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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The plot depicts the degree of correlation between p values for effect size and p values for heterogeneity&#46; Points within the dashed square&#44; are the meta-analyses performed leaving out the PROSEVA trial by Guerin et al&#46; In all the other cases &#40;points within the dashed triangle&#41;&#44; the trial is included and the other RCTs are left out one at the time&#46; When the PROSEVA trial is left out from the meta-analysis&#44; both p values increase significantly compared to when the other trials are left out&#46; This means that both the p values for both the overall effect and heterogeneity are strongly influenced by the presence of the PROSEVA trial&#44; which should be regarded as the only outlier&#46; CMAJ &#61; Canadian Medical Association Journal&#44; ATS &#61; American Thoracic Society&#44; Crit Care &#61; Critical Care&#44; Crit Care Med &#61; Critical Care Medicine&#44; J Thorac Dis &#61; Journal of Thoracic Diseases&#44; Cochrane &#61; Cochrane Database of Systematic Reviews&#44; Med Int &#61; Medicina Intensiva&#44; Int Care Med &#61; Intensive Care Medicine&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">The first report on ventilation in the prone position in ARDS was published in 1976&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The approach was appreciated by intensivists because improved oxygenation was observed in most cases&#46; However&#44; no evidence was given to show that the method resulted in a higher rate of survival&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Moreover&#44; pronation of critically ill patients exposed them to several risks and required skilled specialists to be performed safely&#46; For these reasons&#44; risk and benefit assessments were called for&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">The efficacy of prone ventilation In ARDS was investigated in several trials published between 2001 and 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a> Although all unsuccessful&#44; they helped researchers to generate hypotheses concerning what patients would benefit the most from the treatment&#46; They also helped them to greatly improve the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Guerin and his collaborators designed the PROSEVA trial taking case-mix selection as well as pronation and ventilatory protocols into account&#44; capitalizing on the experience gained through the above-mentioned previous trials&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> These specific features had not been sufficiently brought out by the standard meta-analyses used to investigate prone ventilation in ARDS after 2013&#46; Nine of these meta-analyses were published between 2014 and 2021&#44;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;17</span></a> each of which used between six and eleven randomized controlled trials &#40;RCTs&#41; selected from a pool of thirteen&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0018"><span class="elsevierStyleSup">18&#8211;25</span></a> The efficacy of this treatment&#44; however&#44; was only weakly supported by evidence from the meta-analyses carried out after the PROSEVA study was published&#46; The findings of eight of these were non-significant&#44; although in various subgroups &#40;e&#46;g&#46;&#44; patients with more severe hypoxemia&#44; subjected to prone ventilation for a longer time than others were&#44; or treated with protective ventilation&#41; a significant reduction in mortality was observed&#46; In particular&#44; the Cochrane meta-analysis provided only a rather feeble indication for prone ventilation in the subset of patients with severe hypoxemia&#46; This is no surprise&#44; given the exploratory nature of subgroup analyses in meta-analysis&#44; where studies are assigned to a subgroup according to a specific feature&#44; without accounting for the distribution of other confounders&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Using cumulative meta-analysis and an analysis of heterogeneity&#44; we tested the hypothesis that the PROSEVA trial is an independent source of evidence for the use of prone positioning in ARDS</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Standard and cumulative meta-analyses in ATS meta-analysis trials</span><p id="para0009" class="elsevierStylePara elsevierViewall">We began by using cumulative meta-analysis to investigate how the findings of the trials evolved over time&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Cumulative meta-analysis generates chronological meta-analytical summary effects including in the analysis one study at a time&#46; This approach allows us to evaluate the influence of treatment on the outcome as studies add up&#44; with a stabilizing effect due to the increase of the sample size&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">We based this analysis on the eight trials that were included among the meta-analyses published by the <span class="elsevierStyleItalic">Annals of the American Thoracic Society</span> in 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> We performed two different cumulative meta-analyses&#44; the first one using the studies that reported short-term outcomes &#40;28-day or ICU mortality&#41;&#44; the second one including those that reported medium to long term outcomes &#40;from 2 to 6 months&#41;&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">We also performed standard meta-analyses of the eight trials&#44; and sensitivity meta-analyses&#44; both standard and cumulative&#46; We did so after excluding trials that randomized fewer than one hundred patients&#44; to avoid the small-study bias also known as the &#8220;winner curse&#8221; &#40;i&#46;e&#46;&#44; an exaggerated effect in favour of intervention studied in the trial&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> which is difficult to detect with Egger&#39;s regression&#44; as this test is underpowered when performed on fewer than ten studies&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Standard and leave-one-out meta-analyses</span><p id="para0012" class="elsevierStylePara elsevierViewall">The second step was to spot outliers among the nine meta-analyses that investigated prone ventilation for ARDS after the PROSEVA trial was published&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;16</span></a> We first replicated each meta-analysis using the same original datasets&#46; To improve homogeneity and comparability of the nine meta-analyses &#8211; in terms of effect size&#44; effect precision&#44; and statistical heterogeneity &#8211; we used relative risks as the outcome measure and random effects regardless of the choices made in the original papers&#46; We then performed a leave-one-out analysis by fitting the model repeatedly while excluding one RCT at a time&#44; to evaluate the influence of each RCT on the summary effect and on the statistical heterogeneity of each meta-analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Thus&#44; for example&#44; for a meta-analysis including eight trials&#44; eight different meta-analyses were performed&#44; each including seven trials&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">We then plotted the paired <span class="elsevierStyleItalic">p</span> values in a scatter plot for effect size and heterogeneity provided by each leave-one-out analysis&#46; This plot is a modification of the Baujat graphical method&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> which we call the &#8220;double-p plot&#8221;&#46; We chose to use it because the axis scales are probabilities that are more familiar to the average reader than the standardized square differences used in the Baujat plot&#46; Although the visual information they provide is similar&#44; the two plots are different&#46; In the Baujat plot&#44; each point indicates the contribution of each study to heterogeneity and overall effect&#44; whereas in the double-p plot each point indicates what the <span class="elsevierStyleItalic">p</span> values for heterogeneity and overall effect would be if the meta-analysis was performed on all the trials but one&#46; It is thus a means to assess the impact of the excluded trial on heterogeneity and overall effect&#46; The double-p plot visually represents the correlation between <span class="elsevierStyleItalic">p</span> values for heterogeneity and <span class="elsevierStyleItalic">p</span> values for the overall effect&#44; bringing out particular combination patterns that may occur when one or the other trial is left out of the meta-analysis&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Finally&#44; we performed a subgroup analysis for each of the nine meta-analyses&#44; comparing the PROSEVA trial with the other trials and formally assessing the differences in the effect estimates by means of an interaction test&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a></p><p id="para0015" class="elsevierStylePara elsevierViewall">We assessed heterogeneity in all the meta-analyses&#44; by performing Cochran&#39;s Q statistical tests under a null hypothesis of homogeneity&#44;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> and measuring the fraction of heterogeneity attributable to between-study variability with I<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> We calculated I<span class="elsevierStyleSup">2</span> 95&#37; confidence intervals to assess the degree of imprecision of this measurement&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">All statistical analyses were performed with the <span class="elsevierStyleItalic">metafor</span> package for R &#40;version 4&#46;0&#46;5&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Results</span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Cumulative meta-analysis</span><p id="para0017" class="elsevierStylePara elsevierViewall">Seven of the eight trials included in the ATS meta-analysis reported short-term mortality and seven the medium&#47;long-term outcome&#46; Thus&#44; we performed two different cumulative meta-analyses&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">Both cumulative meta-analyses showed similar trends over time &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46; As the sample size increased&#44; there was a substantial stabilization of the results&#44; which indicated a lack of protective effect for prone ventilation&#46; Before the PROSEVA trial was added&#44; the relative risk was 0&#46;96 &#40;95&#37; confidence interval 0&#46;85-1&#46;08&#41; and 0&#46;98 &#40;95&#37; confidence interval 0&#46;89-1&#46;08&#41; for early and medium&#47;long term mortality&#44; respectively&#46; In contrast&#44; mortality dropped significantly when the PROSEVA trial was included in the analysis&#58; the respective relative risks for the two outcomes were 0&#46;83 and 0&#46;85 &#40;95&#37; confidence interval 0&#46;66-1&#46;05 and 0&#46;70-1&#46;04&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0019" class="elsevierStylePara elsevierViewall">No small-study effect was observed after excluding trials with less than one hundred patients from the cumulative meta-analyses &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46; However&#44; the standard meta-analyses showed an increase of I<span class="elsevierStyleSup">2</span> with increased precision when small studies with strong protective effects &#40;thus closer to the PROSEVA trial&#41; were removed &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0003">Figs&#46; 3</a> to 6&#41;&#46;</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Replication of meta-analyses</span><p id="para0020" class="elsevierStylePara elsevierViewall">Each of the nine meta-analyses included between six and eleven RCTs&#44; selected from a pool of thirteen RCTs&#44; and yielded consistent findings &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46; Relative risks ranged between 0&#46;84 and 0&#46;86&#44; with no significant drop in mortality&#46; In six out of eight studies&#44; the Cochran&#39;s Q test for homogeneity was statistically significant&#44; indicating that between-study variability could not