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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Introduction</span><p id="para0005" class="elsevierStylePara elsevierViewall">Unsafe ventilator settings affect outcomes in critically ill patients with or without preexisting lung damage&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Two worldwide observational studies of ventilation management in intensive care units &#40;ICUs&#41;&#44; one in patients with acute respiratory distress syndrome &#40;ARDS&#41;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> and one in patients at risk for ARDS&#44;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> showed that a substantial proportion of patients does not receive lung&#8211;protective ventilation&#46; One worldwide observational study of ventilation management in the operating room &#40;OR&#41;&#44; showed a comparable underuse of lung&#8211;protective ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">Postoperative pulmonary complications &#40;PPC&#41;&#44; like ARDS&#44; pneumothorax&#44; pneumonia and escalation of ventilatory support are associated with postoperative outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Use of intraoperative protective ventilation has the potential to prevent these complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0006"><span class="elsevierStyleSup">6&#8211;8</span></a> Protective ventilation at least includes the use of a low V<span class="elsevierStyleInf">T</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> and a low driving pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> The role of PEEP is much less certain&#44; but changes in PEEP that result in a lower driving pressure may reduce postoperative pulmonary complications&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> There is much less information on the effects of postoperative protective ventilation on outcomes&#46; In cardiac surgery patients&#44; postoperative ventilation with a low V<span class="elsevierStyleInf">T</span> has an association with less organ dysfunctions and a shorter intensive care unit &#40;ICU&#41; length of stay&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> In hypoxemic cardiac surgery patients&#44; postoperative ventilation with higher positive end&#8211;expiratory pressure &#40;PEEP&#41; reduces the severity of postoperative complications and shortens ICU and hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">It is uncertain whether postoperative ventilation management as provided in the ICU&#44; has associations with outcome alike intraoperative ventilation in the operating room has with the occurrence of postoperative pulmonary complications&#46; We performed a substudy of the LAS VEGAS trial<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> in which we tested the hypotheses that postoperative ventilation in the ICU differs from that in the operating room&#44; and that postoperative ventilation settings have associations with postoperative outcomes&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Study design and ethical concerns</span><p id="para0008" class="elsevierStylePara elsevierViewall">This was a substudy of the LAS VEGAS study&#44;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> the protocol of the study was first approved by the appropriate Institutional Review Board &#40;IRB&#41; of the Amsterdam University Medical Centers&#44; location &#8216;Academic Medical Center&#8217; in Amsterdam&#44; The Netherlands &#40;W12&#95;190&#35;12&#46;17&#46;0227&#41;&#46; The protocol of this substudy was not prepublished&#44; but previously announced&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> This substudy ran in centers that expressed interest in this part of the protocol&#44; and only if it was possible to collect granular ICU data&#46; The results of the substudy have not been reported before&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">Each site was requested to seek approval to implement the study protocol from their respective institutional review boards&#46; If required&#44; written informed consent was obtained from patients&#46; The parent study was registered at clinicaltrials&#46;gov &#40;study identifier NCT01601223&#41;&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Participants</span><p id="para0010" class="elsevierStylePara elsevierViewall">The LAS VEGAS study included adult patients receiving invasive ventilation via either an endotracheal tube or supraglottic device during general anesthesia for elective or non&#8211;elective surgery&#46; Patients were excluded if aged less than 18 years of age&#44; or scheduled for pregnancy&#8211;related surgery&#46; Additional exclusion criteria of the current analysis were mechanical ventilation in the week before index surgery&#44; surgery involving intrathoracic procedures &#40;i&#46;e&#46;&#44; cardiac or lung surgery&#41;&#44; and procedures requiring intraoperative one&#8211;lung ventilation&#46; Procedures outside the operating room and patients who required cardiopulmonary bypass were also excluded&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">Patients were eligible for participation in this substudy if they were admitted at the ICU directly after surgery&#8211;&#8211;whether planned or unplanned&#46; Patients admitted to an ICU at a later time point&#44; i&#46;e&#46;&#44; if first transferred to the ward and then admitted at the ICU&#44; were also not included&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Data collection</span><p id="para0012" class="elsevierStylePara elsevierViewall">The data collected in the LAS VEGAS study included patient baseline characteristics&#44; and the preoperative risk factors for PPC included in the &#8216;Assess