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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and ROX index trends within the first four days of treatment&#46; Patient&#8217;s SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and ROX index improve since NHF and prone position were implemented&#46; &#40;NHF&#58; nasal high flow oxygen&#46; SP&#58; supine position&#44; PP&#58; prone position&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old man with SARS-COV2 infection was admitted to our hospital on November 1st&#44; after 7 days of fever&#46; Comorbidities comprised hypertension and obesity&#46; On the third day after admission&#44; he was transferred to our Respiratory Intensive Care Unit due to worsening of his respiratory condition&#44; including notable shortness of breath with minimal exertion&#46; On arrival&#44; the patient was alert&#44; haemodynamically stable&#46; His respiratory rate was 25&#47;min with a reservoir oxygen mask at 15<span class="elsevierStyleHsp" style=""></span>L&#47;min&#46; Blood gas analysis &#40;ABG&#41; revealed a severe hypoxemia and alkalosis respiratory &#40;pH 7&#46;51&#44; PaCO<span class="elsevierStyleInf">2</span> 35<span class="elsevierStyleHsp" style=""></span>mmHg&#44; PaO<span class="elsevierStyleInf">2</span> 118<span class="elsevierStyleHsp" style=""></span>mmHg&#44; HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span> 27<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 148&#41;&#46; Due to patient&#8217;s gas exchange impairment and clinical progression&#44; NHF therapy trial was attempted&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Initial temperature&#44; inspired oxygen fraction &#40;FiO<span class="elsevierStyleInf">2</span>&#41; and flow rate were 34<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; 60<span class="elsevierStyleHsp" style=""></span>L&#47;min and 60&#37; respectively&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to reduce bio-aerosol dispersion&#44; a surgical mask was placed over the patient&#8217;s mouth and nose&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows bilateral consolidations with ground-glass areas&#44; mainly in the posterior dependent zones on CT-scan&#46; Based on this radiological picture&#44; we continued NHF in awake prone positioning&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> illustrates oxygen pulse saturation&#47;FiO<span class="elsevierStyleInf">2</span> &#40;SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41;&#44; oxygen blood pressure&#47;FiO<span class="elsevierStyleInf">2</span> &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; ratios and ROX index trends within the first four days of treatment&#46; ROX index is defined as the ratio of pulse oximetry&#47;fraction of inspired oxygen to respiratory rate &#40;RR&#41;&#46; This index&#44; described by Roca et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> identifies patients at risk of NHF failure&#46; In particular&#44; a ROX index of 4&#44;88 is associated with a high risk of intubation&#46; In conclusion&#44; NHF setting was adjusted according to the maximum patient<span class="elsevierStyleBold"><span class="elsevierStyleUnderline">&#8217;</span></span>s comfort and the best effects in terms of distending pressure and FiO<span class="elsevierStyleInf">2</span> stability&#46; FiO<span class="elsevierStyleInf">2</span> was also targeted to achieve oxygen saturation between 94&#8211;96&#37;&#46; Prone positioning was implemented because we felt that the mild distension pressure generated by NHF could be enhanced by placing the ventilated areas in a dependent position&#44; leading to increased V&#47;Q mismatch&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Thermo-humidified nasal high flow &#40;NHF&#41; oxygen therapy is increasingly used in the management of respiratory failure&#46; This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#44; acute and chronic&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in order to enhance patient comfort and tolerance compared with standard oxygen by supplying heat and humidified mixture of air and oxygen at flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;minutes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">NHF can be delivered through different devices&#46; Although few studies have compared the clinical effects of different NHF systems&#44; the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice&#46; We have also included a brief description of the most frequently used NHF systems&#58; BioRespira&#174; &#40;IBD&#41;&#44; Airvo 2&#174; and OptiFlow&#174; &#40;Fisher and Paykel&#41;&#44; TNI softFlow 50&#174; &#40;Masimo&#41; and Precision Flow&#174; &#40;Vapotherm&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Physiological benefits of NHF</span><p id="par0030" class="elsevierStylePara elsevierViewall">High flows air&#47;oxygen mixture can be beneficial for both chronic and acute patients&#44; who need additional oxygen supply&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Matches patient&#8217;s inspiratory flow &#40;stable FiO<span class="elsevierStyleInf">2</span>&#41;&#46; Conventional oxygen therapy devices such as Venturi masks or reservoir masks have holes to prevent carbon dioxide rebreathing&#46; The patient inspires the delivered oxygen&#44; but part of the air can be rebreathed&#46; In addition&#44; if the patient&#8217;s ventilatory demand exceeds the flows provided by the device&#44; the patient will breathe part of atmospheric air&#46; For this reason&#44; because of the relationship with the patient-breathing pattern&#44; FiO<span class="elsevierStyleInf">2</span> can be much lower than predicted&#46; Pisani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> observed that calculated FiO<span class="elsevierStyleInf">2</span> approached the prescribed FiO<span class="elsevierStyleInf">2</span> when the delivered gas flow rates were greater than the patient&#8217;s peak inspiratory flow rate&#46; This means that&#44; with low-flow systems&#44; as the peak inspiratory demand increase&#44; we cannot accurately estimate the FiO<span class="elsevierStyleInf">2</span> that the patient is breathing&#46; NHF delivers a flow that is much higher than the patient&#8217;s spontaneous inspiratory flow in any condition&#44; so actual FiO<span class="elsevierStyleInf">2</span> is close to the predicted FiO<span class="elsevierStyleInf">2</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Improves lung mucociliary clearance&#46; In normal conditions&#44; inhaled air is conditioned in the nasal airways&#46; The air is warmed and humidified by the nasal mucosa because of its highly vascular sinusoid tissue&#46; Humidification is always recommended for flow rates above 4<span class="elsevierStyleHsp" style=""></span>L&#47;min&#44; because the humidification function of the nasal mucosa could be insufficient&#46; In addition&#44; unwarmed and dry gas leads to a poor tolerance of oxygen therapy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Washes out anatomical dead space and carbon dioxide &#40;CO<span class="elsevierStyleInf">2</span>&#41;&#44; allowing a higher fraction of minute ventilation to participate in gas exchange&#46; Additionally&#44; the nasal cannula&#44; used for NHF&#44; is the only respiratory interface that does not increase the instrumental dead space&#46; With an oxygen mask&#44; especially at low flow&#44; carbon dioxide is rebreathed&#46; NIV interfaces also increase the dead space&#46; As a consequence&#44; to maintain PaCO<span class="elsevierStyleInf">2</span> &#40;and alveolar ventilation&#41;&#44; the minute volume has to increase&#44; either through respiratory rate or through tidal volume &#40;VT&#41;&#44; or even both&#46; For these reasons&#44; although NHF does not provide an active inspiratory support&#44; it may improve the alveolar ventilation and decrease respiratory rate &#40;RR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Fraser et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> found that NHF leads to a reduction in respiratory rate of 10&#37;&#44; and in some patients&#44; this reduction was associated with a reduction in hypercapnia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Provides a mild distending pressure&#46; Although NHF is an open system&#44; high flow from the nasal cannula increases the airway pressure usually around 3<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> depending on the flow level and the nasal prong size in relation to the nostrils&#46; Richie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> conclude