be ascribed to chance&#46; Although I<span class="elsevierStyleSup">2</span> values were never lower than 50&#37; &#40;high heterogeneity according to conventional thresholds<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a>&#41;&#44; the results were inconclusive because the confidence intervals ranged between low and high heterogeneity&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Leave-one-out analysis</span><p id="para0021" class="elsevierStylePara elsevierViewall">In the double-p plot&#44; each colour designates one of the nine meta-analyses&#46; The number of points per colour is equal to the number of leave-one-out procedures &#40;equal&#44; in its turn&#44; to the number of RCTs included in each meta-analysis&#41;&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The plot &#40;<a class="elsevierStyleCrossRef" href="#fig0003">Fig&#46; 3</a>&#41; shows that every time the PROSEVA study is excluded from a meta-analysis the <span class="elsevierStyleItalic">p</span> values for both effect and heterogeneity increase strikingly&#44; whereas when other trials are omitted&#44; they remain low with small variations&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#44; the interaction test&#44; which formally investigates the heterogeneity of effects across subgroups&#44; was always significant when the PROSEVA trial was compared with the rest of the studies&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Discussion</span><p id="para0024" class="elsevierStylePara elsevierViewall">Prone ventilation is considered to be standard care for severe ARDS&#44; and has been strongly recommended by recent guidelines based on subgroup analyses of negative meta-analysis and negative trials&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> However&#44; the Cochrane handbook regards subgroup analyses as &#8220;observational by nature&#8221; &#40;9&#46;6&#46;2 What are subgroup analyses&#63;&#41;&#46; Indeed&#44; subgroup analyses in meta-analysis are exploratory in nature&#44; since studies are assigned to a subgroup according to a specific feature&#44; without accounting for the distribution of other confounders&#46; Thus&#44; when more confounders than one are present in the subgroup&#44; we may be unable to recognize the ones affecting the outcome&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Meta-regression was also used in three studies to try to identify the subset of patients who responded to prone ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> However&#44; it has the same limitations as subgroup analysis &#40;Cochrane handbook 10&#46;11&#46;6 <span class="elsevierStyleItalic">Interpretation of subgroup analyses and meta-regressions</span>&#41;&#46; Only one variable at a time is tested as a moderator when the number of studies is too small to adopt a multivariable approach &#40;as a rule of thumb&#44; ten studies are required for each moderator&#41;&#46; Therefore&#44; the information provided by these studies should not be regarded as evidence but preferably as a possible basis for an hypothesis&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">Thus&#44; evidence in support of prone ventilation in ARDS is inherently weak if we rely on meta-analytical approaches&#44; implicitly prioritizing them with respect to the PROSEVA trial&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">On the other hand&#44; the standard assessment of heterogeneity by means of I<span class="elsevierStyleSup">2</span> is of limited usefulness when dealing with only a few studies&#44; as in our case&#46; If we only looked at the I<span class="elsevierStyleSup">2</span> estimates&#44; which were high in the nine meta-analyses &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#44; we could wrongly conclude that they showed high heterogeneity&#46; Nevertheless&#44; we considered heterogeneity assessment using the I<span class="elsevierStyleSup">2</span> to be inconclusive because confidence intervals ranged between low and high heterogeneity&#46; In our case&#44; lack of power diminished the usefulness of I<span class="elsevierStyleSup">2</span>&#46; However&#44; when numerous large studies are meta-analysed&#44; the opposite problem may come up&#44; with clinically homogeneous studies &#40;i&#46;e&#46;&#44; with similar case-mixes&#44; treatments and controls&#41; turning out to be statistically heterogeneous&#46; Hence&#44; clinical reasoning should always be used to support and integrate statistical analyses&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Given these premises&#44; the use of a leave-one-out approach to investigate outliers turned out to be a winning strategy for testing our hypothesis that the PROSEVA trial was clinically too different from the previous trials to be meta-analytically combined with them&#46; However&#44; none of the nine meta-analyses adopted this strategy&#44; although Cochrane&#39;s handbook does recommend meta-analyses both with and without clearly outlying studies &#40;9&#46;5&#46;3 <span class="elsevierStyleItalic">Strategies for addressing heterogeneity</span>&#41;&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">Only one study investigated outliers&#44;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> using studentized residuals&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> However&#44; seeing PROSEVA trial was an outlier did not substantially affect its conclusions&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">The use of a leave-one-out strategy allowed us to investigate heterogeneity in greater detail&#44; providing evidence in support of our hypothesis by showing that the higher heterogeneity was mainly attributable to the PROSEVA trial&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">There were good clinical reasons for not combining the PROSEVA trial with the other studies&#46; The main four RCTs that were published earlier had been unsuccessful in demonstrating improved survival &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a> However&#44; progress in physiological knowledge regarding ventilation in ARDS led to improvements in how the trials were designed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a> Thus&#44; it was possible to hypothesize that patients with the most severe hypoxia would benefit the most from pronation&#44;<a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> the duration of pronation needed to be prolonged&#44; and protective ventilation needed to be associated with prone ventilation&#46; The PROSEVA trial was designed on the basis of these hypotheses&#44; which make it inherently different from previous RCTs&#44; as Gattinoni et al&#46; have shown&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">However&#44; when trials bearing differences in case-mix&#44; study treatment and other associated treatments that may modify the outcome are combined in a meta-analysis&#44; the risk of generating spurious findings is high&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">Our study supports the hypothesis that the PROSEVA trial is an outlier compared to the RCTs that preceded it&#46; Our cumulative meta-analyses show that the PROSEVA trial changes the estimate of effect strikingly&#46; Moreover&#44; given the strong protective effect of the PROSEVA trial compared to the other trials&#44; the exclusion of the PROSEVA trial from any meta-analysis markedly increases the Cochran&#39;s Q p value and the p value for effectiveness&#46; Finally&#44; the protective effect of the PROSEVA trial was formally confirmed by interaction tests &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Several topics in medicine have been investigated over long periods of time as knowledge of these topics evolved&#46; Thus&#44; the case of the PROSEVA trial should not be considered an exception&#46; When it does happen&#44; attention should be paid to clinical heterogeneity before studies are selected for meta-analysis&#46; The problem of heterogeneity across studies&#44; typical for aggregated data&#44; could be offset by sharing trial datasets making individual-patient granular information public&#46; Individual-patient data could be analysed with powerful multivariable and machine-learning tools&#44; as has recently been done for ARDS phenotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Limitations</span><p id="para0035" class="elsevierStylePara elsevierViewall">The protocol for our meta-analysis was neither registered nor published&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">Cochran&#39;s Q test has been criticized for its sensitivity to the number of studies included in meta-analysis and for its lack of power when performed on a low number of studies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> We argue&#44; however&#44; that neither the number of studies nor power issues could have affected the results of our study&#46; At each round in the leave-one-out process&#44; the number of studies remains the same &#40;the total number of RCTs minus one&#41; for each meta-analysis&#46; As to power&#44; it can be an issue if a threshold has to be reached&#59; in our study&#44; however&#44; we only focus on Cochran&#39;s Q <span class="elsevierStyleItalic">p</span>-value variations on a continuous scale&#44; regardless of any threshold&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">The double-p plot is not a formal approach&#59; it only provides visual information&#46; The combination with an interaction test gives more precise measurement of difference in statistical terms but statistically significant differences do not necessarily have clinical relevance&#46; Moreover&#44; the double-p plot may yield very different patterns&#44; which may not be readily interpretable&#46; However&#44; in the specific case of prone ventilation for ARDS&#44; the clinical premises of heterogeneity and very clear patterns leave little uncertainty about the advisability of considering evidence from a PROSEVA trial independently of other trials&#46;</p><p id="para0038" class="elsevierStylePara elsevierViewall">Some authors have questioned the quality of evidence provided by the PROSEVA trial&#44; arguing that a higher prevalence of important prognostic factors may have favoured survival in the prone ventilation group&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> However&#44; assessment of quality lies outside the purview of our study&#44; which is to evaluate the appropriateness of the use of meta-analysis in a particular case&#46;</p></span></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Conclusions</span><p id="para0039" class="elsevierStylePara elsevierViewall">Weak evidence provided by meta-analyses may have fostered the low rate of prone ventilation prescriptions in severe ARDS reported in literature&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a> Our study brings out the limitations of the meta-analytical approach in treating ARDS and strongly reinforces Cochrane&#39;s recommendation that a one-by-one study exclusion analysis be performed when potential outlier studies are identified&#46;</p><p id="para0040" class="elsevierStylePara elsevierViewall">For clinical recommendations&#44; the findings of the PROSEVA trial should be regarded as an independent source of evidence&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Funding statement</span><p id="para0042" class="elsevierStylePara elsevierViewall">Research for the present paper has not been funded by any grant from funding agencies&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">This research has not received any grant from funding agencies in the public&#44; commercial or not-for-profit sectors&#46; non-profit sectors&#46;</p></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Authorship</span><p id="para0045" class="elsevierStylePara elsevierViewall">Daniele Poole had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis&#46; Daniele Poole&#44; Roberto Fumagalli and Andrea Pisa contributed to the interpretation of studies and the writing of the manuscript&#46;</p></span><span id="sec0013a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019a">CRediT authorship contribution statement</span><p id="para0045a" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">D&#46; Poole&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#44; Data curation&#44; Formal analysis&#44; Methodology&#44; Writing &#8211; original draft&#46; <span class="elsevierStyleBold">A&#46; Pisa&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">R&#46; Fumagalli&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#46;</p></span></span>"