Respiratory Risk in Surgical Patients in Catalonia risk score&#8217; &#40;ARISCAT risk score&#41; for PPC&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> During the intraoperative period&#44; ventilation settings were collected hourly&#44; including V<span class="elsevierStyleInf">T</span>&#44; PEEP&#44; plateau pressure &#40;Pplat&#41;&#44; respiratory rate &#40;RR&#41; and fraction of oxygen in inspired air &#40;FiO<span class="elsevierStyleInf">2</span>&#41;&#46; During the postoperative period&#44; the highest and lowest daily value of these ventilation variables&#46; In addition&#44; occurrence of PPC was scored up to postoperative day 5&#44; or up to ICU&#8211;discharge&#44; whichever occurred first&#46; Life status was collected up to day 28&#44; or up to hospital&#8211;discharge&#44; whichever occurred first&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Outcomes</span><p id="para0013" class="elsevierStylePara elsevierViewall">The coprimary endpoints were V<span class="elsevierStyleInf">T</span> and PEEP during intraoperative and postoperative ventilation&#46; Secondary endpoints were the proportion of patients receiving low V<span class="elsevierStyleInf">T</span> ventilation &#40;LTVV&#41; in the OR and in the ICU&#44; and other ventilation variables like Pplat&#44; RR and FiO<span class="elsevierStyleInf">2</span>&#44; occurrence of PPC&#44; and ICU and hospital length of stay &#40;LOS&#41; and day&#8211;28 in&#8211;hospital mortality&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Definitions</span><p id="para0014" class="elsevierStylePara elsevierViewall">Low V<span class="elsevierStyleInf">T</span> ventilation &#40;LTVV&#41; was defined as ventilation with a median V<span class="elsevierStyleInf">T</span> &#8804; 8 ml&#47;kg PBW&#59; ARDS was defined according to the Berlin definition for ARDS&#59;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> pneumothorax was scored if it was seen on clinically indicated chest X&#8211;ray&#59; pneumonia was diagnosed if a new or progressive infiltrate was seen on a postoperative chest X&#8211;ray&#44; and if at least two of the following three following features were present&#8212;fever &#40;&#62; 38&#46;0&#176;C&#41;&#44; leukocytosis or leukopenia &#40;white blood cell count &#62; 12&#160;&#215;&#160;10<span class="elsevierStyleSup">9</span>&#47;ml or &#60; 4&#160;&#215;&#160;10<span class="elsevierStyleSup">9</span>&#47;ml&#41; and purulent secretions&#46; Escalation of ventilatory support was defined as any increase in ventilatory support on a subsequent day&#8212;from &#8216;simple oxygen administration&#8217; &#40;i&#46;e&#46;&#44; through a nasal prong&#44; or non&#8211;rebreather mask&#41; to &#8216;continuous positive airway pressure&#8217; &#40;CPAP&#41;&#44; to &#8216;noninvasive ventilation&#8217; &#40;NIV&#41; or to &#8216;invasive ventilation&#8217;&#46; For example&#44; escalation of ventilation was scored when a patient was on CPAP on day 1&#44; but needed NIV on day 2&#44; and also if a patient received NIV on day 1&#44; but needed &#8216;invasive ventilation&#8217; on day 2&#44; etc&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Analysis plan</span><p id="para0015" class="elsevierStylePara elsevierViewall">Descriptive statistics are used to study patient characteristics&#44; ventilation parameters and outcomes&#46; Continuous variables are compared using the Wilcoxon Rank&#8211;Sum Test or the Wilcoxon signed&#8211;rank test&#44; where appropriate&#59; proportions are compared using the chi&#8211;squared test or Fisher exact test&#46; Effects are shown as the average odds ratio with its 95&#37; confidence interval &#40;95&#37; CI&#41;&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">V<span class="elsevierStyleInf">T</span> is reported in absolute volume as well as normalized for PBW&#46; PBW was calculated as 50&#160;&#43;&#160;0&#46;91 x &#40;centimeters of height &#8211; 152&#46;4&#41; for males and 45&#46;5&#160;&#43;&#160;0&#46;91 x &#40;centimeters of height &#8211; 152&#46;4&#41; for females&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">To compare intraoperative with postoperative ventilation&#44; distribution plots are constructed for V<span class="elsevierStyleInf">T</span>&#44; PEEP&#44; Pplat and RR&#46; These plots used cutoffs that represent widely accepted values of each parameter and are used in most daily practices&#59; V<span class="elsevierStyleInf">T</span> size of 8 ml&#47;kg PBW&#44; RR of 15 breaths per minute&#44; PEEP of 5 cm H<span class="elsevierStyleInf">2</span>O and 25 cm H<span class="elsevierStyleInf">2</span>O for Pplat to form the matrices&#46; For FiO<span class="elsevierStyleInf">2</span> a cutoff of 40&#37; was used&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">Nearly all PPC needed a chest X&#8211;ray for confirmation&#59; if a X&#8211;ray was not obtained&#44; ARDS&#44; pneumothorax and pneumonia was deemed not present&#46; In one posthoc analysis&#44; patients with a planned postoperative ICU admission are compared to patients with an unplanned admission&#46; Kaplan&#8211;Meier graphs are used to compare occurrence of PPC&#44; LOS and mortality in ICU and hospital&#46;</p><p id="para0019" class="elsevierStylePara elsevierViewall">All analyses were performed with R version 3&#46;1 &#40;<a href="http://www">http&#58;&#47;&#47;www</a>&#46; R-project&#46;org&#47;&#41;&#46; A <span class="elsevierStyleItalic">P</span> value &#60; 0&#46;05 was considered significant&#46;</p></span></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Participating centers and patients</span><p id="para0020" class="elsevierStylePara elsevierViewall">Among the 146 sites that participated in the LAS VEGAS study&#44; 117 &#40;80&#37;&#41; took part in