Letter to the Editor
Sequential use of noninvasive ventilation and high flow nasal therapy after early extubation in chest trauma patients recovering from acute hypoxaemic respiratory failure
G. Accursoa,
, A.N. Cracchioloc, D.M. Palmac, G. Misserid, M. Ippolitoa, V. Alvinoe, S.M. Raineria,b, A. Giarratanoa,b, A. Cortegiania,b, C. Gregorettib,d
Corresponding author
giuseppe.accurso86@gmail.com
Corresponding author at: Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy.
Corresponding author at: Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy.
a Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
b Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy
c U.O. Anestesia e Rianimazione con Trauma Center, ARNAS Ospedale Civico di Cristina Benfratelli, Palermo, Italy
d “G.Giglio” Fundation Cefalù, Italy
e U.O.S.D. TerapiaIntensiva Post Operatoria, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy
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(A) Protein gel electrophoresis. Index case ZQ0 displays only a band corresponding to PI*Z allele. (B) Electropherogram of the index case for SERPINA1 (NM_000295.5) exon 5, covering the mutations that define Z, Q0Leiria and M3 alleles. The arrows show the position of the corresponding nucleotide substitutions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.J.V. Silva, S. Seixas, M.J. Canotilho, S. Feijó" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.J.V." "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Seixas" ] 2 => array:2 [ "nombre" => "M.J." "apellidos" => "Canotilho" ] 3 => array:2 [ "nombre" => "S." 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Anestesia e Rianimazione con Trauma Center, ARNAS Ospedale Civico di Cristina Benfratelli, Palermo, Italy" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "“G.Giglio” Fundation Cefalù, Italy" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "U.O.S.D. TerapiaIntensiva Post Operatoria, Azienda Ospedaliera San Giovanni Addolorata, Roma, Italy" "etiqueta" => "e" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1209 "Ancho" => 2500 "Tamanyo" => 121396 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Protocol flowchart and study times point. (T0), before extubation; (T1), 1 h after extubation during the first NIV cycle, (T2), 3 h after extubation during the first HFNT session; (T3) 4 h after extubation during second NIV cycle. iMV, invasive mechanical ventilation, NIV noninvasive mechanical ventilation, HFNT high flow nasal therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">Post-traumatic lung injury may lead to acute respiratory distress syndrome (ARDS).<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1-2</span></a> Non invasive ventilation (NIV) has been used both before and after extubation in these patients.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1-8</span></a> The sequential use of NIV and High Flow Nasal Therapy (HFNT)<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9-11</span></a> may improve oxygenation while avoiding intubation, preventing reintubation, and reducing the length of invasive mechanical ventilation (iMV).<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> However, there is scarce evidence on the use of HFNT the trauma population at risk of weaning failure.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">This prospective single-center pilot study assessed feasibility and safety of early extubation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> followed by sequential use of NIV and HFNT in consecutive blunt chest trauma patients admitted to ICU between January 2nd 2017 and December 31st 2019. The study was approved by the local Ethics Committee and registered. All patients or legal representatives gave their written permission.</p><p id="para0004" class="elsevierStylePara elsevierViewall">Patients were included for early extubation<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> if meeting all the following criteria: 1) age ≥18 years; 2) invasive Mechanical Ventilation (iMV) for at least 48 h; 3) pressure support ventilation (PSV) with a total applied pressure (i.e. positive end-expiratory pressure (PEEP) + inspiratory support) ≤20 cmH<span class="elsevierStyleInf">2</span>O and a PEEP level between 8 and 10 cmH<span class="elsevierStyleInf">2</span>O; 4) the ratio between the partial pressure of oxygen and fraction of inspired oxygen (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2 ratio</span>) between 200 and 300 mmHg with FiO2 ≤ 0.6 and lack of ARDS; 5) PaCO<span class="elsevierStyleInf">2</span> ≤ 45 mmHg and pH ≥7.35; 6) respiratory rate (RR) ≤ 30 breaths/min; 7) core temperature <38.5 °C; 8) Glasgow Coma Scale (GCS) ≥11; 9) Richmond Agitation Sedation Score (RASS) <3; 10) preserved cough-reflex on suctioning and need for <2 tracheobronchial suctioning per hour.</p><p id="para0005" class="elsevierStylePara elsevierViewall">Patients were excluded if they met one or more of the following criteria: 1) hemodynamic instability (defined as systolic arterial pressure <90 mmHg despite fluid resuscitation and/or use of vasopressors); 2) life-threatening arrhythmias and/or electrocardiographic signs of ischemia; 3) sepsis; 4) secondary acute respiratory failure due to neurological disorders, status asthmaticus, chronic obstructive pulmonary disease or cardiogenic pulmonary edema; 5) tracheotomy; 6) uncontrolled vomiting; 7) RASS ≥3; 8) two or more organ failures; 9) body mass index (BMI) > 30 kg/m; <span class="elsevierStyleSup">2</span>10) documented history or suspicion of obstructive sleep apnea; 11) unstable flail chest; 12) recent upper airway or esophageal surgery; 13) pregnancy; 14) inclusion in other research protocols; 15) denied consent.