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            1 => "Meta-analysis"
            2 => "Clinical heterogeneity"
            3 => "Statistical heterogeneity"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Researchers have tried unsuccessfully for many years using randomized controlled trials to show the efficacy of prone ventilation in treating ARDS&#46; These failed attempts were of use in designing the successful PROSEVA trial&#44; published in 2013&#46; However&#44; the evidence provided by meta-analyses in support of prone ventilation for ARDS was too low to be conclusive&#46; The present study shows that meta-analysis is indeed not the best approach for the assessment of evidence as to the efficacy of prone ventilation&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">We performed a cumulative meta-analysis to prove that only the PROSEVA trial&#44; due to its strong protective effect&#44; has substantially impacted on the outcome&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">We also replicated nine published meta-analyses including the PROSEVA trial&#46; We performed leave-one-out analyses&#44; removing one trial at a time from each meta-analysis&#44; measuring <span class="elsevierStyleItalic">p</span> values for effect size&#44; and also the Cochran&#39;s Q test for heterogeneity assessment&#46; We represented these analyses in a scatter plot to identify outlier studies influencing heterogeneity or overall effect size&#46; We used interaction tests to formally identify and evaluate differences with the PROSEVA trial&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">The positive effect of the PROSEVA trial accounted for most of the heterogeneity and for the reduction of overall effect size in the meta-analyses&#46; The interaction tests we conducted on the nine meta-analyses formally confirmed the difference in the effectiveness of prone ventilation between the PROSEVA trial the other studies&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">The clinical lack of homogeneity between the PROSEVA trial design and the other studies should have discouraged the use of meta-analysis&#46; Statistical considerations support this hypothesis&#44; suggesting that the PROSEVA trial is an independent source of evidence&#46;</p></span>"
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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The plot depicts the degree of correlation between p values for effect size and p values for heterogeneity&#46; Points within the dashed square&#44; are the meta-analyses performed leaving out the PROSEVA trial by Guerin et al&#46; In all the other cases &#40;points within the dashed triangle&#41;&#44; the trial is included and the other RCTs are left out one at the time&#46; When the PROSEVA trial is left out from the meta-analysis&#44; both p values increase significantly compared to when the other trials are left out&#46; This means that both the p values for both the overall effect and heterogeneity are strongly influenced by the presence of the PROSEVA trial&#44; which should be regarded as the only outlier&#46; CMAJ &#61; Canadian Medical Association Journal&#44; ATS &#61; American Thoracic Society&#44; Crit Care &#61; Critical Care&#44; Crit Care Med &#61; Critical Care Medicine&#44; J Thorac Dis &#61; Journal of Thoracic Diseases&#44; Cochrane &#61; Cochrane Database of Systematic Reviews&#44; Med Int &#61; Medicina Intensiva&#44; Int Care Med &#61; Intensive Care Medicine&#46;</p>"
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                  \t\t\t\t\t\t</th><a name="en0005"></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">Estimate p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></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">I&#178; &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></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">Heterogeneity <span class="elsevierStyleItalic">p</span> value&nbsp;\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="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Annals of the ATS-2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&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">at 28 days&#44; if not available&#44; at 30 days&#44; hospital or ICU discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;84 &#40;0&#46;67-1&#46;05&#41;&nbsp;\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">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63 &#40;4-92&#41;&nbsp;\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">0&#46;018&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Crit Care-2014&nbsp;\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">7&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">at 28-30 days&nbsp;\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">0&#46;86 &#40;0&#46;68-1&#46;09&#41;&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">0&#46;203&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">68 &#40;12-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Crit Care Med-2014&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">11&nbsp;\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">at the longest available follow-up&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">0&#46;86 &#40;0&#46;73-1&#46;01&#41;&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">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50 &#40;0-80&#41;&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">0&#46;087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CMAJ-2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></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="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">at hospital discharge&#44; if not available&#44; at the longest duration of follow-up&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">0&#46;85 &#40;0&#46;72-1&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;072&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">50 &#40;0-83&#41;&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">0&#46;085&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cochrane&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">8&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">at 10 to 30 days&#44; or ICU discharge&nbsp;\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">0&#46;84 &#40;0&#46;67-1&#46;06&#41;&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">0&#46;137&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">65 &#40;7-91&#41;&nbsp;\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="" valign="top">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Int Care Med-2014&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">8&nbsp;\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="" valign="top">at 60 days&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">0&#46;84 &#40;0&#46;68-1&#46;02&#41;&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">0&#46;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65 &#40;14-92&#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">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">J Int Care Med-2021&nbsp;\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="" valign="top">6&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">at 28-30 days&#44; or ICU discharge&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">0&#46;84 &#40;0&#46;65-1&#46;09&#41;&nbsp;\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="" valign="top">0&#46;193&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">73 &#40;20-95&#41;&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">0&#46;006&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">J Thorac Dis-2015&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">8&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">at the longest available follow-up&nbsp;\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="" valign="top">0&#46;86 &#40;0&#46;71-1&#46;04&#41;&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">0&#46;124&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">66 &#40;8-93&#41;&nbsp;\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="" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Med Int-2015&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">7&nbsp;\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="" valign="top">at the longest available follow-up&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">0&#46;86 &#40;0&#46;7-1&#46;04&#41;&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">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70 &#40;17-96&#41;&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">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Results of the nine meta-analyses performed using relative risks to measure outcome and random-effects models for variance assessment&#46; RR &#61; Relative risk&#44; Heterogeneity p value &#61; p value for the Cochran&#39;s Q statistics for assessment of heterogeneity&#44; 95&#37;-CI &#61; 95&#37; confidence interval&#44; <span class="elsevierStyleItalic">CMAJ</span> &#61; <span class="elsevierStyleItalic">Canadian Medical Association</span> Journal&#44; <span class="elsevierStyleItalic">ATS</span> &#61; <span class="elsevierStyleItalic">American Thoracic Society</span>&#44; Crit Care &#61; <span class="elsevierStyleItalic">Critical Care&#44; Crit Care Med</span> &#61; <span class="elsevierStyleItalic">Critical Care Medicine&#44; J Thorac Dis</span> &#61; <span class="elsevierStyleItalic">Journal of Thoracic Diseases&#44; Cochrane</span> &#61; <span class="elsevierStyleItalic">Cochrane Database of Systematic Reviews&#44; Med Int</span> &#61; <span class="elsevierStyleItalic">Medicina Intensiva</span>&#44; Int Care Med &#61; <span class="elsevierStyleItalic">Intensive Care Medicine</span>&#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="en0071"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Journal-year</th><a name="en0072"></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">PROSEVA trial</th><a name="en0073"></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">Meta-analysis ofthe other trials</th><a name="en0074"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value for interaction</th></tr><tr title="table-row"><a name="en0076"></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">RR &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0077"></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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0078"></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">RR &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0079"></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&nbsp;\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="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Annals of the ATS-2017&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">0&#46;49 &#40;0&#46;35-0&#46;69&#41;&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">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">0&#46;96 &#40;0&#46;85-1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
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                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24134414"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in severe acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C Guerin"
                            1 => "J Reignier"
                            2 => "JC Richard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1214103"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "numero" => "23"
                        "paginaInicial" => "2159"
                        "paginaFinal" => "2168"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position for acute respiratory distress syndrome&#46; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Munshi"