this substudy in the ICU&#46; The hospital characteristics of sites that did and did not participate are presented in <span class="elsevierStyleBold">eTable 1</span>&#46; Participating hospitals were more often teaching hospitals&#44; with a higher number of ICU beds and hospital beds&#46; Patient flow is presented in <a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#46; Of 9&#44;185 patients undergoing surgery in hospitals participating in this substudy&#44; 1&#44;042 were admitted to an ICU&#8211;&#8211;0&#46;3 patients per ICU bed over a 1&#8211;week period&#46; After exclusion of patients with invasive ventilation before surgery&#44; ICU admission not immediately following the surgical procedure&#44; and patients who underwent thoracic surgery&#44; we were left with 653 fully analyzable patients&#8211;&#8211;494 patients &#40;76&#37;&#41; with a planned ICU admission&#44; and 274 patients &#40;42&#37;&#41; who continued with invasive ventilation in the ICU&#46; Baseline characteristics of patients are presented in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Primary outcome</span><p id="para0021" class="elsevierStylePara elsevierViewall">Ventilation management is presented in <a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#46; Median duration of postoperative invasive ventilation was 3 &#91;2&#8211;7&#93; hours&#59; median duration of controlled ventilation was 1 &#91;0&#8211;4&#93; hours&#44; after which patients continued with assisted ventilation until tracheal extubation&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">Median V<span class="elsevierStyleInf">T</span> in the ICU was 8&#46;4 &#91;7&#46;3&#8211;9&#46;8&#93; ml&#47;kg PBW and PEEP was 5 &#91;5&#8211;5&#93; cm H<span class="elsevierStyleInf">2</span>O&#44; statistically significant but not meaningfully different from V<span class="elsevierStyleInf">T</span> &#40;8&#46;1 &#91;7&#46;3&#8211;8&#46;9&#93; ml&#47;kg PBW&#59; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;001&#41; and PEEP in the OR &#40;4 &#91;2&#8211;5&#93; cm H<span class="elsevierStyleInf">2</span>O&#59; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;001&#41;&#46; The proportion of patients receiving LTVV in the ICU was 47&#37;&#44; similar to that in the OR &#40;41&#37;&#59; <span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;13&#41;&#46; The proportion of patients receiving a median V<span class="elsevierStyleInf">T</span> &#62; 10 ml&#47;kg PBW was 21&#37;&#44; higher than that in the OR &#40;10&#37;&#44; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;001&#41;&#46; The proportion of patients with median PEEP &#62; 5 cm H<span class="elsevierStyleInf">2</span>O in the ICU was 23&#37;&#44; higher than that in the OR &#40;14&#37; &#60; 0&#46;001&#41;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Secondary outcomes</span><p id="para0023" class="elsevierStylePara elsevierViewall">Occurrence of PPC was 10&#37;&#46; Six patients &#40;1&#37;&#41; developed ARDS&#44; 13 patients &#40;2&#37;&#41; were diagnosed with a pneumothorax&#44; and 20 patients &#40;3&#37;&#41; developed pneumonia&#46; The most frequent PPC was escalation of ventilatory support&#8211;&#8211;of 39 patients &#40;6&#37; of total&#41; who developed this PPC&#44; 33 &#40;85&#37;&#41; needed a step up to invasive ventilation &#40;<a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">In patients who developed one or more PPCs median length of stay in the ICU and hospital was 3 &#91;1&#8211;5&#93; days and 9 &#91;6&#8211;18&#93; days&#44; compared to 1 &#91;1&#8211;2&#93; days and 8 &#91;5&#8211;13&#93; days in patients who did not develop any PPC &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#62;0&#46;01 and <span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;0&#46;09&#41;&#46; Hospital mortality was 24 and 4&#37; &#40;<span class="elsevierStyleItalic">P &#61;</span> &#60;0&#46;001&#41; in patients who did develop one or more PPCs versus patients who did not develop any PPC&#46; Kaplan&#8211;Meier curves are presented in <a class="elsevierStyleCrossRef" href="#fig0003">Fig&#46; 3</a>&#46; Length of ICU and hospital stay was shorter for patients who did not develop any PPC&#46; When comparing the composite outcome of PPC patients who developed ARDS&#44; pneumothorax or pneumonia to patients who needed escalation of ventilation&#44; patients with a PPC were discharged earlier from the ICU&#46; Of note&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#44; patients who developed ARDS or pneumothorax spent the longest time in the hospital&#46; Mortality at day 28 was highest for patients who developed ARDS&#44; and higher for patients who needed escalation of ventilation&#44; compared to patients who developed pneumothorax or pneumonia and lowest for patients with no PPC&#46;</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Posthoc analysis</span><p id="para0025" class="elsevierStylePara elsevierViewall">Median length of stay in the ICU and hospital was 1 &#91;1&#8211;2&#93; days and 7 &#91;5&#8211;9&#93; days&#44; not different between planned and unplanned ICU admissions&#46; Mortality was 6 and 3&#37; &#40;<span class="elsevierStyleItalic">P &#61;</span> 0&#46;25&#41;&#44; for planned and unplanned ICU admissions&#46;</p></span></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Discussion</span><p id="para0026" class="elsevierStylePara elsevierViewall">The findings of this substudy of a worldwide international 1&#8211;week observational study in non&#8211;thoracic surgery patients can be summarized as follows&#58; &#40;1&#41; approximately 10&#37; of patients is admitted to ICU after surgery&#44; &#40;2&#41; but less than a third of these patients receive postoperative ventilation&#59; and &#40;3&#41; duration