</p><p id="para0006" class="elsevierStylePara elsevierViewall">Patients underwent sequential application of NIV and HFNT as represented in <a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>. During NIV session full-face or oronasal masks were rotated to avoid skin breakdown.<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> Humidification was achieved through a heated humidifier. Non invasive pressure support ventilation (PSV) was set up according to the pressure level applied before extubation and was then titrated to achieve an expired tidal volume of 7–8 ml/kg, with PaCO<span class="elsevierStyleInf">2</span> < 45 mmHg, pH >7.35, and respiratory rate (RR)< 30 breaths/min. PEEP was adjusted to maintain PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio > 225 mmHg.</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0007" class="elsevierStylePara elsevierViewall">HFNT was delivered at a gas flow rate of 60 L/min and FIO<span class="elsevierStyleInf">2</span> of 1.0, via large-bore dedicated nasal prongs at 37 °C and then adjusted according to the patient's comfort. FiO<span class="elsevierStyleInf">2</span> was then adjusted to maintain a SpO<span class="elsevierStyleInf">2</span> > 92%.</p><p id="para0008" class="elsevierStylePara elsevierViewall">After extubation patients received intravenous analgo-sedation with remifentanil (dose range of 0.02–0.08 mcg/kg/min) or dexmetedomidine (dose range 0.4–1 mcg/kg/h) in case of RASS ≥1 and/or Behavioural Pain Scale (BPS) >4. For lower BPS levels acetaminophen 1 g three time a day was given.</p><p id="para0009" class="elsevierStylePara elsevierViewall">A weaning trial was attempted when patients reached PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio > 250 mmHg. In these cases, PSV levels and PEEP were progressively decreased (by 2 cmH<span class="elsevierStyleInf">2</span>O sequential steps), until they reached a minimum threshold value of 5 and 8 cmH<span class="elsevierStyleInf">2</span>O, respectively. Then, NIV was interrupted, and patients were switched to HFNT only. Weaning from HFNT was considered successful if patients met all the following criteria: pH >7.35, PaCO<span class="elsevierStyleInf">2</span>〈 45 mmHg and PaO<span class="elsevierStyleInf">2</span>〉 70 mmHg, RR < 30 breaths/min, absence of dyspnea, respiratory accessory muscles recruitment, and paradoxical abdominal motion during 30-min trial with oxygen supplementation through a Venturi-mask with a FiO<span class="elsevierStyleInf">2</span> 0.35.</p><p id="para0010" class="elsevierStylePara elsevierViewall">Reintubation was considered in the occurrence of any of the following complications during the study period: a) cardiac or respiratory arrest; b) inability to protect the airway; c) coma or psychomotor agitation with RASS >3 not controlled by continuous i.v. sedative infusion; d) unmanageable secretions or uncontrolled vomiting; e) life-threatening arrhythmias or electrocardiographic signs of ischemia; f) hemodynamic instability; g) intolerance to all interface; or in the occurrence of at least two of the following criteria: h) PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio < 200 mmHg; i) respiratory acidosis (pH < 7.35 and PaCO<span class="elsevierStyleInf">2</span> > 50 mmHg); j) RR > 40 breaths /min. Vital parameters (systemic blood pressure - SBP, heart rate - HR, respiratory rate -RR) were continuously monitored.</p><p id="para0011" class="elsevierStylePara elsevierViewall">Continuous variables were expressed as means standard deviation (SD) or as medians (interquartile range, IQR) as appropriate, and discrete variables as counts (percentage). The analysis of the medians over the times, was carried out using the non-parametric Friedman test, considered not-normal distribution of values. Pairwise comparisons to groups were carried out using Wilcoxon signed-rank test and <span class="elsevierStyleItalic">P</span>-value adjustment with Bonferroni's method. The association between the presentation variables were first analyzed by mean of non-parametric Spearman correlation coefficient. Multiple linear regression was used to identify the variables with an important contribution to the response variability and to adjust for confounding variables with the stepwise method by Aikake Information Criterion (Aic). A <span class="elsevierStyleItalic">P</span> value <0.05 was considered statistically significant.</p><p id="para0012" class="elsevierStylePara elsevierViewall">Twenty-five patients met the inclusion criteria during the study period; five patients were excluded before intervention due to respiratory and cardiovascular complications. Baseline characteristics of the study cohort at admission are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1a</a>. iMV was required for a mean time of 56.4 h (55.5). The protocol, ranged from 6.5 to 100.5 h (41.4 ± 28.36). <a class="elsevierStyleCrossRef" href="#tbl0002">Table 1b</a> summarizes the results of blood gas analysis and clinical parameters at different time points and at the end of the study. No cases of reintubation or death were recorded. We found that there was a positive correlation between the time of iMV and the duration of the protocol, <span class="elsevierStyleItalic">R</span> = 0.624 (95%; CI 0.25–0.836, <span class="elsevierStyleItalic">p</span>. = 0.0033). Each hour of iMV was associated with an average 32 min increase in protocol time (<span class="elsevierStyleItalic">p</span>. 