                            1 => "L Del Sorbo"
                            2 => "NKJ Adhikari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/AnnalsATS.201704-343OT"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Am Thorac Soc"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "numero" => "Supplement&#95;4"
                        "paginaInicial" => "S280"
                        "paginaFinal" => "S2S8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29068269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S Sud"
                            1 => "JO Friedrich"
                            2 => "NK Adhikari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1503/cmaj.140081"
                      "Revista" => array:7 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2014"
                        "volumen" => "186"
                        "numero" => "10"
                        "paginaInicial" => "E381"
                        "paginaFinal" => "E390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0011"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position for acute respiratory failure in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Bloomfield"
                            1 => "DW Noble"
                            2 => "A&#46; Sudlow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD008095.pub2"
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2015"
                        "numero" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0012"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of prone positioning on mortality in patients with acute respiratory distress syndrome&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "SL Hu"
                            1 => "HL He"
                            2 => "C Pan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc13896"
                      "Revista" => array:6 [
                        "tituloSerie" => "Critical Care"
                        "fecha" => "2014"
                        "volumen" => "18"
                        "numero" => "3"
                        "paginaInicial" => "R109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24887034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0013"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome&#58; updated study-level meta-analysis of 11 randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JM Lee"
                            1 => "W Bae"
                            2 => "YJ Lee"
                            3 => "YJ&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000000122"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "42"
                        "numero" => "5"
                        "paginaInicial" => "1252"
                        "paginaFinal" => "1262"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0014"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JR Beitler"
                            1 => "S Shaefi"
                            2 => "SB Montesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-3194-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "numero" => "3"
                        "paginaInicial" => "332"
                        "paginaFinal" => "341"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24435203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "SY Park"
                            1 => "HJ Kim"
                            2 => "KH Yoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2072-1439.2014.12.49"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "numero" => "3"
                        "paginaInicial" => "356"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25922713"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0016"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of prone position ventilation in patients with acute respiratory distress syndrome&#46; A systematic review and metaanalysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JA Mora-Arteaga"
                            1 => "OJ Bernal-Ramirez"
                            2 => "SJ&#46; Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2014.11.003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Medicina Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "numero" => "6"
                        "paginaInicial" => "359"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25599942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0017"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multivariate meta-analysis of the mortality effect of prone positioning in the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JL Moran"
                            1 => "PL&#46; Graham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/08850666211014479"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2021"
                        "volumen" => "36"
                        "numero" => "11"
                        "paginaInicial" => "1323"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33942659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0018"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MC Chan"
                            1 => "JY Hsu"
                            2 => "HH Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0929-6646(08)60032-7"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Formos Med Assoc"
                        "fecha" => "2007"
                        "volumen" => "106"
                        "numero" => "9"
                        "paginaInicial" => "708"
                        "paginaFinal" => "716"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17908660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0019"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prone positioning on clinical outcomes in children with acute lung injury&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MA Curley"
                            1 => "PL Hibberd"
                            2 => "LD Fineman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.294.2.229"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2005"
                        "volumen" => "294"
                        "numero" => "2"
                        "paginaInicial" => "229"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16014597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D Demory"
                            1 => "P Michelet"
                            2 => "JM Arnal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000251128.60336.FE"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "numero" => "1"
                        "paginaInicial" => "106"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0021"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in acute respiratory distress syndrome&#58; a multicenter randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R Fernandez"
                            1 => "X Trenchs"
                            2 => "J Klamburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-008-1119-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "numero" => "8"
                        "paginaInicial" => "1487"
                        "paginaFinal" => "1491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18427774"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0022"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning improves oxygenation in post-traumatic lung injury&#8211;a prospective randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G Voggenreiter"
                            1 => "M Aufmkolk"
                            2 => "RJ Stiletto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2005"
                        "volumen" => "59"
                        "numero" => "2"
                        "paginaInicial" => "333"
                        "paginaFinal" => "341"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0023"
              "etiqueta" => "23"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position as prevention of lung injury in comatose patients&#58; a prospective&#44; randomized&#44; controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P Beuret"
                            1 => "MJ Carton"
                            2 => "K Nourdine"
                            3 => "M Kaaki"
                            4 => "G Tramoni"
                            5 => "JC&#46; Ducreux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-002-1266-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "numero" => "5"
                        "paginaInicial" => "564"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12029403"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0024"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Papazian"
                            1 => "M Gainnier"
                            2 => "V Marin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ccm.0000181298.05474.2b"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "numero" => "10"
                        "paginaInicial" => "2162"
                        "paginaFinal" => "2171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16215365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effect of a prone position for patients with hypoxemia after transthoracic esophagectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I Watanabe"
                            1 => "H Fujihara"
                            2 => "K Sato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00003246-200208000-00021"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "numero" => "8"
                        "paginaInicial" => "1799"
                        "paginaFinal" => "1802"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12163796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0026"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cumulative meta-analysis of therapeutic trials for myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J Lau"
                            1 => "EM Antman"
                            2 => "J Jimenez-Silva"
                            3 => "B Kupelnick"
                            4 => "F Mosteller"
                            5 => "TC&#46; Chalmers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199207233270406"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1992"
                        "volumen" => "327"
                        "numero" => "4"
                        "paginaInicial" => "248"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1614465"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0027"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of study size on meta-analyses&#58; examination of underpowered studies in Cochrane reviews"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "RM Turner"
                            1 => "SM Bird"
                            2 => "JP&#46; Higgins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0059202"
                      "Revista" => array:6 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "numero" => "3"
                        "paginaInicial" => "e59202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23544056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0028"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why most discovered true associations are inflated"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "JP&#46; Ioannidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EDE.0b013e31818131e7"
                      "Revista" => array:7 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "numero" => "5"
                        "paginaInicial" => "640"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18633328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0029"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Publication and related bias in meta-analysis&#58; power of statistical tests and prevalence in the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JA Sterne"
                            1 => "D Gavaghan"
                            2 => "M&#46; Egger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0895-4356(00)00242-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "2000"
                        "volumen" => "53"
                        "numero" => "11"