that NHF could deliver a clinically relevant mean positive airway pressure directly proportional to delivered gas flow rates&#46; In addition&#44; high flows could act as a resistance to exhalation when the mouth is closed&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; it remains unclear whether NHF is sufficient to increase lung volume or recruit the collapsed alveoli&#46; Evaluating end-expiratory lung volume &#40;EELV&#41;&#44; Corley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported increased end-expiratory lung impedance&#44; suggesting increasing volumes and functional residual capacity with NHF compared with low-flow oxygen therapy&#46; Also using electrical lung impedance tomography on healthy subjects in supine and prone position&#44; Riera et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> found that NHF increased global EELV&#44; suggesting an increase in functional residual capacity&#44; regardless of the body position&#46; This effect could be important in patients with a higher body mass index&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Attenuates inspiratory resistance and increases expiratory resistance&#46; The attenuation of inspiratory resistance takes place essentially by providing an adequate warmed and humidified flow&#46; It is known that in normal subjects&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> inhalation of cold air causes the activation of specific receptors or osmoreceptors in the nasal mucosa&#44; which may induce bronchoconstriction through a mechanism mediated by the activation of muscarinic receptors&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Besides&#44; NHF is able to increase the expiratory resistance depending on the size of the nasal cannula and the patient&#8217;s expiratory flow&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">A typical NHF system consists of a flow generator&#44; active heated humidifier&#44; single-limb heated circuit&#44; and nasal cannula &#40;or tracheostomy interface&#41;&#46; There are three types of flow generators&#58; air-oxygen blender devices&#44; built-in flow generators &#40;turbines&#41;&#44; and entrainment systems &#40;Venturi Systems&#41;&#46; The humidifier can be a traditional &#8220;pass-over heated humidifying system&#8221; or a &#8220;filter-type humidifying system&#8221; in which humidification is generated by passing gas through a bundle of narrow tubes&#44; or which requires an evaporative surface in contact with the gas&#46; A heated-wire inspiratory circuit is preferred to ensure delivery of adequately humidified medical gas as well as to avoid circuit vapour loss and condensation&#46; The lower the ambient temperature&#44; the more likely there is to be condensation&#46; One major reason for the patient&#8217;s discomfort or intolerance is the interface&#46; Beyond the circuit&#44; condensation may also accumulate in the nasal prongs&#44; which results in water droplet spray into the nostrils&#46; NHF interfaces are specifically for this purpose&#46; They can vary from a slender nasal cannula similar in appearance to a regular nasal oxygen cannula in which both the internal diameter and nasal prong bore are narrow&#44; to a large bore nasal prong&#46; Using slender nasal cannulas results in high flow out of the nasal prongs&#46; The volumetric flow is the volume of gas that passes in a certain unit of time&#46; The speed at which the volume moves is the velocity&#46; The speed&#44; at a constant volumetric flow&#44; varies inversely proportional to the cross-sectional area of the tube&#46; This is the reason why the smaller the cross-sectional area of the nasal cannula&#44; the greater the speed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Implementation technique</span><p id="par0205" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General considerations</span> &#40;regardless of the NHF device used&#41;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Gas connection to the device &#40;O<span class="elsevierStyleInf">2</span>&#44; and compressed air if required&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Place distilled water in the humidifier&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Connect the circuit&#44; appropriate to the system used&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Switch on and heat up the water until the temperature reaches 31&#8722;37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Select the size of the nasal cannula properly&#46; When using a large bore nasal prong&#44; it must not occlude more than 50&#37; of the nostril&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Position the cannula correctly in the patient&#8217;s nostrils&#44; to avoid lateral leakage&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Program the parameters&#44; according to the equipment used &#40;temperature&#44; flow&#44; and FiO<span class="elsevierStyleInf">2</span> if the setting is available&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Switch on the device &#40;some devices allow parameters to be programmed once the machine is on&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">b&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General monitoring</span></p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Patients must be spontaneously breathing&#44; alert and must be able to protect the airway&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Check that there is no accumulation of condensed water in the tube&#44; ensuring its inclination towards the heater&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Aspiration of patient&#8217;s secretions&#44; if needed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Check that the cannula is not occluded by a mucus plug or against the patient&#8217;s nose&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">Make sure the patient is in a semi-seated position at 45&#176;&#46; NHF can be implemented in &#8220;awake prone position&#8221;&#44; if needed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Check that the device is not disconnected from the electrical source when using high-flow devices&#44; because not many have an internal battery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">c&#41;</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General set up</span></p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">Temperature&#58; it must be targeted according to the patient&#8217;s comfort&#46; The temperature needs to be set at higher values at cold weathers or high flows&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Flow&#58; the maximum benefit of this treatment is achieved at higher flows&#44; although the flow should also be titrated according to the patient&#39;s comfort&#46; It is suggested starting with flows close to 50<span class="elsevierStyleHsp" style=""></span>L&#47;m&#44; according to the patient&#39;s tolerance&#44; in order to increase or decrease the flow&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#58; depending on the NHF device used&#44; FiO<span class="elsevierStyleInf">2</span> can be a parameter to be programmed or a parameter that depends on the flow&#46; By using an air-oxygen blender device&#44; oxygen concentrations are stable&#46; On the other hand&#44; by using turbine devices&#44; oxygen is supplied via a low-pressure system&#44; while the device just monitors the oxygen concentration &#40;FiO<span class="elsevierStyleInf">2</span>&#41;&#46; Any rise in the flow&#44; will decrease the FiO<span class="elsevierStyleInf">2</span>&#44; and vice versa&#46; Venturi high flow systems use a flow generator to create a high flow by Venturi&#46; It is composed of a flow meter and an oxygen concentration monitor&#46; Regardless of the system used&#44; in all cases&#44; FiO<span class="elsevierStyleInf">2</span> titration should depend on the SpO<span class="elsevierStyleInf">2</span> target&#44; recommending an SpO<span class="elsevierStyleInf">2</span> range between 94&#37; and 96&#37;&#44; or between 88&#37;&#8211;92&#37; in hypercapnic COPD patients&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">NHF devices</span><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main characteristics associated with the currently available devices&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">BioRespira&#174; &#40;IBD&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">This innovative system is a &#8220;built-in high flow generator&#8221; with a turbine capable of generating high flows starting from