of postoperative ventilation in the ICU is short&#46; In addition&#44; &#40;4&#41; postoperative ventilation management mirrors management of intraoperative ventilation with regard to V<span class="elsevierStyleInf">T</span> and PEEP settings&#59; &#40;5&#41; one in every ten patients develops a PPC&#44; not different in planned and unplanned admissions&#44; and &#40;6&#41; development of a PPC is associated with mortality&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">Strengths of this study are its prospective data collection and sample size&#59; this was the largest prospective cohort to date describing postoperative ventilation in non&#8211;thoracic surgery patients&#46; This is also the first study comparing intraoperative to postoperative ventilation&#44; and reporting the occurrence of PPCs after surgery in patients who need postoperative care in an ICU&#46; We included a yet non&#8211;standard pulmonary complication&#44; named &#8216;escalation of ventilation&#8217;&#46; This complication has been proposed before&#44; as it represents respiratory failure other than that caused by ARDS&#44; pneumonia of pneumothorax&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> We believe this is a strength as it shows a group of patients with worse outcome that would otherwise not have been captured&#46; The short inclusion window of one week for the LAS VEGAS study decreases the influence of changes in care over time&#46; The international&#44; multicenter character of this study likely makes the findings generalizable&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Three large prospective observational studies have showed that there is room for improvement in invasive ventilation practice&#44; in ICU patients with ARDS&#44;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> in ICU patients at risk for ARDS&#44;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> and in patients receiving intraoperative ventilation during general anesthesia for surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> The same is true for acutely ill patients receiving invasive ventilation before admission to a hospital&#44; and in the emergency room&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> The findings of the current study are in line with the findings of those studies&#46; Indeed&#44; a large proportion of patients did not receive postoperative LTVV&#46; Our findings are important&#44; as a substantial number of patients need postoperative ventilation in the ICU&#46; At a global scale&#44; this means that improvements in this practice can have enormous effects&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">PEEP during ventilation in the ICU was largely the same as during intraoperative ventilation&#44; and PEEP was low in both settings&#46; This may seem in line with recent findings that suggest that most benefit comes from V<span class="elsevierStyleInf">T</span> limitation&#44; and absence of benefit of high PEEP when a low V<span class="elsevierStyleInf">T</span> is used&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> Ventilation with high PEEP also increases the risk for hypotension&#44; thus may increase the need for vasopressors&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> The finding that practice of postoperative ventilation mirrors intraoperative ventilation may suggest that caregivers probably do not change ventilator settings when a patient arrives at the ICU after surgery&#46; A rise in PEEP may only be beneficial in patients who present with postoperative hypoxemia&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a></p><p id="para0030" class="elsevierStylePara elsevierViewall">PPCs are common and strongly associated with poor outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> The proportion of patients developing PPCs in the parent LAS VEGAS study<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> and the current substudy are notably different &#40;2&#46;8 <span class="elsevierStyleItalic">vs</span> 10&#46;4&#37;&#41;&#46; Compared to the general postoperative population&#44; patients who are transferred directly from the OR to the ICU usually have more comorbidities&#44; and this is indeed reflected by higher ARISCAT risk scores &#40;47 &#91;40&#8211;57&#93; in the current cohort versus 15 &#91;3&#8211;26&#93; in the full LAS VEGAS study cohort&#41;&#46; Higher ARISCAT scores are associated with more frequent development of PPC and worse outcomes&#44;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> which is affirmed by the current findings&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">This study has limitations&#46; Compared to the large number of patients in the parent study&#44; the number of patients in this substudy was small as we had only access to ventilation data in the ICU of 274 patients&#44; representing 2&#44;6&#37; of the number of patients in the parent study &#40;10&#44;520 patients&#41;&#46; Assuming that the incidence of postoperative ventilation in the ICU in the current cohort is representative for the overall cohort&#44; there could still be reporting bias due to the fact that participation in this substudy was voluntary&#44; and participation could have been rejected because of other reasons than a lack of time or access to the data&#46; This limits the generalizability&#46; Selection bias may have been introduced by two factors&#46; First&#44; a number of hospitals that participated in the parent study did not take part in this substudy&#46; Second&#44; patients with a delayed admission to the ICU&#44; i&#46;e&#46;&#44; patients that went to the normal ward after surgery and then were admitted to the ICU for escalation of care&#44; were excluded from this study&#46; Thus&#44; the