                        "paginaInicial" => "1119"
                        "paginaFinal" => "1129"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conducting meta-analyses in R with the metafor package"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46; Viechtbauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Statistic Software"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "numero" => "3"
                        "paginaInicial" => "1"
                        "paginaFinal" => "48"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0031"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A graphical method for exploring heterogeneity in meta-analyses&#58; application to a meta-analysis of 65 trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B Baujat"
                            1 => "C Mahe"
                            2 => "JP Pignon"
                            3 => "C&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/sim.1221"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stat Med"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "numero" => "18"
                        "paginaInicial" => "2641"
                        "paginaFinal" => "2652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12228882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0032"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interaction revisited&#58; the difference between two estimates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "DG Altman"
                            1 => "JM&#46; Bland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.326.7382.219"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "326"
                        "numero" => "7382"
                        "paginaInicial" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12543843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0033"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The combination of estimates from different experiments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46; Cochran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Biometrics"
                        "fecha" => "1954"
                        "volumen" => "10"
                        "paginaInicial" => "101"
                        "paginaFinal" => "129"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0034"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring inconsistency in meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JP Higgins"
                            1 => "SG Thompson"
                            2 => "JJ Deeks"
                            3 => "DG&#46; Altman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.327.7414.557"
                      "Revista" => array:7 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "327"
                        "numero" => "7414"
                        "paginaInicial" => "557"
                        "paginaFinal" => "560"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12958120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quantifying heterogeneity in a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JP Higgins"
                            1 => "SG&#46; Thompson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/sim.1186"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stat Med"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "numero" => "11"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12111919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0036"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "R&#58; A Language and Environment for Statistical Computing"
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                        0 => array:2 [
                          "colaboracion" => "R Core Team"
                          "etal" => false
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                      ]
                    ]
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                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;R-project&#46;org&#47;"
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            36 => array:3 [
              "identificador" => "bib0037"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American thoracic society&#47;European Society of intensive care medicine&#47;society of critical care medicine clinical practice guideline&#58; mechanical ventilation in adult patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E Fan"
                            1 => "L Del Sorbo"
                            2 => "EC Goligher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201703-0548ST"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "195"
                        "numero" => "9"
                        "paginaInicial" => "1253"
                        "paginaFinal" => "1263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28459336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0038"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning improves survival in severe ARDS&#58; a pathophysiologic review and individual patient meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L Gattinoni"
                            1 => "E Carlesso"
                            2 => "P Taccone"
                            3 => "F Polli"
                            4 => "C Guerin"
                            5 => "J&#46; Mancebo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "numero" => "6"
                        "paginaInicial" => "448"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20473258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0039"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outlier and influence diagnostics for meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W Viechtbauer"
                            1 => "MW&#46; Cheung"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jrsm.11"
                      "Revista" => array:6 [
                        "tituloSerie" => "Res Synthesis Methods"
                        "fecha" => "2010"
                        "volumen" => "1"
                        "numero" => "2"
                        "paginaInicial" => "112"
                        "paginaFinal" => "125"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Gattinoni"
                            1 => "M Busana"
                            2 => "L Giosa"
                            3 => "MM Macri"
                            4 => "M&#46; Quintel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0039-1685180"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2019"
                        "volumen" => "40"
                        "numero" => "1"
                        "paginaInicial" => "94"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31060091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0041"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S Sud"
                            1 => "JO Friedrich"
                            2 => "P Taccone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-009-1748-1"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "numero" => "4"
                        "paginaInicial" => "585"
                        "paginaFinal" => "599"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20130832"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0042"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interpretation of tests of heterogeneity and bias in meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "JP&#46; Ioannidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2753.2008.00986.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Eval Clin Pract"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "numero" => "5"
                        "paginaInicial" => "951"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19018930"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0043"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of parsimonious algorithms to classify acute respiratory distress syndrome phenotypes&#58; a secondary analysis of randomised controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P Sinha"
                            1 => "KL Delucchi"
                            2 => "DF McAuley"
                            3 => "CM O&#39;Kane"
                            4 => "MA Matthay"
                            5 => "CS&#46; Calfee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(19)30369-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2020"
                        "volumen" => "8"
                        "numero" => "3"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31948926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0044"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to improve assessment of balance in baseline characteristics of clinical trial participants-example from PROSEVA trial data&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E Festic"
                            1 => "B Rawal"
                            2 => "O&#46; Gajic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2305-5839.2016.01.30"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Transl Med"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "numero" => "4"
                        "paginaInicial" => "79"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0045"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; patterns of care&#44; and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G Bellani"
                            1 => "JG Laffey"
                            2 => "T Pham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2016.0291"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2016"
                        "volumen" => "315"
                        "numero" => "8"
                        "paginaInicial" => "788"
                        "paginaFinal" => "800"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26903337"
                            "web" => "Medline"
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Original article
Prone position for acute respiratory distress syndrome and the hazards of meta-analysis
D. Poolea,
Corresponding author
daniele.poole@alice.it

Corresponding author at: San Martino Hospital, Viale EUROPA 22, 32100 Belluno, Italy.
, A. Pisab, R. Fumagallib,c
a Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy
b Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan, Italy
c Department of Anesthesia and Intensive Care, Niguarda Hospital, Milan, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">The first report on ventilation in the prone position in ARDS was published in 1976&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> The approach was appreciated by intensivists because improved oxygenation was observed in most cases&#46; However&#44; no evidence was given to show that the method resulted in a higher rate of survival&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Moreover&#44; pronation of critically ill patients exposed them to several risks and required skilled specialists to be performed safely&#46; For these reasons&#44; risk and benefit assessments were called for&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">The efficacy of prone ventilation In ARDS was investigated in several trials published between 2001 and 2009&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a> Although all unsuccessful&#44; they helped researchers to generate hypotheses concerning what patients would benefit the most from the treatment&#46; They also helped them to greatly improve the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Guerin and his collaborators designed the PROSEVA trial taking case-mix selection as well as pronation and ventilatory protocols into account&#44; capitalizing on the experience gained through the above-mentioned previous trials&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> These specific features had not been sufficiently brought out by the standard meta-analyses used to investigate prone ventilation in ARDS after 2013&#46; Nine of these meta-analyses were published between 2014 and 2021&#44;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;17</span></a> each of which used between six and eleven randomized controlled trials &#40;RCTs&#41; selected