the ambient air&#44; mixed with medical oxygen that can be supplied via a hospital cylinder or medical gas plant&#46; Despite being a turbine device&#44; it guarantees a fixed FiO<span class="elsevierStyleInf">2</span> even when the flow changes&#46; This control is based on an internal oxygen sensor and a valve that guarantees by opening and closing&#44; the desired FiO<span class="elsevierStyleInf">2</span>&#46; It is the only turbine system that allows setting a precise FiO<span class="elsevierStyleInf">2</span>&#44; with a maximum achieved by 100&#37;&#44; independent of the variations of the flow setting&#46; Originally&#44; this device was invented for CPAP therapy&#44; for this reason the flow range goes from 5 to 120<span class="elsevierStyleHsp" style=""></span>L&#47;m and at the same time&#44; the device allows an accurate monitoring of the airway pressure&#46; This wide range of flow enables the patient to perform a combined therapy with CPAP requirement &#40;flows &#62;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#41; and NHF &#40;flows &#60;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#41; during resting periods&#46; Both the nasal cannula and the tubing and humidification system are generic&#44; recommending the use of a pass over system with a heated wire circuit&#44; to avoid condensation and heat loss from the inspired air&#46; Other parameters that can be monitored&#44; apart from the airway pressure&#44; are respiratory rate&#44; SpO<span class="elsevierStyleInf">2</span>&#44; heart rate and ROX index&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Airvo 2&#174; &#40;Fisher and Paykel&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Fisher and Paykel defines this device as a &#8220;pass-over humidifier with integrated flow generator&#8221;&#46; Its internal blower delivers high flow warmed and humidified gases to patients through a heated-wired circuit and a nasal cannula or a tracheotomy interface&#46; Temperature can be set to three target dew-point settings in 31&#44; 34 or 37<span class="elsevierStyleHsp" style=""></span>&#176;C and flows can be set between 10&#8722;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#46; A flow meter up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;m of supplementary oxygen can be connected to achieve FiO<span class="elsevierStyleInf">2</span> around 90&#37;&#46; It contains an oxygen analyser to determine the oxygen fraction delivered to the patient&#44; affected by changes to the flow setting or supplemental oxygen setting&#46; The nasal prongs and tubing between the nasal prong and heated-wired inspiratory circuit are both large bore&#44; and the flow to the prongs is delivered from only one side&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Optiflow&#174; &#40;Fisher and Pykel&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">This is a fixed-performance delivery device&#44; also known as an &#8220;air-oxygen blender device&#8221;&#46; With a blending system&#44; separate pressurized air and O<span class="elsevierStyleInf">2</span> sources are input&#44; and the gases are mixed with a precision valve &#40;blender&#41;&#46; This system allows a precise control over both FiO<span class="elsevierStyleInf">2</span> and total flow output&#46; This blending system can provide flow rates from 30<span class="elsevierStyleHsp" style=""></span>L&#47;m to 60<span class="elsevierStyleHsp" style=""></span>L&#47;min and adjustable FiO<span class="elsevierStyleInf">2</span> from 21 to 100&#37;&#46; Humidification is achieved by a &#8220;pass over humidifier&#8221; connected to a heated wire circuit and a bore Nasal Cannula &#40;Optiflow nasal cannula&#41; or Trach Connection&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">TNI softFlow 50&#174; &#40;Masimo&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">This device is a &#8220;built in flow generator&#8221; which generates the flow through an internal turbine&#46; The applicator plug &#40;circuit&#41; is a silicone heated-wired circuit that enables a nasal application through a slender nasal cannula &#40;also heated-wired and made of silicone&#41; as well as a specific tracheal application&#46; The TNI softFlow can be operated with two different humidifier types&#44; but it always consists of a &#8220;pass-over system&#8221; chamber &#40;Intersurgical&#174;&#41;&#44; with 1<span class="elsevierStyleHsp" style=""></span>&#176;C steps&#44; within the range from 30 to 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; It can be used with the &#8220;Humidifier Clinic&#8221; for patients in clinics or in care facilities&#44; or with the &#8220;Humidifier Homecare&#8221; for patients at home&#46; When supplemental oxygen is required&#44; an external&#44; medically approved oxygen source can be connected to the TNI softFlow using the lateral oxygen inlet port&#46; If no oxygen supply is needed&#44; the oxygen inlet port must be kept sealed by the protective cap&#46; The minimal operational flow is 10<span class="elsevierStyleHsp" style=""></span>L&#47;m&#44; with 0&#44;5<span class="elsevierStyleHsp" style=""></span>L&#47;m steps&#44; to a maximum value of60<span class="elsevierStyleHsp" style=""></span>L&#47;m for a nasal application or 50<span class="elsevierStyleHsp" style=""></span>L&#47;m for tracheal application&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Precision Flow Vapotherm&#174;</span><p id="par0190" class="elsevierStylePara elsevierViewall">The Precision Flow has an electronic gas mixer &#40;proportional solenoid&#47;flow valve&#41; similar to that found in mechanical ventilators&#46; For this reason&#44; it requires a supply of high-pressure air and oxygen&#46; This allows the device to use FiO<span class="elsevierStyleInf">2</span> between 21 and 100&#37; regardless of the flow&#46; It uses a different humidification system from the conventional pass-over humidifiers&#44; which consists of a cartridge of steam transfer that allows no direct contact between the gas and water phases&#46; Thus&#44; gas and water are separated by a micro-porous membrane &#40;0&#46;005<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; which could represent a &#34;protective barrier&#34; for the gas flow to the patient&#46; The circuit consists of a triple lumen supply tube&#58; a central one&#44; through which the gas flow circulates&#44; surrounded by two external lumens through which hot water circulates to maintain the gas temperature &#40;at the set temperature&#41;&#46; This guarantees temperature uniformity &#40;33<span class="elsevierStyleHsp" style=""></span>&#176;C&#8211;39<span class="elsevierStyleHsp" style=""></span>&#176;C range&#41; throughout the circuit&#44; reducing the possibility of condensation&#46; The interface &#40;Hi-VNI&#44; Vapotherm&#41; is a slender nasal cannula similar in appearance to a regular nasal oxygen cannula&#46; Both the internal diameter and nasal prong bore are narrow&#44; and this results in high flow out of the nasal prongs&#46; The Precision Flow has a specially designed circuit to combine NHF with nitric oxide as well as helium-oxygen &#40;Heliox&#41; conditioned gas mixtures&#46; This device has an internal battery&#46; The battery takes 2<span class="elsevierStyleHsp" style=""></span>h to fully charge for one hour of use&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In summary&#44; NHF has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#46; It is important to know the implementation technique of this treatment&#44; as well as how to perform NHF with the different devices available in the market&#44; because they each have different characteristics&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Thermo-humidified nasal high flow &#40;NHF&#41; oxygen therapy is increasingly used in the management of respiratory failure&#46; This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#44; including acute and chronic settings&#46; NHF enhances the patient&#8217;s comfort and tolerance when compared with standard oxygen by supplying a heated and humidified mixture of air and oxygen at flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;min&#46; It can be delivered through different devices&#46; Although few studies have compared the clinical effects of different NHF systems&#44; the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice&#46; We have also included a brief description of the most frequently used NHF systems&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Airvo2 &#40;F&#38;P&#174;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Optiflow &#40;F&#38;P&#174;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TNI softFlow 50 Masimo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Precision Flow Vapotherm&#174;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \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"><elsevierMultimedia ident="202105020810301761"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301762"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301763"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301764"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301765"></elsevierMultimedia>&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">FLOW &#40;L&#47;M&#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"><span class="elsevierStyleBold">5&#8722;120 &#40;NHF AND CPAP USE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8722;60 &#40;5<span class="elsevierStyleHsp" style=""></span>L&#47;M STEPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30- 60&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">1060 &#40;0&#44;5 STEPS&#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&#8722;40 &#40;1<span class="elsevierStyleHsp" style=""></span>L&#47;M STEPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FLOW GENERATION&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">BLOWER&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">BLOWER&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">BLENDER&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">BLOWER&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">ELECTRONIC BLENDER&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">FIO<span class="elsevierStyleInf">2</span> INDEPENDENT OF SETUP FLOW&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">YES&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">NO&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">YES&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">NO&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">YES&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">POSSIBILITY OF FIO<span class="elsevierStyleInf">2</span> 100&#37;&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">YES&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">NO&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">YES&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">NO&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">YES&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">TYPE OF CONNECTION O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIGH PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span> LOW PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LOW PRESSURE O<span class="elsevierStyleInf">2</span> &#40;UP TO 30<span class="elsevierStyleHsp" style=""></span>L&#47;M&#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">HIGH PRESSURE SYSTEM AIR AND O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LOW PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span> &#40;UP TO 60<span class="elsevierStyleHsp" style=""></span>L&#47;M&#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">HIGH PRESSURE SYSTEM AIR AND O<span class="elsevierStyleInf">2</span>&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">NEED FOR COMPRESSED AIR FROM THE WALL&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">NO&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">NO&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">YES&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">NO&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">YES&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 rowgroup " rowspan="3" align="left" valign="middle">BUILT-IN HUMMIDIFIER</td><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">EXTERNAL GENERIC&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">INCORPOATED F&#38;P&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">EXTERNAL F&#38;P&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">INCORPOATED INTERSURGICAL&#174;&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">INCORPORATED&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">PASS OVER&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">PASS OVER&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">PASS OVER&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">PASS OVER&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">FILTER-TYPE&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">SYSTEM&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">SYSTEM&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">SYSTEM&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">SYSTEM&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">HUMIDIFYING SYSTEM&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">TUBES &#40;INSPIRATORY CIRCUIT&#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">GENERIC &#40;HEATED WIRED SYSTEM RECCOMENDED&#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">SPECIFIC &#40;HEATED WIRED SYSTEM&#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">GENERIC&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">SPECIFIC &#40;HEATED WIRED SYSTEM&#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">SPECIFIC TRIPLE LUMEN PATIENT CIRCUIT HEATED BY WATER RESERVOIR&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">INTERFASE&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">GENERIC&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">OPTIFLOW INTERFASE &#40;SILICONE&#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">OPTIFLOW INTERFASE&#46; &#40;SILICONE&#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">SPECIFIC&#58; &#40;SLENDER SILICONE HEATED WIRED NASAL CANNULA&#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">Hi-VNI&#44; Vapotherm&#58; &#40;SLENDER SILICONE CANNULA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " rowspan="2" align="left" valign="middle">NASAL&#58; 3 SIZES&#44; REGARDLES THE FLOW SET</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">NASAL&#58; 3 SIZES&#44; REGARDLES THE FLOW SET</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">Standard-Plus&#58; Flows up to 35<span class="elsevierStyleHsp" style=""></span>L&#47;m&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  " rowspan="3" align="left" valign="middle">TRACH MASK ADAPTER</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">&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">Large&#58; Flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;m&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">&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">TRAQUEAL INTERFASE&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">TRAQUEAL INTERFASE&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">Tracheal&#58; Flows up to 50<span class="elsevierStyleHsp" style=""></span>L&#47;m&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 rowgroup " rowspan="8" align="left" valign="middle">ON-SCREEN MONITORING</td><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">SET FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SET FIO<span class="elsevierStyleInf">2</span>&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> AIRWAY PRESSURE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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">SPO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">&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">&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></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">BPM&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">&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">&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">RR&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">&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">&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">ROX INDEX&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">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of most frequent used NHF devices&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ippolito"
                            1 => "F&#46; Vitale"
                            2 => "G&#46; Accurso"
                            3 => "P&#46; Iozzo"
                            4 => "C&#46; Gregoretti"
                            5 => "A&#46; Giarratano"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pulmoe.2020.04.009"
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Thematic series: How I do it. Serie Editor: Stefano Nava
Nasal high flow oxygen in acute respiratory failure
M.L. Vega
Corresponding author
laluvega@gmail.com

Corresponding author.