findings of this analysis may not be generalizable&#46; However&#44; the latter may also explain why the proportion of patients developing PPC was lower than what would have been expected based on the ARISCAT score&#44; as these patients may need escalation of care after having stayed in the normal ward&#46; Nevertheless&#44; the incidence of PPC was relatively high in comparison to the parent trial&#46; Another important limitation is that duration of ventilation seems relatively short&#44; i&#46;e&#46;&#44; median 3 &#91;2&#8211;7&#93; hours&#44; but this is not surprising for this category of patients&#8211;&#8211;in the majority of patients it was simple postoperative ventilation&#46; Also&#44; most patients were under controlled ventilation at the moment of collection of ventilation data&#46; Due to the study design&#44; we were not able to define whether or not a patient was having spontaneous breathing activity&#44; and it could also be that some patients were at a spontaneous ventilation mode at the latest time point ventilation data were captured&#46; In addition&#44; due to the short duration of ventilation in the ICU&#44; biologically plausible relationships could be harder to determine&#46; Nevertheless&#44; the current findings are in line with what has been described over recent years&#46; For instance&#44; duration of ventilation in the ICU was longer than ventilation in the operating room in these patients&#44; and clear associations have been found between intraoperative ventilation settings and postoperative complications&#46; Lastly&#44; using a relatively new and yet unstudied variable&#44; &#8216;escalation of ventilatory support&#8217;&#44; introduces uncertainty&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Conclusions</span><p id="para0032" class="elsevierStylePara elsevierViewall">Non&#8211;thoracic surgery patients seldom need postoperative ICU admission and among those who do&#44; less than half require postoperative ventilation&#46; Intraoperative and postoperative mechanical ventilation settings are comparable&#44; but there is room for improved use of LTVV&#46; PPCs develop as frequent in planned as in unplanned admission&#44; and their occurrence impacts outcome&#46;</p></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Assistance with the article</span><p id="para0033" class="elsevierStylePara elsevierViewall">The members of the Steering Committee of the &#8216;Local ASsessment of VEntilatory management during General Anesthesia for Surgery study&#8217; &#40;LAS VEGAS&#41; designed and overviewed conduct of the parent study&#44; and all substudies&#46; LAS VEGAS collaborators for the ICU substudy of LAS VEGAS&#44; consisting of National &#8211; and Local Investigators&#44; collected the data&#46; Sabrine N&#46; Hemmes was the overall LAS VEGAS coordinator&#46; The substudy was proposed by Sharon Einav&#44; Sabrine N&#46; Hemmes and Marcus J&#46; Schultz&#44; and lead by Fabienne D&#46; Simonis and Sharon Einav&#46;</p></span><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0024">Members of the LAS VEGAS steering committee</span><p id="para0034" class="elsevierStylePara elsevierViewall">Sabrine N&#46;T&#46; Hemmes &#40;Academic Medical Center&#44; University of Amsterdam&#44; Amsterdam&#44; Netherlands&#41;&#59; Ary Serpa Neto &#40;Hospital Israelita Albert Einstein&#44; S&#227;o Paulo&#44; Brazil&#41;&#59; Marcelo Gama de Abreu &#40;University Hospital Dresden&#44; Technical University Dresden&#44; Dresden&#44; Germany&#41;&#59; Paolo Pelosi &#40;IRCCS AOU San Martino IST Hospital&#44; University of Genoa&#44; Genoa&#44; Italy&#41;&#59; and Marcus J Schultz &#40;Academic Medical Center&#44; University of Amsterdam&#44; Amsterdam&#44; Netherlands &#38; Mahidol University&#44; Bangkok&#44; Thailand&#41;</p></span><span id="sec0018" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0025">The LAS VEGAS network collaborators</span><p id="para0035" class="elsevierStylePara elsevierViewall">Collaborators are listed in the Supplemental digital content &#40;pp&#46; 9&#8211;18&#41;&#46;</p></span><span id="sec0019" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0026">Funding</span><p id="para0036" class="elsevierStylePara elsevierViewall">The LAS VEGAS study was endorsed&#44; and funded in part by the European Society of Anaesthesiology</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0027">Author contributions</span><p id="para0037" class="elsevierStylePara elsevierViewall">Conception and design&#58; Sabrine N&#46; Hemmes&#44; Marcus J&#46; Schultz&#44; Marcelo Gama de Abreu&#44; Paolo Pelosi&#59; Administrative support&#58; Sabrine N&#46; Hemmes&#59; Provision of study materials or patients&#58; Sabrine N&#46; Hemmes&#44; Marcus J&#46; Schultz&#59; Collection and assembly of data&#58; Sabrine N&#46; Hemmes&#59; Marcelo Gama de Abreu&#59; Paolo Pelosi&#59; and Marcus J&#46; Schultz&#59; Data analysis and interpretation&#58; Fabienne D&#46; Simonis&#44; Ary Serpa Neto and Marcus J&#46; Schultz&#59; Manuscript writing&#58; Fabienne D&#46; Simonis and Sharon Einav&#44; supported by all other authors&#59; Final approval of manuscript&#58; All authors</p></span><span id="sec0021" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0028">LAS VEGAS Writing committee &#38; study collaborators</span><p id="para0038" class="elsevierStylePara elsevierViewall">The LAS VEGAS Steering Committee members &#38; Writing Committee members are listed in the acknowledgements section&#46; Collaborators are listed in the Supplemental Digital Content &#40;pp&#46; 9-18&#41;</p></span><span id="sec0022" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0029">Trial registration</span><p id="para0039" class="elsevierStylePara elsevierViewall">Clinicaltrials&#46;gov &#40;study identifier NCT01601223&#41;</p></span></span>"