from a pool of thirteen&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bib0018"><span class="elsevierStyleSup">18&#8211;25</span></a> The efficacy of this treatment&#44; however&#44; was only weakly supported by evidence from the meta-analyses carried out after the PROSEVA study was published&#46; The findings of eight of these were non-significant&#44; although in various subgroups &#40;e&#46;g&#46;&#44; patients with more severe hypoxemia&#44; subjected to prone ventilation for a longer time than others were&#44; or treated with protective ventilation&#41; a significant reduction in mortality was observed&#46; In particular&#44; the Cochrane meta-analysis provided only a rather feeble indication for prone ventilation in the subset of patients with severe hypoxemia&#46; This is no surprise&#44; given the exploratory nature of subgroup analyses in meta-analysis&#44; where studies are assigned to a subgroup according to a specific feature&#44; without accounting for the distribution of other confounders&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Using cumulative meta-analysis and an analysis of heterogeneity&#44; we tested the hypothesis that the PROSEVA trial is an independent source of evidence for the use of prone positioning in ARDS</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Standard and cumulative meta-analyses in ATS meta-analysis trials</span><p id="para0009" class="elsevierStylePara elsevierViewall">We began by using cumulative meta-analysis to investigate how the findings of the trials evolved over time&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Cumulative meta-analysis generates chronological meta-analytical summary effects including in the analysis one study at a time&#46; This approach allows us to evaluate the influence of treatment on the outcome as studies add up&#44; with a stabilizing effect due to the increase of the sample size&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">We based this analysis on the eight trials that were included among the meta-analyses published by the <span class="elsevierStyleItalic">Annals of the American Thoracic Society</span> in 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> We performed two different cumulative meta-analyses&#44; the first one using the studies that reported short-term outcomes &#40;28-day or ICU mortality&#41;&#44; the second one including those that reported medium to long term outcomes &#40;from 2 to 6 months&#41;&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">We also performed standard meta-analyses of the eight trials&#44; and sensitivity meta-analyses&#44; both standard and cumulative&#46; We did so after excluding trials that randomized fewer than one hundred patients&#44; to avoid the small-study bias also known as the &#8220;winner curse&#8221; &#40;i&#46;e&#46;&#44; an exaggerated effect in favour of intervention studied in the trial&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> which is difficult to detect with Egger&#39;s regression&#44; as this test is underpowered when performed on fewer than ten studies&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Standard and leave-one-out meta-analyses</span><p id="para0012" class="elsevierStylePara elsevierViewall">The second step was to spot outliers among the nine meta-analyses that investigated prone ventilation for ARDS after the PROSEVA trial was published&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9&#8211;16</span></a> We first replicated each meta-analysis using the same original datasets&#46; To improve homogeneity and comparability of the nine meta-analyses &#8211; in terms of effect size&#44; effect precision&#44; and statistical heterogeneity &#8211; we used relative risks as the outcome measure and random effects regardless of the choices made in the original papers&#46; We then performed a leave-one-out analysis by fitting the model repeatedly while excluding one RCT at a time&#44; to evaluate the influence of each RCT on the summary effect and on the statistical heterogeneity of each meta-analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Thus&#44; for example&#44; for a meta-analysis including eight trials&#44; eight different meta-analyses were performed&#44; each including seven trials&#46;</p><p id="para0013" class="elsevierStylePara elsevierViewall">We then plotted the paired <span class="elsevierStyleItalic">p</span> values in a scatter plot for effect size and heterogeneity provided by each leave-one-out analysis&#46; This plot is a modification of the Baujat graphical method&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> which we call the &#8220;double-p plot&#8221;&#46; We chose to use it because the axis scales are probabilities that are more familiar to the average reader than the standardized square differences used in the Baujat plot&#46; Although the visual information they provide is similar&#44; the two plots are different&#46; In the Baujat plot&#44; each point indicates the contribution of each study to heterogeneity and overall effect&#44; whereas in the double-p plot each point indicates what the <span class="elsevierStyleItalic">p</span> values for heterogeneity and overall effect would be if the meta-analysis was performed on all the trials but one&#46; It is thus a means to assess the impact of the excluded trial on heterogeneity and overall effect&#46; The double-p plot visually represents the correlation between <span class="elsevierStyleItalic">p</span> values for heterogeneity and <span class="elsevierStyleItalic">p</span> values for the overall effect&#44; bringing out particular combination patterns that may occur when one or the other trial is left out of the meta-analysis&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Finally&#44; we performed a subgroup analysis for each of the nine meta-analyses&#44; comparing the PROSEVA trial with the other trials and formally assessing the differences in the effect estimates by means of an interaction test&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a></p><p id="para0015" class="elsevierStylePara elsevierViewall">We assessed heterogeneity in all the meta-analyses&#44; by performing Cochran&#39;s Q statistical tests under a null hypothesis of homogeneity&#44;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> and measuring the fraction of heterogeneity attributable to between-study variability with I<span class="elsevierStyleSup">2</span><span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> We calculated I<span class="elsevierStyleSup">2</span> 95&#37; confidence intervals to assess the degree of imprecision of this measurement&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">All statistical analyses were performed with the <span class="elsevierStyleItalic">metafor</span> package for R &#40;version 4&#46;0&#46;5&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a></p></span></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Results</span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Cumulative meta-analysis</span><p id="para0017" class="elsevierStylePara elsevierViewall">Seven of the eight trials included in the ATS meta-analysis reported short-term mortality and seven the medium&#47;long-term outcome&#46; Thus&#44; we performed two different cumulative meta-analyses&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">Both cumulative meta-analyses showed similar trends over time &#40;<a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46; As the sample size increased&#44; there was a substantial stabilization of the results&#44; which indicated a lack of protective effect for prone ventilation&#46; Before the PROSEVA trial was added&#44; the relative risk was 0&#46;96 &#40;95&#37; confidence interval 0&#46;85-1&#46;08&#41; and 0&#46;98 &#40;95&#37; confidence interval 0&#46;89-1&#46;08&#41; for early and medium&#47;long term mortality&#44; respectively&#46; In contrast&#44; mortality dropped significantly when the PROSEVA trial was included in the analysis&#58; the respective relative risks for the two outcomes were 0&#46;83 and 0&#46;85 &#40;95&#37; confidence interval 0&#46;66-1&#46;05 and 0&#46;70-1&#46;04&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0019" class="elsevierStylePara elsevierViewall">No small-study effect was observed after excluding trials with less than one hundred patients from the cumulative meta-analyses &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46; However&#44; the standard meta-analyses showed an increase of I<span class="elsevierStyleSup">2</span> with increased precision when small studies with strong protective effects &#40;thus closer to the PROSEVA trial&#41; were removed &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0003">Figs&#46; 3</a> to 6&#41;&#46;</p><elsevierMultimedia ident="fig0003"></elsevierMultimedia></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Replication of meta-analyses</span><p id="para0020" class="elsevierStylePara elsevierViewall">Each of the nine meta-analyses included between six and eleven RCTs&#44; selected from a pool of thirteen RCTs&#44; and yielded consistent findings &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#46; Relative risks ranged between 0&#46;84 and 0&#46;86&#44; with no significant drop in mortality&#46; In six out of eight studies&#44; the Cochran&#39;s Q test for homogeneity was statistically significant&#44; indicating that between-study variability could not be ascribed to chance&#46; Although I<span class="elsevierStyleSup">2</span> values were never lower than 50&#37; &#40;high heterogeneity according to conventional thresholds<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a>&#41;&#44; the results were inconclusive because the confidence intervals ranged between low and high heterogeneity&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Leave-one-out analysis</span><p id="para0021" class="elsevierStylePara elsevierViewall">In the double-p plot&#44; each colour designates one of the nine meta-analyses&#46; The number of points per colour is equal to the number of leave-one-out procedures &#40;equal&#44; in its turn&#44; to the number of RCTs included in each meta-analysis&#41;&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The plot &#40;<a class="elsevierStyleCrossRef" href="#fig0003">Fig&#46; 3</a>&#41; shows that every time the PROSEVA study is excluded from a meta-analysis the <span class="elsevierStyleItalic">p</span> values for both effect and heterogeneity increase strikingly&#44; whereas when other trials are omitted&#44; they remain low with small variations&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#44; the interaction test&#44; which formally investigates the heterogeneity of effects across subgroups&#44; was always significant when the PROSEVA trial was compared with the rest of the studies&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Discussion</span><p id="para0024" class="elsevierStylePara elsevierViewall">Prone ventilation is considered to be standard care for severe ARDS&#44; and has been strongly recommended by recent guidelines based on subgroup analyses of negative meta-analysis and negative trials&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> However&#44; the Cochrane handbook regards subgroup analyses as &#8220;observational by nature&#8221; &#40;9&#46;6&#46;2 What are subgroup analyses&#63;&#41;&#46; Indeed&#44; subgroup analyses in meta-analysis are exploratory in nature&#44; since studies are assigned to a subgroup according to a specific feature&#44; without accounting for the distribution of other confounders&#46; Thus&#44; when more confounders than one are present in the subgroup&#44; we may be unable to recognize the ones affecting the outcome&#46;</p><p id="para0025" class="elsevierStylePara elsevierViewall">Meta-regression was also used in three studies to try to identify the subset of patients who responded to prone ventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> However&#44; it has the same limitations as subgroup analysis &#40;Cochrane handbook 10&#46;11&#46;6 <span class="elsevierStyleItalic">Interpretation of subgroup analyses and meta-regressions</span>&#41;&#46; Only one variable at a time is