, L. Pisani
Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and ROX index trends within the first four days of treatment&#46; Patient&#8217;s SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> and ROX index improve since NHF and prone position were implemented&#46; &#40;NHF&#58; nasal high flow oxygen&#46; SP&#58; supine position&#44; PP&#58; prone position&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-year-old man with SARS-COV2 infection was admitted to our hospital on November 1st&#44; after 7 days of fever&#46; Comorbidities comprised hypertension and obesity&#46; On the third day after admission&#44; he was transferred to our Respiratory Intensive Care Unit due to worsening of his respiratory condition&#44; including notable shortness of breath with minimal exertion&#46; On arrival&#44; the patient was alert&#44; haemodynamically stable&#46; His respiratory rate was 25&#47;min with a reservoir oxygen mask at 15<span class="elsevierStyleHsp" style=""></span>L&#47;min&#46; Blood gas analysis &#40;ABG&#41; revealed a severe hypoxemia and alkalosis respiratory &#40;pH 7&#46;51&#44; PaCO<span class="elsevierStyleInf">2</span> 35<span class="elsevierStyleHsp" style=""></span>mmHg&#44; PaO<span class="elsevierStyleInf">2</span> 118<span class="elsevierStyleHsp" style=""></span>mmHg&#44; HCO<span class="elsevierStyleInf">3</span><span class="elsevierStyleSup">&#8722;</span> 27<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span> 148&#41;&#46; Due to patient&#8217;s gas exchange impairment and clinical progression&#44; NHF therapy trial was attempted&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Initial temperature&#44; inspired oxygen fraction &#40;FiO<span class="elsevierStyleInf">2</span>&#41; and flow rate were 34<span class="elsevierStyleHsp" style=""></span>&#176;C&#44; 60<span class="elsevierStyleHsp" style=""></span>L&#47;min and 60&#37; respectively&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to reduce bio-aerosol dispersion&#44; a surgical mask was placed over the patient&#8217;s mouth and nose&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows bilateral consolidations with ground-glass areas&#44; mainly in the posterior dependent zones on CT-scan&#46; Based on this radiological picture&#44; we continued NHF in awake prone positioning&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> illustrates oxygen pulse saturation&#47;FiO<span class="elsevierStyleInf">2</span> &#40;SpO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41;&#44; oxygen blood pressure&#47;FiO<span class="elsevierStyleInf">2</span> &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#41; ratios and ROX index trends within the first four days of treatment&#46; ROX index is defined as the ratio of pulse oximetry&#47;fraction of inspired oxygen to respiratory rate &#40;RR&#41;&#46; This index&#44; described by Roca et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> identifies patients at risk of NHF failure&#46; In particular&#44; a ROX index of 4&#44;88 is associated with a high risk of intubation&#46; In conclusion&#44; NHF setting was adjusted according to the maximum patient<span class="elsevierStyleBold"><span class="elsevierStyleUnderline">&#8217;</span></span>s comfort and the best effects in terms of distending pressure and FiO<span class="elsevierStyleInf">2</span> stability&#46; FiO<span class="elsevierStyleInf">2</span> was also targeted to achieve oxygen saturation between 94&#8211;96&#37;&#46; Prone positioning was implemented because we felt that the mild distension pressure generated by NHF could be enhanced by placing the ventilated areas in a dependent position&#44; leading to increased V&#47;Q mismatch&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Thermo-humidified nasal high flow &#40;NHF&#41; oxygen therapy is increasingly used in the management of respiratory failure&#46; This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#44; acute and chronic&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in order to enhance patient comfort and tolerance compared with standard oxygen by supplying heat and humidified mixture of air and oxygen at flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;minutes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">NHF can be delivered through different devices&#46; Although few studies have compared the clinical effects of different NHF systems&#44; the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice&#46; We have also included a brief description of the most frequently used NHF systems&#58; BioRespira&#174; &#40;IBD&#41;&#44; Airvo 2&#174; and OptiFlow&#174; &#40;Fisher and Paykel&#41;&#44; TNI softFlow 50&#174; &#40;Masimo&#41; and Precision Flow&#174; &#40;Vapotherm&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Physiological benefits of NHF</span><p id="par0030" class="elsevierStylePara elsevierViewall">High flows air&#47;oxygen mixture can be beneficial for both chronic and acute patients&#44; who need additional oxygen supply&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Matches patient&#8217;s inspiratory flow &#40;stable FiO<span class="elsevierStyleInf">2</span>&#41;&#46; Conventional oxygen therapy devices such as Venturi masks or reservoir masks have holes to prevent carbon dioxide rebreathing&#46; The patient inspires the delivered oxygen&#44; but part of the air can be rebreathed&#46; In addition&#44; if the patient&#8217;s ventilatory demand exceeds the flows provided by the device&#44; the patient will breathe part of atmospheric air&#46; For this reason&#44; because of the relationship with the patient-breathing pattern&#44; FiO<span class="elsevierStyleInf">2</span> can be much lower than predicted&#46; Pisani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> observed that calculated FiO<span class="elsevierStyleInf">2</span> approached the prescribed FiO<span class="elsevierStyleInf">2</span> when the delivered gas flow rates were greater than the patient&#8217;s peak inspiratory flow rate&#46; This means that&#44; with low-flow systems&#44; as the peak inspiratory demand increase&#44; we cannot accurately estimate the FiO<span class="elsevierStyleInf">2</span> that the patient is breathing&#46; NHF delivers a flow that is much higher than the patient&#8217;s spontaneous inspiratory flow in any condition&#44; so actual FiO<span class="elsevierStyleInf">2</span> is close to the predicted FiO<span class="elsevierStyleInf">2</span>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Improves lung mucociliary clearance&#46; In normal conditions&#44; inhaled air is conditioned in the nasal airways&#46; The air is warmed and humidified by the nasal mucosa because of its highly vascular sinusoid tissue&#46; Humidification is always recommended for flow rates above 4<span class="elsevierStyleHsp" style=""></span>L&#47;min&#44; because the humidification function of the nasal mucosa could be insufficient&#46; In addition&#44; unwarmed and dry gas leads to a poor tolerance of oxygen therapy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0045" class="elsevierStylePara elsevierViewall">Washes out anatomical dead space and carbon dioxide &#40;CO<span class="elsevierStyleInf">2</span>&#41;&#44; allowing a higher fraction of minute ventilation to participate in gas exchange&#46; Additionally&#44; the nasal cannula&#44; used for NHF&#44; is the only respiratory interface that does not increase the instrumental dead space&#46; With an oxygen mask&#44; especially at low flow&#44; carbon dioxide is rebreathed&#46; NIV interfaces also increase the dead space&#46; As a consequence&#44; to maintain PaCO<span class="elsevierStyleInf">2</span> &#40;and alveolar ventilation&#41;&#44; the minute volume has to increase&#44; either through respiratory rate or through tidal volume &#40;VT&#41;&#44; or even both&#46; For these reasons&#44; although NHF does not provide an active inspiratory support&#44; it may improve the alveolar ventilation and decrease respiratory rate &#40;RR&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Fraser et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> found that NHF leads to a reduction in respiratory rate of 10&#37;&#44; and in some patients&#44; this reduction was associated with a reduction in hypercapnia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Provides a mild distending pressure&#46; Although NHF is an open system&#44; high flow from the nasal cannula increases the airway pressure usually around 3<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> depending on the flow level and the nasal prong size in relation to the nostrils&#46; Richie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> conclude that NHF could deliver a clinically relevant mean positive airway pressure directly proportional to delivered gas flow rates&#46; In addition&#44; high flows could act as a resistance to exhalation when the mouth is closed&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; it remains unclear whether NHF is sufficient to increase lung volume or recruit the collapsed alveoli&#46; Evaluating end-expiratory lung volume &#40;EELV&#41;&#44; Corley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported increased end-expiratory lung impedance&#44; suggesting increasing volumes and functional residual capacity with NHF compared with low-flow oxygen therapy&#46; Also using electrical lung impedance tomography on healthy subjects in supine and prone position&#44; Riera et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> found that NHF increased global EELV&#44; suggesting an increase in functional residual capacity&#44; regardless of the body position&#46; This effect could be important in patients with a higher body mass index&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Attenuates inspiratory resistance and increases expiratory resistance&#46; The attenuation of inspiratory resistance takes place essentially by providing an adequate warmed and humidified flow&#46; It is known that in normal subjects&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> inhalation of cold air causes the activation of specific receptors or osmoreceptors in the nasal mucosa&#44; which may induce bronchoconstriction through a mechanism mediated by the activation of muscarinic receptors&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Besides&#44; NHF is able to increase the expiratory resistance depending on the size of the nasal cannula and the patient&#8217;s expiratory flow&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">A typical NHF system consists of a flow generator&#44; active heated humidifier&#44; single-limb heated circuit&#44; and nasal cannula &#40;or tracheostomy interface&#41;&#46; There are three types of flow generators&#58; air-oxygen blender devices&#44; built-in flow generators &#40;turbines&#41;&#44; and entrainment systems &#40;Venturi Systems&#41;&#46; The humidifier can be a traditional &#8220;pass-over heated humidifying system&#8221; or a &#8220;filter-type humidifying system&#8221; in which humidification is generated by passing gas through a bundle of narrow tubes&#44; or which requires an evaporative surface in contact with the gas&#46; A heated-wire inspiratory circuit is preferred to ensure delivery of adequately humidified medical gas as well as to avoid circuit vapour loss and condensation&#46; The lower the ambient temperature&#44; the more likely there is to be condensation&#46; One major reason for the patient&#8217;s discomfort or intolerance is the interface&#46; Beyond the circuit&#44; condensation may also accumulate in the nasal prongs&#44; which results in water droplet spray into the nostrils&#46; NHF interfaces are specifically for this purpose&#46; They can vary from a slender nasal cannula similar in appearance to a regular nasal oxygen cannula in which both the internal diameter and nasal prong bore are narrow&#44; to a large bore nasal prong&#46; Using slender nasal cannulas results in high flow out of the nasal prongs&#46; The volumetric flow is the volume of gas that passes in a certain unit of time&#46; The speed at which the volume moves is the velocity&#46; The speed&#44; at a constant volumetric flow&#44; varies inversely proportional to the cross-sectional area of the tube&#46; This is the reason why the smaller the cross-sectional area of the nasal cannula&#44; the greater the speed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Implementation technique</span><p id="par0205" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General considerations</span> &#40;regardless of the NHF device used&#41;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Gas connection to the device &#40;O<span class="elsevierStyleInf">2</span>&#44; and compressed air if required&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Place distilled water in the humidifier&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Connect the circuit&#44; appropriate to the system used&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Switch on and heat up the water until the temperature reaches 31&#8722;37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Select the size of the nasal cannula properly&#46; When using a large bore nasal prong&#44; it must not occlude more than 50&#37; of the nostril&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Position the cannula correctly in the patient&#8217;s nostrils&#44; to avoid lateral leakage&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Program the parameters&#44; according to the equipment used &#40;temperature&#44; flow&#44; and FiO<span class="elsevierStyleInf">2</span> if the setting is available&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Switch on the device &#40;some devices allow parameters to be programmed once the machine is on&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">b&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General monitoring</span></p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">-</span><p id="par0115" class="elsevierStylePara elsevierViewall">Patients must be spontaneously breathing&#44; alert and must be able to protect the airway&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">-</span><p id="par0120" class="elsevierStylePara elsevierViewall">Check that there is no accumulation of condensed water in the tube&#44; ensuring its inclination towards the heater&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Aspiration of patient&#8217;s secretions&#44; if needed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Check that the cannula is not occluded by a mucus plug or against the patient&#8217;s nose&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">Make sure the patient is in a semi-seated position at 45&#176;&#46; NHF can be implemented in &#8220;awake prone position&#8221;&#44; if needed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0140" class="elsevierStylePara elsevierViewall">Check that the device is not disconnected from the electrical source when using high-flow devices&#44; because not many have an internal battery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">c&#41;</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">General set up</span></p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">Temperature&#58; it must be targeted according to the patient&#8217;s comfort&#46; The temperature needs to be set at higher values at cold weathers or high flows&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Flow&#58; the maximum benefit of this treatment is achieved at higher flows&#44; although the flow should also be titrated according to the patient&#39;s comfort&#46; It is suggested starting with flows close to 50<span class="elsevierStyleHsp" style=""></span>L&#47;m&#44; according to the patient&#39;s tolerance&#44; in order to increase or decrease the flow&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#58; depending on the NHF device used&#44; FiO<span class="elsevierStyleInf">2</span> can be a parameter to be programmed or a parameter that depends on the flow&#46; By using an air-oxygen blender device&#44; oxygen concentrations are stable&#46; On the other hand&#44; by using turbine devices&#44; oxygen is supplied via a low-pressure system&#44; while the device just monitors the oxygen concentration &#40;FiO<span class="elsevierStyleInf">2</span>&#41;&#46; Any rise in the flow&#44; will decrease the FiO<span class="elsevierStyleInf">2</span>&#44; and vice versa&#46; Venturi high flow systems use a flow generator to create a high flow by Venturi&#46; It is composed of a flow meter and an oxygen concentration monitor&#46; Regardless of the system used&#44; in all cases&#44; FiO<span class="elsevierStyleInf">2</span> titration should depend on the SpO<span class="elsevierStyleInf">2</span> target&#44; recommending an SpO<span class="elsevierStyleInf">2</span> range between 94&#37; and 96&#37;&#44; or between 88&#37;&#8211;92&#37; in hypercapnic COPD patients&#46;</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">NHF devices</span><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main characteristics associated with the currently available devices&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">BioRespira&#174; &#40;IBD&#41;</span><p id="par0170" class="elsevierStylePara elsevierViewall">This innovative system is a &#8220;built-in high flow generator&#8221; with a turbine capable of generating high flows starting from the ambient air&#44; mixed with medical oxygen that can be supplied via a hospital cylinder or medical gas plant&#46; Despite being a turbine device&#44; it guarantees a fixed FiO<span class="elsevierStyleInf">2</span> even when the flow changes&#46; This control is based on an internal oxygen sensor and a valve that guarantees by opening and closing&#44; the desired FiO<span class="elsevierStyleInf">2</span>&#46; It is the only turbine system that allows setting a precise FiO<span class="elsevierStyleInf">2</span>&#44; with a maximum achieved by 100&#37;&#44; independent of the variations of the flow setting&#46; Originally&#44; this device was invented for CPAP therapy&#44; for this reason the flow range goes from 5 to 120<span class="elsevierStyleHsp" style=""></span>L&#47;m and at the same time&#44; the device allows an accurate monitoring