0.005).</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0013" class="elsevierStylePara elsevierViewall">Five patients, during HFNT needed to be switched to NIV because of PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio between 200 and 225 mmHg before reattempting HFNT. No severe adverse events were recorded. Comfort score as measured by VAS was not significantly different (p. 0.66) over time between HFNT and NIV as well as vital parameters were not different over time between HFNT and NIV. Remifentanil was never used in any patients while dexmetedomidine was used in 16 patients (mean dose range 0.8 mcg/kg/h ± 0,2).</p><p id="para0014" class="elsevierStylePara elsevierViewall">In this prospective single-center observational pilot study of a cohort of chest trauma patients, the sequential use of NIV and HFNT following early extubation was found to be feasible and safe. None of the included patients required reintubation. Alternating the use of NIV and HFNT has proven to cause neither clinically relevant changes in respiratory parameters nor complications. This strategy may help avoid re-intubation in this patient population. However, our study has several limitations. Firstly, it lacks a control group since we did not compare the applied post-extubation protocol with other protocols or weaning practices. Secondly, we applied restrictive inclusion criteria obtaining a small, selected cohort of patients. This could explain the fact that none of the treated patients were intubated. Thirdly we did not compare dyspnea at the different study times point.</p><p id="para0015" class="elsevierStylePara elsevierViewall">Therefore, the preliminary results obtained have low generalizability in the reference population and should be considered as feasibility, hypothesis-generating study for further controlled trials.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-03" "fechaAceptado" => "2022-06-16" "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1209 "Ancho" => 2500 "Tamanyo" => 121396 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Protocol flowchart and study times point. (T0), before extubation; (T1), 1 h after extubation during the first NIV cycle, (T2), 3 h after extubation during the first HFNT session; (T3) 4 h after extubation during second NIV cycle. iMV, invasive mechanical ventilation, NIV noninvasive mechanical ventilation, HFNT high flow nasal therapy.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1a" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table 1" "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">BMI: Body Mass Index, GCS: Glasgow Coma Scale, TTSs: Thoracic Trauma Severity Score.</p><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Data are expressed by Mean (SD), Median (IQR).</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></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">Patients (<span class="elsevierStyleItalic">n</span> = 20) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0003"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Age y \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">51.95 (19.50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0005"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Gender male N. (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">BMI kg/m2 \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">28.10 [17.50, 30.00] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Pneumothorax N.(%) \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">14 (70.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Liver contusion N.(%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Spleen contusion N.(%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">4 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Pelvis fracture N.(%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">5 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Retroperitoneal hematoma N.(%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1(5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Upper or lower limbs fractures N.(%) \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">5 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Need for chest drainage N. (%) \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">12 (60.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">GCS \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">15.00 [6.00, 15.00] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">TTSscore \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">12.00 (3.16) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the patients.