tested as a moderator when the number of studies is too small to adopt a multivariable approach &#40;as a rule of thumb&#44; ten studies are required for each moderator&#41;&#46; Therefore&#44; the information provided by these studies should not be regarded as evidence but preferably as a possible basis for an hypothesis&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">Thus&#44; evidence in support of prone ventilation in ARDS is inherently weak if we rely on meta-analytical approaches&#44; implicitly prioritizing them with respect to the PROSEVA trial&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">On the other hand&#44; the standard assessment of heterogeneity by means of I<span class="elsevierStyleSup">2</span> is of limited usefulness when dealing with only a few studies&#44; as in our case&#46; If we only looked at the I<span class="elsevierStyleSup">2</span> estimates&#44; which were high in the nine meta-analyses &#40;<a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#41;&#44; we could wrongly conclude that they showed high heterogeneity&#46; Nevertheless&#44; we considered heterogeneity assessment using the I<span class="elsevierStyleSup">2</span> to be inconclusive because confidence intervals ranged between low and high heterogeneity&#46; In our case&#44; lack of power diminished the usefulness of I<span class="elsevierStyleSup">2</span>&#46; However&#44; when numerous large studies are meta-analysed&#44; the opposite problem may come up&#44; with clinically homogeneous studies &#40;i&#46;e&#46;&#44; with similar case-mixes&#44; treatments and controls&#41; turning out to be statistically heterogeneous&#46; Hence&#44; clinical reasoning should always be used to support and integrate statistical analyses&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Given these premises&#44; the use of a leave-one-out approach to investigate outliers turned out to be a winning strategy for testing our hypothesis that the PROSEVA trial was clinically too different from the previous trials to be meta-analytically combined with them&#46; However&#44; none of the nine meta-analyses adopted this strategy&#44; although Cochrane&#39;s handbook does recommend meta-analyses both with and without clearly outlying studies &#40;9&#46;5&#46;3 <span class="elsevierStyleItalic">Strategies for addressing heterogeneity</span>&#41;&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">Only one study investigated outliers&#44;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> using studentized residuals&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> However&#44; seeing PROSEVA trial was an outlier did not substantially affect its conclusions&#46;</p><p id="para0030" class="elsevierStylePara elsevierViewall">The use of a leave-one-out strategy allowed us to investigate heterogeneity in greater detail&#44; providing evidence in support of our hypothesis by showing that the higher heterogeneity was mainly attributable to the PROSEVA trial&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">There were good clinical reasons for not combining the PROSEVA trial with the other studies&#46; The main four RCTs that were published earlier had been unsuccessful in demonstrating improved survival &#40;ESM <a class="elsevierStyleCrossRef" href="#fig0001">Figs&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#fig0002">2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0003"><span class="elsevierStyleSup">3&#8211;6</span></a> However&#44; progress in physiological knowledge regarding ventilation in ARDS led to improvements in how the trials were designed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a> Thus&#44; it was possible to hypothesize that patients with the most severe hypoxia would benefit the most from pronation&#44;<a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> the duration of pronation needed to be prolonged&#44; and protective ventilation needed to be associated with prone ventilation&#46; The PROSEVA trial was designed on the basis of these hypotheses&#44; which make it inherently different from previous RCTs&#44; as Gattinoni et al&#46; have shown&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">However&#44; when trials bearing differences in case-mix&#44; study treatment and other associated treatments that may modify the outcome are combined in a meta-analysis&#44; the risk of generating spurious findings is high&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">Our study supports the hypothesis that the PROSEVA trial is an outlier compared to the RCTs that preceded it&#46; Our cumulative meta-analyses show that the PROSEVA trial changes the estimate of effect strikingly&#46; Moreover&#44; given the strong protective effect of the PROSEVA trial compared to the other trials&#44; the exclusion of the PROSEVA trial from any meta-analysis markedly increases the Cochran&#39;s Q p value and the p value for effectiveness&#46; Finally&#44; the protective effect of the PROSEVA trial was formally confirmed by interaction tests &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Several topics in medicine have been investigated over long periods of time as knowledge of these topics evolved&#46; Thus&#44; the case of the PROSEVA trial should not be considered an exception&#46; When it does happen&#44; attention should be paid to clinical heterogeneity before studies are selected for meta-analysis&#46; The problem of heterogeneity across studies&#44; typical for aggregated data&#44; could be offset by sharing trial datasets making individual-patient granular information public&#46; Individual-patient data could be analysed with powerful multivariable and machine-learning tools&#44; as has recently been done for ARDS phenotypes&#46;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Limitations</span><p id="para0035" class="elsevierStylePara elsevierViewall">The protocol for our meta-analysis was neither registered nor published&#46;</p><p id="para0036" class="elsevierStylePara elsevierViewall">Cochran&#39;s Q test has been criticized for its sensitivity to the number of studies included in meta-analysis and for its lack of power when performed on a low number of studies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> We argue&#44; however&#44; that neither the number of studies nor power issues could have affected the results of our study&#46; At each round in the leave-one-out process&#44; the number of studies remains the same &#40;the total number of RCTs minus one&#41; for each meta-analysis&#46; As to power&#44; it can be an issue if a threshold has to be reached&#59; in our study&#44; however&#44; we only focus on Cochran&#39;s Q <span class="elsevierStyleItalic">p</span>-value variations on a continuous scale&#44; regardless of any threshold&#46;</p><p id="para0037" class="elsevierStylePara elsevierViewall">The double-p plot is not a formal approach&#59; it only provides visual information&#46; The combination with an interaction test gives more precise measurement of difference in statistical terms but statistically significant differences do not necessarily have clinical relevance&#46; Moreover&#44; the double-p plot may yield very different patterns&#44; which may not be readily interpretable&#46; However&#44; in the specific case of prone ventilation for ARDS&#44; the clinical premises of heterogeneity and very clear patterns leave little uncertainty about the advisability of considering evidence from a PROSEVA trial independently of other trials&#46;</p><p id="para0038" class="elsevierStylePara elsevierViewall">Some authors have questioned the quality of evidence provided by the PROSEVA trial&#44; arguing that a higher prevalence of important prognostic factors may have favoured survival in the prone ventilation group&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> However&#44; assessment of quality lies outside the purview of our study&#44; which is to evaluate the appropriateness of the use of meta-analysis in a particular case&#46;</p></span></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Conclusions</span><p id="para0039" class="elsevierStylePara elsevierViewall">Weak evidence provided by meta-analyses may have fostered the low rate of prone ventilation prescriptions in severe ARDS reported in literature&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a> Our study brings out the limitations of the meta-analytical approach in treating ARDS and strongly reinforces Cochrane&#39;s recommendation that a one-by-one study exclusion analysis be performed when potential outlier studies are identified&#46;</p><p id="para0040" class="elsevierStylePara elsevierViewall">For clinical recommendations&#44; the findings of the PROSEVA trial should be regarded as an independent source of evidence&#46;</p></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Funding statement</span><p id="para0042" class="elsevierStylePara elsevierViewall">Research for the present paper has not been funded by any grant from funding agencies&#46;</p><p id="para0043" class="elsevierStylePara elsevierViewall">This research has not received any grant from funding agencies in the public&#44; commercial or not-for-profit sectors&#46; non-profit sectors&#46;</p></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Authorship</span><p id="para0045" class="elsevierStylePara elsevierViewall">Daniele Poole had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis&#46; Daniele Poole&#44; Roberto Fumagalli and Andrea Pisa contributed to the interpretation of studies and the writing of the manuscript&#46;</p></span><span id="sec0013a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019a">CRediT authorship contribution statement</span><p id="para0045a" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">D&#46; Poole&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#44; Data curation&#44; Formal analysis&#44; Methodology&#44; Writing &#8211; original draft&#46; <span class="elsevierStyleBold">A&#46; Pisa&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">R&#46; Fumagalli&#58;</span> Conceptualization&#44; Writing &#8211; review &#38; editing&#46;</p></span></span>"
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            1 => "Meta-analysis"
            2 => "Clinical heterogeneity"
            3 => "Statistical heterogeneity"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Background</span><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Researchers have tried unsuccessfully for many years using randomized controlled trials to show the efficacy of prone ventilation in treating ARDS&#46; These failed attempts were of use in designing the successful PROSEVA trial&#44; published in 2013&#46; However&#44; the evidence provided by meta-analyses in support of prone ventilation for ARDS was too low to be conclusive&#46; The present study shows that meta-analysis is indeed not the best approach for the assessment of evidence as to the efficacy of prone ventilation&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">We performed a cumulative meta-analysis to prove that only the PROSEVA trial&#44; due to its strong protective effect&#44; has substantially impacted on the outcome&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">We also replicated nine published meta-analyses including the PROSEVA trial&#46; We performed leave-one-out analyses&#44; removing one trial at a time from each meta-analysis&#44; measuring <span class="elsevierStyleItalic">p</span> values for effect size&#44; and also the Cochran&#39;s Q test for heterogeneity assessment&#46; We represented these analyses in a scatter plot to identify outlier studies influencing heterogeneity or overall effect size&#46; We used interaction tests to formally identify and evaluate differences with the PROSEVA trial&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">The positive effect of the PROSEVA trial accounted for most of the heterogeneity and for the reduction of overall effect size in the meta-analyses&#46; The interaction tests we conducted on the nine meta-analyses formally confirmed the difference in the effectiveness of prone ventilation between the PROSEVA trial the other studies&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">The clinical lack of homogeneity between the PROSEVA trial design and the other studies should have discouraged the use of meta-analysis&#46; Statistical considerations support this hypothesis&#44; suggesting that the PROSEVA trial is an independent source of evidence&#46;</p></span>"