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          "titulo" => "LAS VEGAS Writing committee &#38; study collaborators"
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        14 => array:2 [
          "identificador" => "sec0022"
          "titulo" => "Trial registration"
        ]
        15 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-03-07"
    "fechaAceptado" => "2021-10-26"
    "PalabrasClave" => array:1 [
      "en" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1484352"
          "palabras" => array:6 [
            0 => "Intraoperative ventilation"
            1 => "Postoperative ventilation"
            2 => "Tidal volume"
            3 => "Positive end&#8211;expiratory pressure"
            4 => "Postoperative pulmonary complications"
            5 => "PPC"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1484351"
          "palabras" => array:15 [
            0 => "ARDS"
            1 => "ARISCAT"
            2 => "CPAP"
            3 => "FiO<span class="elsevierStyleInf">2</span>"
            4 => "ICU"
            5 => "IRB"
            6 => "LAS VEGAS"
            7 => "NIV"
            8 => "OR"
            9 => "PBW"
            10 => "PEEP"
            11 => "PPC"
            12 => "Pplat"
            13 => "RR"
            14 => "V<span class="elsevierStyleInf">T</span>"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Introduction and objectives</span><p id="spara015" class="elsevierStyleSimplePara elsevierViewall">Information about epidemiology&#44; ventilation management and outcome in postoperative intensive care unit &#40;ICU&#41; patients remains scarce&#46; The objective was to test whether postoperative ventilation differs from that in the operation room&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Material and methods</span><p id="spara016" class="elsevierStyleSimplePara elsevierViewall">This was a substudy of the worldwide observational LAS VEGAS study&#44; including patients undergoing non&#8211;thoracic surgeries&#46; Of 146 study sites participating in the LAS VEGAS study&#44; 117 &#40;80&#37;&#41; sites reported on the postoperative ICU course&#44; including ventilation and complications&#46; The coprimary outcomes were two key elements of ventilator management&#44; i&#46;e&#46;&#44; tidal volume &#40;V<span class="elsevierStyleInf">T</span>&#41; and positive end&#8211;expiratory pressure &#40;PEEP&#41;&#46; Secondary outcomes included the proportion of patients receiving low V<span class="elsevierStyleInf">T</span> ventilation &#40;LTVV&#44; defined as ventilation with a median V<span class="elsevierStyleInf">T</span> &#60; 8&#46;0 ml&#47;kg PBW&#41;&#44; and the proportion of patients developing postoperative pulmonary complications &#40;PPC&#41;&#44; including ARDS&#44; pneumothorax&#44; pneumonia and need for escalation of ventilatory support&#44; ICU and hospital length of stay&#44; and mortality at day 28&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara017" class="elsevierStyleSimplePara elsevierViewall">Of 653 patients who were admitted to the ICU after surgery&#44; 274 &#40;42&#37;&#41; patients received invasive postoperative ventilation&#46; Median postoperative V<span class="elsevierStyleInf">T</span> was 8&#46;4 &#91;7&#46;3&#8211;9&#46;8&#93; ml&#47;kg predicted body weight &#40;PBW&#41;&#44; PEEP was 5 &#91;5&#8211;5&#93; cm H<span class="elsevierStyleInf">2</span>O&#44; statistically significant but not meaningfully different from median intraoperative V<span class="elsevierStyleInf">T</span> &#40;8&#46;1 &#91;7&#46;3&#8211;8&#46;9&#93; ml&#47;kg PBW&#59; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;001&#41; and PEEP &#40;4 &#91;2&#8211;5&#93; cm H<span class="elsevierStyleInf">2</span>O&#59; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;001&#41;&#46; The proportion of patients receiving LTVV after surgery was 41&#37;&#46; The PPC rate was 10&#37;&#46; Length of stay in ICU and hospital was independent of development of a PPC&#44; but hospital mortality was higher in patients who developed a PPC &#40;24 versus 4&#37;&#59; <span class="elsevierStyleItalic">P &#60;</span> 0&#46;001&#41;&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara018" class="elsevierStyleSimplePara elsevierViewall">In this observational study of patients undergoing non&#8211;thoracic surgeries&#44; postoperative ventilation was not meaningfully different from that in the operating room&#46; Like in the operating room&#44; there is room for improved use of LTVV&#46; Development of PPC is associated with mortality&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abss0001"
            "titulo" => "Introduction and objectives"
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            "identificador" => "abss0002"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abss0003"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abss0004"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="para0040a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix"
            "titulo" => "Supplementary materials"
            "identificador" => "sec0024"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:8 [
        "identificador" => "fig0001"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1626
            "Ancho" => 2167
            "Tamanyo" => 198601
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0001"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0002"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2463
            "Ancho" => 2500
            "Tamanyo" => 309088