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 1b" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table 1" "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "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="en0027"></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"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0028"></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">T0 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0029"></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">T1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0030"></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">T2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0031"></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">T3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0032"></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">End of treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0033"></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"><span class="elsevierStyleItalic">P</span> value overall \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0034"></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="elsevierStyleBold">Patient</span> \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">20 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 \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">20 \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">20 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">20 \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></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">pH \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></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">7.44 [7.36, 7.67] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.48 [7.36, 7.66] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.46 [7.32, 7.66] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></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">7.47 [7.35, 7.56] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.45 [4.48, 7.66] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 \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">PaO<span class="elsevierStyleInf">2</span> (mmHg) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129.00 [75.00, 170.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">118.00 [65.00, 313.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0051"></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">100.00 [72.00, 236.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130.00 [101.00, 263.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124.50 [75.00, 238.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></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"><span class="elsevierStyleBold">< 0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0055"></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">PaCO<span class="elsevierStyleInf">2</span> (mmHg) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.00 [31.00, 50.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0057"></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">36.00 [23.00, 52.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.50 [22.00, 60.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.50 [30.00, 52.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></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">39.00 [22.00, 50.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">0.03</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0062"></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">Base Excess \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></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">3.80 [−2.00, 32.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.85 [−4.10, 10.10] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.50 [−2.60, 11.90] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0066"></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">4.40 [−2.80, 11.30] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.95 [0.60, 8.90] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87 \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">Lactate (mEq/l) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 [0.40, 2.60] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.20 [0.60, 3.70] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></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">1.10 [0.50, 3.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.90 [0.60, 2.30] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.00 [0.50, 2.10] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></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"><span class="elsevierStyleBold">0.02</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></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">HCO<span class="elsevierStyleInf">3</span> (mmol/l) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.20 [23.00, 39.20] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></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">26.75 [21.80, 34.10] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.30 [22.80, 35.10] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.15 [22.80, 34.30] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0081"></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">27.60 [23.70, 32.80] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0083"></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">FiO<span class="elsevierStyleInf">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></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">0.53 [0.30, 0.60] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 [0.35, 0.60] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 [0.40, 0.60] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0087"></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">0.50 [0.40, 0.70] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 [0.30, 0.60] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.30 \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">PO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">239.00 [203.00, 350.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">227.00 [163.00, 522.