of the airway pressure&#46; This wide range of flow enables the patient to perform a combined therapy with CPAP requirement &#40;flows &#62;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#41; and NHF &#40;flows &#60;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#41; during resting periods&#46; Both the nasal cannula and the tubing and humidification system are generic&#44; recommending the use of a pass over system with a heated wire circuit&#44; to avoid condensation and heat loss from the inspired air&#46; Other parameters that can be monitored&#44; apart from the airway pressure&#44; are respiratory rate&#44; SpO<span class="elsevierStyleInf">2</span>&#44; heart rate and ROX index&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Airvo 2&#174; &#40;Fisher and Paykel&#41;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Fisher and Paykel defines this device as a &#8220;pass-over humidifier with integrated flow generator&#8221;&#46; Its internal blower delivers high flow warmed and humidified gases to patients through a heated-wired circuit and a nasal cannula or a tracheotomy interface&#46; Temperature can be set to three target dew-point settings in 31&#44; 34 or 37<span class="elsevierStyleHsp" style=""></span>&#176;C and flows can be set between 10&#8722;60<span class="elsevierStyleHsp" style=""></span>L&#47;m&#46; A flow meter up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;m of supplementary oxygen can be connected to achieve FiO<span class="elsevierStyleInf">2</span> around 90&#37;&#46; It contains an oxygen analyser to determine the oxygen fraction delivered to the patient&#44; affected by changes to the flow setting or supplemental oxygen setting&#46; The nasal prongs and tubing between the nasal prong and heated-wired inspiratory circuit are both large bore&#44; and the flow to the prongs is delivered from only one side&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Optiflow&#174; &#40;Fisher and Pykel&#41;</span><p id="par0180" class="elsevierStylePara elsevierViewall">This is a fixed-performance delivery device&#44; also known as an &#8220;air-oxygen blender device&#8221;&#46; With a blending system&#44; separate pressurized air and O<span class="elsevierStyleInf">2</span> sources are input&#44; and the gases are mixed with a precision valve &#40;blender&#41;&#46; This system allows a precise control over both FiO<span class="elsevierStyleInf">2</span> and total flow output&#46; This blending system can provide flow rates from 30<span class="elsevierStyleHsp" style=""></span>L&#47;m to 60<span class="elsevierStyleHsp" style=""></span>L&#47;min and adjustable FiO<span class="elsevierStyleInf">2</span> from 21 to 100&#37;&#46; Humidification is achieved by a &#8220;pass over humidifier&#8221; connected to a heated wire circuit and a bore Nasal Cannula &#40;Optiflow nasal cannula&#41; or Trach Connection&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">TNI softFlow 50&#174; &#40;Masimo&#41;</span><p id="par0185" class="elsevierStylePara elsevierViewall">This device is a &#8220;built in flow generator&#8221; which generates the flow through an internal turbine&#46; The applicator plug &#40;circuit&#41; is a silicone heated-wired circuit that enables a nasal application through a slender nasal cannula &#40;also heated-wired and made of silicone&#41; as well as a specific tracheal application&#46; The TNI softFlow can be operated with two different humidifier types&#44; but it always consists of a &#8220;pass-over system&#8221; chamber &#40;Intersurgical&#174;&#41;&#44; with 1<span class="elsevierStyleHsp" style=""></span>&#176;C steps&#44; within the range from 30 to 37<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; It can be used with the &#8220;Humidifier Clinic&#8221; for patients in clinics or in care facilities&#44; or with the &#8220;Humidifier Homecare&#8221; for patients at home&#46; When supplemental oxygen is required&#44; an external&#44; medically approved oxygen source can be connected to the TNI softFlow using the lateral oxygen inlet port&#46; If no oxygen supply is needed&#44; the oxygen inlet port must be kept sealed by the protective cap&#46; The minimal operational flow is 10<span class="elsevierStyleHsp" style=""></span>L&#47;m&#44; with 0&#44;5<span class="elsevierStyleHsp" style=""></span>L&#47;m steps&#44; to a maximum value of60<span class="elsevierStyleHsp" style=""></span>L&#47;m for a nasal application or 50<span class="elsevierStyleHsp" style=""></span>L&#47;m for tracheal application&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Precision Flow Vapotherm&#174;</span><p id="par0190" class="elsevierStylePara elsevierViewall">The Precision Flow has an electronic gas mixer &#40;proportional solenoid&#47;flow valve&#41; similar to that found in mechanical ventilators&#46; For this reason&#44; it requires a supply of high-pressure air and oxygen&#46; This allows the device to use FiO<span class="elsevierStyleInf">2</span> between 21 and 100&#37; regardless of the flow&#46; It uses a different humidification system from the conventional pass-over humidifiers&#44; which consists of a cartridge of steam transfer that allows no direct contact between the gas and water phases&#46; Thus&#44; gas and water are separated by a micro-porous membrane &#40;0&#46;005<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; which could represent a &#34;protective barrier&#34; for the gas flow to the patient&#46; The circuit consists of a triple lumen supply tube&#58; a central one&#44; through which the gas flow circulates&#44; surrounded by two external lumens through which hot water circulates to maintain the gas temperature &#40;at the set temperature&#41;&#46; This guarantees temperature uniformity &#40;33<span class="elsevierStyleHsp" style=""></span>&#176;C&#8211;39<span class="elsevierStyleHsp" style=""></span>&#176;C range&#41; throughout the circuit&#44; reducing the possibility of condensation&#46; The interface &#40;Hi-VNI&#44; Vapotherm&#41; is a slender nasal cannula similar in appearance to a regular nasal oxygen cannula&#46; Both the internal diameter and nasal prong bore are narrow&#44; and this results in high flow out of the nasal prongs&#46; The Precision Flow has a specially designed circuit to combine NHF with nitric oxide as well as helium-oxygen &#40;Heliox&#41; conditioned gas mixtures&#46; This device has an internal battery&#46; The battery takes 2<span class="elsevierStyleHsp" style=""></span>h to fully charge for one hour of use&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In summary&#44; NHF has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#46; It is important to know the implementation technique of this treatment&#44; as well as how to perform NHF with the different devices available in the market&#44; because they each have different characteristics&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper&#46;</p></span></span>"
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              "titulo" => "Optiflow&#174; &#40;Fisher and Pykel&#41;"
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              "titulo" => "TNI softFlow 50&#174; &#40;Masimo&#41;"
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            1 => "HFO"
            2 => "Nasal high flow"
            3 => "NHF"
            4 => "High flow nasal cannula"
            5 => "HFNC"
            6 => "Acute respiratory failure"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Thermo-humidified nasal high flow &#40;NHF&#41; oxygen therapy is increasingly used in the management of respiratory failure&#46; This therapy has recently gained attention as an alternative non-invasive respiratory support in several clinical scenarios&#44; including acute and chronic settings&#46; NHF enhances the patient&#8217;s comfort and tolerance when compared with standard oxygen by supplying a heated and humidified mixture of air and oxygen at flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;min&#46; It can be delivered through different devices&#46; Although few studies have compared the clinical effects of different NHF systems&#44; the purpose of this paper is to describe the major benefits of NHF and to provide a quick guide on how to implement this therapy in daily practice&#46; We have also included a brief description of the most frequently used NHF systems&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT-scan&#46; Bilateral consolidations with ground-glass areas&#44; mainly in the posterior dependent zones&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Precision Flow Vapotherm&#174;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \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"><elsevierMultimedia ident="202105020810301761"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301762"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301763"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301764"></elsevierMultimedia>&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"><elsevierMultimedia ident="202105020810301765"></elsevierMultimedia>&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">FLOW &#40;L&#47;M&#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"><span class="elsevierStyleBold">5&#8722;120 &#40;NHF AND CPAP USE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#8722;60 &#40;5<span class="elsevierStyleHsp" style=""></span>L&#47;M STEPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30- 60&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">1060 &#40;0&#44;5 STEPS&#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&#8722;40 &#40;1<span class="elsevierStyleHsp" style=""></span>L&#47;M STEPS&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FLOW GENERATION&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">BLOWER&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">BLOWER&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">BLENDER&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">BLOWER&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">ELECTRONIC BLENDER&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">FIO<span class="elsevierStyleInf">2</span> INDEPENDENT OF SETUP FLOW&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">YES&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">NO&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">YES&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">NO&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">YES&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">POSSIBILITY OF FIO<span class="elsevierStyleInf">2</span> 100&#37;&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">YES&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">NO&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">YES&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">NO&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">YES&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">TYPE OF CONNECTION O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIGH PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span> LOW PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LOW PRESSURE O<span class="elsevierStyleInf">2</span> &#40;UP TO 30<span class="elsevierStyleHsp" style=""></span>L&#47;M&#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">HIGH PRESSURE SYSTEM AIR AND O<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LOW PRESSURE SYSTEM O<span class="elsevierStyleInf">2</span> &#40;UP TO 60<span class="elsevierStyleHsp" style=""></span>L&#47;M&#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">HIGH PRESSURE SYSTEM AIR AND O<span class="elsevierStyleInf">2</span>&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">NEED FOR COMPRESSED AIR FROM THE WALL&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">NO&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">NO&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">YES&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">NO&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">YES&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 rowgroup " rowspan="3" align="left" valign="middle">BUILT-IN HUMMIDIFIER</td><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">EXTERNAL GENERIC&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">INCORPOATED F&#38;P&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">EXTERNAL F&#38;P&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">INCORPOATED INTERSURGICAL&#174;&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">INCORPORATED&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">PASS OVER&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">PASS OVER&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">PASS OVER&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">PASS OVER&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">FILTER-TYPE&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">SYSTEM&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">SYSTEM&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">SYSTEM&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">SYSTEM&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">HUMIDIFYING SYSTEM&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">TUBES &#40;INSPIRATORY CIRCUIT&#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">GENERIC &#40;HEATED WIRED SYSTEM RECCOMENDED&#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">SPECIFIC &#40;HEATED WIRED SYSTEM&#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">GENERIC&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">SPECIFIC &#40;HEATED WIRED SYSTEM&#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">SPECIFIC TRIPLE LUMEN PATIENT CIRCUIT HEATED BY WATER RESERVOIR&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">INTERFASE&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">GENERIC&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">OPTIFLOW INTERFASE &#40;SILICONE&#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">OPTIFLOW INTERFASE&#46; &#40;SILICONE&#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">SPECIFIC&#58; &#40;SLENDER SILICONE HEATED WIRED NASAL CANNULA&#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">Hi-VNI&#44; Vapotherm&#58; &#40;SLENDER SILICONE CANNULA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " rowspan="2" align="left" valign="middle">NASAL&#58; 3 SIZES&#44; REGARDLES THE FLOW SET</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">NASAL&#58; 3 SIZES&#44; REGARDLES THE FLOW SET</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">Standard-Plus&#58; Flows up to 35<span class="elsevierStyleHsp" style=""></span>L&#47;m&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  " rowspan="3" align="left" valign="middle">TRACH MASK ADAPTER</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">&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">Large&#58; Flows up to 60<span class="elsevierStyleHsp" style=""></span>L&#47;m&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">&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">TRAQUEAL INTERFASE&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">TRAQUEAL INTERFASE&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">Tracheal&#58; Flows up to 50<span class="elsevierStyleHsp" style=""></span>L&#47;m&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 rowgroup " rowspan="8" align="left" valign="middle">ON-SCREEN MONITORING</td><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">SET FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEASURED FIO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SET FIO<span class="elsevierStyleInf">2</span>&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">SET FLOW&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">&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&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">SET GAS TEMPERATURE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> AIRWAY PRESSURE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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"><span class="elsevierStyleBold"><span class="elsevierStyleUnderline">CONTINUOUS MONITORING OF PATIENT&#8217;S PARAMETERS&#58;</span></span> NO&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">SPO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">&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">&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></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">BPM&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">&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">&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">RR&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">&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">&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">ROX INDEX&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">&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2586802.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Main characteristics of most frequent used NHF devices&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Ippolito"
                            1 => "F&#46; Vitale"
                            2 => "G&#46; Accurso"
                            3 => "P&#46; Iozzo"
                            4 => "C&#46; Gregoretti"
                            5 => "A&#46; Giarratano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pulmoe.2020.04.009"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pulmonology&#46;"
                        "fecha" => "2020"
                        "volumen" => "26"
                        "numero" => "July&#8211;August &#40;4&#41;"
                        "paginaInicial" => "204"
                        "paginaFinal" => "212"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32362505"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure&#58; the utility of the ROX index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Roca"
                            1 => "J&#46; Messika"
                            2 => "B&#46; Caralt"
                            3 => "M&#46; Garc&#237;a-de-Acilu"
                            4 => "B&#46; Sztrymf"
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Pulmonology

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