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0002"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Ventilation parameters in the operating room vs&#46; in the intensive care unit&#46; Cumulative frequency distribution of tidal volume &#40;top left&#41;&#59; positive end&#8211;expiratory pressure &#40;top right&#41;&#59; plateau pressure &#40;bottom left&#41;&#59; and respiratory rate &#40;bottom right&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0003"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 3058
            "Ancho" => 3000
            "Tamanyo" => 318941
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0003"
            "detalle" => "Fig "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves showing outcome in patients who did or did not develop a PPC&#44; split up for no PPC vs pneumothorax&#44; pneumonia and ARDS vs escalation of ventilatory support for &#40;A&#41; probability of ICU discharge&#59; &#40;B&#41; probability of hospital discharge&#59; &#40;C&#41; probability of in&#8211;hospital mortality&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0001"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ARISCAT Assess Respiratory Risk in Surgical Patients in Catalonia&#59; IQR interquartile range&#59; GI gastro-intestinal&#59; COPD chronic obstructive pulmonary disease&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">All patients N&#61; 653</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Age&#44; Median &#91;IQR&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0004"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;48&#46;8-72&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">ARISCAT score&#44; Median &#91;IQR&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;40-51&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Gender&#44; male&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">&#40;53&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0012"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Ethnicity&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Asian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0018"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Black ethnicity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Caucasian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">561&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;85&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0024"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Hispanic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0027"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;8&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0030"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Reason for critical care admission&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0033"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Intensive monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;61&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0039"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Circulatory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0042"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Routine care &#40;planned&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;75&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0045"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Airway protection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0048"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Reason for invasive ventilation&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0054"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Aspiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0060"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac overload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0063"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Airway protection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Fatigue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Coma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0072"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Postoperative ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;48&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0075"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Surgical procedure&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0078"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower GI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;17&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper GI&#44; hepatobiliary and pancreas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0084"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Vascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0087"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Aortic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0090"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurosurgery&#44; head and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;26&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0093"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Urological and kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0096"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Gynaecological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Endocrine surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0102"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0105"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Plastic&#44; cutaneous and breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0106"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0108"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Bone&#44; joint&#44; trauma and spine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0114"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">Comorbidity&#44; N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0117"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Metastatic cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0123"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0126"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;15&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0129"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0132"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Obstructive sleep apnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0135"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Neuromuscular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2845923.png"