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></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">200.00 [144.00, 393.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">257.00 [202.00, 526.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">265.00 [240.00, 595.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0096"></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"><span class="elsevierStyleBold"><0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0097"></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">SpO<span class="elsevierStyleInf">2</span> (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 [97.00, 100.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0099"></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">100.00 [98.00, 100.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.70 [97.00, 100.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 [98.90, 100.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0102"></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">100.00 [97.80, 100.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold"><0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0104"></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">Respiratory Rate (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0105"></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">14 [12.00, 18.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5 [12.00, 22.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 [12.00, 26.00] \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></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">16 [12.00, 20.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 [12.00, 22.00] \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold"><0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Analysis of the medians (IQR) of each variables at different study times point. (T0), before extubation; (T1), 1 h after extubation during the first NIV cycle, (T2), 3 h after extubation during the first HFNT session; (T3) 4 h after extubation during second NIV cycle and at the end of treatment. NIV noninvasive ventilation, HFNT high flow nasal therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Duggal" 1 => "P. Perez" 2 => "E. Golan" 3 => "L. Tremblay" 4 => "T. Sinuff" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc12821" "Revista" => array:6 [ "tituloSerie" => "Crit. Care" "fecha" => "2013" "volumen" => "17" "numero" => "4" "paginaInicial" => "R142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23876230" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation in chest trauma: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Chiumello" 1 => "S. Coppola" 2 => "S. Froio" 3 => "C. Gregoretti" 4 => "D. Consonni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-013-2901-4" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2013" "volumen" => "39" "numero" => "7" "paginaInicial" => "1171" "paginaFinal" => "1180" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571872" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pressure control ventilation and minitracheotomy in treating severe flail chest trauma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Gregoretti" 1 => "G. Foti" 2 => "F. Beltrame" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01700674" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "1995" "volumen" => "21" "numero" => "12" "paginaInicial" => "1054" "paginaFinal" => "1056" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8750136" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of non-invasive ventilation in blunt chest trauma: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Roberts" 1 => "D. Skinner" 2 => "B. Biccard" 3 => "R.N. Rodseth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00068-013-0370-7" "Revista" => array:7 [ "tituloSerie" => "Eur. J. Trauma Emerg. Surg." "fecha" => "2014" "volumen" => "40" "numero" => "5" "paginaInicial" => "553" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26814511" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Rochwerg" 1 => "L. Brochard" 2 => "M.W. Elliott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.02426-2016" "Revista" => array:6 [ "tituloSerie" => "Eur. Respir. J." "fecha" => "2017" "volumen" => "50" "numero" => "2" "paginaInicial" => "1602426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28860265" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Hernandez" 1 => "R. Fernandez" 2 => "P. Lopez-Reina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-1114" "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "numero" => "1" "paginaInicial" => "74" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19749006" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physiologic evaluation of non-invasive pressure support ventilation in trauma patients with acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Gregoretti" 1 => "F. Beltrame" 2 => "U. Lucangelo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s001340050666" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "1998" "volumen" => "24" "numero" => "8" "paginaInicial" => "785" "paginaFinal" => "790" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9757921" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Nava" 1 => "C. Gregoretti" 2 => "F. Fanfulla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ccm.0000186416.44752.72" "Revista" => array:7 [ "tituloSerie" => "Crit. Care