83
2020 February 60 16 76
2020 January 89 7 96
2019 December 64 16 80
2019 November 83 10 93
2019 October 96 18 114
2019 September 71 18 89
2019 August 97 10 107
2019 July 96 15 111
2019 June 105 12 117
2019 May 87 18 105
2019 April 86 20 106
2019 March 148 13 161
2019 February 75 11 86
2019 January 129 25 154
2018 December 89 5 94
2018 November 52 0 52
2018 October 64 10 74
2018 September 40 6 46
2018 August 42 30 72
2018 July 52 20 72
2018 June 61 18 79
2018 May 72 21 93
2018 April 111 21 132
2018 March 94 20 114
2018 February 40 11 51
2018 January 80 19 99
2017 December 59 12 71
2017 November 46 12 58
2017 October 39 9 48
2017 September 45 25 70
2017 August 37 26 63
2017 July 39 18 57
2017 June 42 12 54
2017 May 41 14 55
2017 April 12 6 18
2017 March 12 34 46
2017 February 19 5 24
2017 January 23 6 29
2016 December 16 14 30
2016 November 23 6 29
2016 October 15 7 22
2016 September 10 5 15
2016 August 11 2 13
2016 July 8 8 16
2016 June 1 6 7
2016 May 19 0 19
2016 April 30 4 34
2016 March 39 7 46
2016 February 43 21 64
2016 January 43 17 60
2015 December 39 19 58
2015 November 28 18 46
2015 October 43 17 60
2015 September 38 15 53
2015 August 29 9 38
2015 July 40 6 46
2015 June 24 3 27
2015 May 60 8 68
2015 April 116 13 129
2015 March 89 6 95
2015 February 99 12 111
2015 January 100 11 111
2014 December 115 10 125
2014 November 108 20 128
2014 October 131 21 152
2014 September 135 20 155
2014 August 107 10 117
2014 July 130 19 149
2014 June 100 16 116
2014 May 123 16 139
2014 April 112 18 130
2014 March 124 15 139
2014 February 93 18 111
2014 January 110 24 134
2013 December 85 23 108
2013 November 79 18 97
2013 October 65 24 89
2013 September 75 25 100
2013 August 120 45 165
2013 July 101 55 156
Show all

Follow this link to access the full text of the article

Pulmonology

Are you a health professional able to prescribe or dispense drugs?