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        ]
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          "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "alt0005"
            "detalle" => "Table "
            "rol" => "short"
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          "leyenda" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Data are presented as median &#91;interquartile range&#93; or number &#40;percentage&#41;&#46;</p><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">OR operation room&#59; ICU intensive care unit&#59; V<span class="elsevierStyleInf">T</span> tidal volume&#59; PBW predicted bodyweight&#59; PEEP positive end-expiratory pressure&#59; RR respiratory rate&#59; bpm breaths per minute&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">Percentages are calculated on the amount of available values&#46;</p><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">&#42;of 653 patients transferred to ICU&#44; 274 patients were on invasive ventilation on day 1&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0138"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Ventilatory parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0139"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">In OR N&#61; 653</th><a name="en0140"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">In ICU N&#61; 274&#42;</th><a name="en0141"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">P-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">T&#44;</span> ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">510&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&#91;465-575&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">525&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;475-600&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">V<span class="elsevierStyleInf">T</span>&#44; ml&#47;kg PBW&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;7&#46;3-8&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;7&#46;3-9&#46;8&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8804; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">244&#47;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">92&#47;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#62; 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">272&#47;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">132&#47;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8804; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">466&#47;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">178&#47;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#62; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50&#47;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">46&#47;224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0176"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">PEEP&#44; cm H<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;2-5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;5-5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8804; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">551&#47;645&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">200&#47;265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0190"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#62; 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">94&#47;645&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65&#47;265&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Ppeak&#44; cm H<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0197"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;15&#46;7-21&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;20-23&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Pplat&#44; cm H<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0204"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;14&#46;3-19&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">16&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#91;14-19&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RR&#44; bpm&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Data are presented as median &#91;interquartile range&#93; or number &#40;percentage&#41;&#46;</p><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">ICU intensive care unit&#59; LOS length of stay&#59; IQR interquartile range&#59; MV mechanical ventilation&#46;</p><p id="spara014" class="elsevierStyleSimplePara elsevierViewall">Patients are only counted once&#44; i&#46;e&#46;&#44; when a patient scored for ARDS&#44; he is no longer counted for another PPC - from left to right&#46;</p>"
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                      "titulo" => "Epidemiology&#44; patterns of care&#44; and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                      "titulo" => "Epidemiological characteristics&#44; practice of ventilation&#44; and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries &#40;PRoVENT&#41;&#58; an international&#44; multicentre&#44; prospective study"
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                          "autores" => array:3 [
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