Med." "fecha" => "2005" "volumen" => "33" "numero" => "11" "paginaInicial" => "2465" "paginaFinal" => "2470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16276167" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physiopathological rationale of using high-flow nasal therapy in the acute and chronic setting: a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Spoletini" 1 => "A. Cortegiani" 2 => "C. Gregoretti" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Trends Anaesth. Crit. Care" "fecha" => "2019" "volumen" => "26-27" "paginaInicial" => "22" "paginaFinal" => "29" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High flow nasal therapy in immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Cortegiani" 1 => "C. Crimi" 2 => "F. Sanfilippo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2018.12.015" "Revista" => array:6 [ "tituloSerie" => "J. Crit. Care" "fecha" => "2019" "volumen" => "50" "paginaInicial" => "250" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30622042" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.M. Maggiore" 1 => "F.A. Idone" 2 => "R. Vaschetto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201402-0364OC" "Revista" => array:7 [ "tituloSerie" => "Am. J. Respir. Crit. Care Med." "fecha" => "2014" "volumen" => "190" "numero" => "3" "paginaInicial" => "282" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25003980" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.-.P. Frat" 1 => "B. Brugiere" 2 => "S. Ragot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.03075" "Revista" => array:7 [ "tituloSerie" => "Respir. Care" "fecha" => "2015" "volumen" => "60" "numero" => "2" "paginaInicial" => "170" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25294935" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of postextubation high-flow nasal oxygen with noninvasive ventilation vs high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A.W. Thille" 1 => "G. Muller" 2 => "A. Gacouin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2019.14901" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2019" "volumen" => "322" "numero" => "15" "paginaInicial" => "1465" "paginaFinal" => "1475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31577036" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-flow nasal cannula therapy for patients with blunt thoracic injury: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.E. Halub" 1 => "S.K. Spilman" 2 => "K.A. Gaunt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2009.04.007" "Revista" => array:7 [ "tituloSerie" => "Can. J. Respir. Ther." "fecha" => "2016" "volumen" => "52" "numero" => "4" "paginaInicial" => "110" "paginaFinal" => "113" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30996619" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0015" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Vaschetto" 1 => "F. Longhini" 2 => "P. Persona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-018 -5478-0" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2019" "volumen" => "45" "numero" => "1" "paginaInicial" => "62" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30535516" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0016" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of early extubation followed by noninvasive ventilation versus standard extubation on the duration of invasive mechanical ventilation in hypoxemic non-hypercapnic patients: a systematic review and individual patient data meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Vaschetto" 1 => "A. Pecere" 2 => "G.D. Perkins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-021-03595" "Revista" => array:5 [ "tituloSerie" => "Crit. Care" "fecha" => "2021" "volumen" => "25" "paginaInicial" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34074314" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0017" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Helmet ventilation for acute respiratory failure and nasal skin breakdown in neuromuscular disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Racca" 1 => "L. Appendini" 2 => "G. Berta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ane.0b013e3181a1f708" "Revista" => array:7 [ "tituloSerie" => "Anesth. Analg." "fecha" => "2009" "volumen" => "109" "numero" => "1" "paginaInicial" => "164" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19439687" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002900000001/v1_202301030817/S2531043722001325/v1_202301030817/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002900000001/v1_202301030817/S2531043722001325/v1_202301030817/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043722001325?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 6 | 15 |
| 2024 October | 37 | 41 | 78 |
| 2024 September | 45 | 31 | 76 |
| 2024 August | 57 | 31 | 88 |
| 2024 July | 66 | 33 | 99 |
| 2024 June | 38 | 35 | 73 |
| 2024 May | 40 | 29 | 69 |
| 2024 April | 37 | 29 | 66 |
| 2024 March | 51 | 32 | 83 |
| 2024 February | 54 | 25 | 79 |
| 2024 January | 62 | 27 | 89 |
| 2023 December | 85 | 24 | 109 |
| 2023 November | 110 | 43 | 153 |
| 2023 October | 73 | 39 | 112 |
| 2023 September | 44 | 50 | 94 |
| 2023 August | 42 | 23 | 65 |
| 2023 July | 39 | 27 | 66 |
| 2023 June | 49 | 22 | 71 |
| 2023 May | 36 | 43 | 79 |
| 2023 April | 30 | 26 | 56 |
| 2023 March | 76 | 49 | 125 |
| 2023 February | 99 | 54 | 153 |
| 2023 January | 93 | 62 | 155 |
| 2022 December | 26 | 27 | 53 |
| 2022 November | 33 | 44 | 77 |
| 2022 October | 35 | 43 | 78 |
| 2022 September | 18 | 34 | 52 |
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