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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">The plot depicts the degree of correlation between p values for effect size and p values for heterogeneity&#46; Points within the dashed square&#44; are the meta-analyses performed leaving out the PROSEVA trial by Guerin et al&#46; In all the other cases &#40;points within the dashed triangle&#41;&#44; the trial is included and the other RCTs are left out one at the time&#46; When the PROSEVA trial is left out from the meta-analysis&#44; both p values increase significantly compared to when the other trials are left out&#46; This means that both the p values for both the overall effect and heterogeneity are strongly influenced by the presence of the PROSEVA trial&#44; which should be regarded as the only outlier&#46; CMAJ &#61; Canadian Medical Association Journal&#44; ATS &#61; American Thoracic Society&#44; Crit Care &#61; Critical Care&#44; Crit Care Med &#61; Critical Care Medicine&#44; J Thorac Dis &#61; Journal of Thoracic Diseases&#44; Cochrane &#61; Cochrane Database of Systematic Reviews&#44; Med Int &#61; Medicina Intensiva&#44; Int Care Med &#61; Intensive Care Medicine&#46;</p>"
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                  \t\t\t\t\t\t</th><a name="en0005"></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">Estimate p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></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">I&#178; &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></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">Heterogeneity <span class="elsevierStyleItalic">p</span> value&nbsp;\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="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Annals of the ATS-2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8&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">at 28 days&#44; if not available&#44; at 30 days&#44; hospital or ICU discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;84 &#40;0&#46;67-1&#46;05&#41;&nbsp;\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">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">63 &#40;4-92&#41;&nbsp;\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">0&#46;018&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Crit Care-2014&nbsp;\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">7&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">at 28-30 days&nbsp;\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">0&#46;86 &#40;0&#46;68-1&#46;09&#41;&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">0&#46;203&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">68 &#40;12-92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Crit Care Med-2014&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">11&nbsp;\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">at the longest available follow-up&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">0&#46;86 &#40;0&#46;73-1&#46;01&#41;&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">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">50 &#40;0-80&#41;&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">0&#46;087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CMAJ-2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></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="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">at hospital discharge&#44; if not available&#44; at the longest duration of follow-up&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">0&#46;85 &#40;0&#46;72-1&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;072&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">50 &#40;0-83&#41;&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">0&#46;085&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Cochrane&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">8&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">at 10 to 30 days&#44; or ICU discharge&nbsp;\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">0&#46;84 &#40;0&#46;67-1&#46;06&#41;&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">0&#46;137&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">65 &#40;7-91&#41;&nbsp;\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="" valign="top">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Int Care Med-2014&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">8&nbsp;\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="" valign="top">at 60 days&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">0&#46;84 &#40;0&#46;68-1&#46;02&#41;&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">0&#46;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">65 &#40;14-92&#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">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">J Int Care Med-2021&nbsp;\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="" valign="top">6&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">at 28-30 days&#44; or ICU discharge&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">0&#46;84 &#40;0&#46;65-1&#46;09&#41;&nbsp;\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="" valign="top">0&#46;193&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">73 &#40;20-95&#41;&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">0&#46;006&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">J Thorac Dis-2015&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">8&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">at the longest available follow-up&nbsp;\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="" valign="top">0&#46;86 &#40;0&#46;71-1&#46;04&#41;&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">0&#46;124&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">66 &#40;8-93&#41;&nbsp;\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="" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Med Int-2015&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">7&nbsp;\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="" valign="top">at the longest available follow-up&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">0&#46;86 &#40;0&#46;7-1&#46;04&#41;&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">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">70 &#40;17-96&#41;&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">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Results of the nine meta-analyses performed using relative risks to measure outcome and random-effects models for variance assessment&#46; RR &#61; Relative risk&#44; Heterogeneity p value &#61; p value for the Cochran&#39;s Q statistics for assessment of heterogeneity&#44; 95&#37;-CI &#61; 95&#37; confidence interval&#44; <span class="elsevierStyleItalic">CMAJ</span> &#61; <span class="elsevierStyleItalic">Canadian Medical Association</span> Journal&#44; <span class="elsevierStyleItalic">ATS</span> &#61; <span class="elsevierStyleItalic">American Thoracic Society</span>&#44; Crit Care &#61; <span class="elsevierStyleItalic">Critical Care&#44; Crit Care Med</span> &#61; <span class="elsevierStyleItalic">Critical Care Medicine&#44; J Thorac Dis</span> &#61; <span class="elsevierStyleItalic">Journal of Thoracic Diseases&#44; Cochrane</span> &#61; <span class="elsevierStyleItalic">Cochrane Database of Systematic Reviews&#44; Med Int</span> &#61; <span class="elsevierStyleItalic">Medicina Intensiva</span>&#44; Int Care Med &#61; <span class="elsevierStyleItalic">Intensive Care Medicine</span>&#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="en0071"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Journal-year</th><a name="en0072"></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">PROSEVA trial</th><a name="en0073"></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">Meta-analysis ofthe other trials</th><a name="en0074"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value for interaction</th></tr><tr title="table-row"><a name="en0076"></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">RR &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0077"></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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0078"></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">RR &#40;95&#37;-CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0079"></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&nbsp;\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="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Annals of the ATS-2017&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">0&#46;49 &#40;0&#46;35-0&#46;69&#41;&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">&#60; 0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">0&#46;96 &#40;0&#46;85-1&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
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                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24134414"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0008"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in severe acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C Guerin"
                            1 => "J Reignier"
                            2 => "JC Richard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1214103"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "numero" => "23"
                        "paginaInicial" => "2159"
                        "paginaFinal" => "2168"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23688302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0009"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position for acute respiratory distress syndrome&#46; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Munshi"
                            1 => "L Del Sorbo"
                            2 => "NKJ Adhikari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/AnnalsATS.201704-343OT"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Am Thorac Soc"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "numero" => "Supplement&#95;4"
                        "paginaInicial" => "S280"
                        "paginaFinal" => "S2S8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29068269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S Sud"
                            1 => "JO Friedrich"
                            2 => "NK Adhikari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1503/cmaj.140081"
                      "Revista" => array:7 [
                        "tituloSerie" => "CMAJ"
                        "fecha" => "2014"
                        "volumen" => "186"
                        "numero" => "10"
                        "paginaInicial" => "E381"
                        "paginaFinal" => "E390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0011"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position for acute respiratory failure in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Bloomfield"
                            1 => "DW Noble"
                            2 => "A&#46; Sudlow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD008095.pub2"
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2015"
                        "numero" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0012"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of prone positioning on mortality in patients with acute respiratory distress syndrome&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "SL Hu"
                            1 => "HL He"
                            2 => "C Pan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc13896"
                      "Revista" => array:6 [
                        "tituloSerie" => "Critical Care"
                        "fecha" => "2014"
                        "volumen" => "18"
                        "numero" => "3"
                        "paginaInicial" => "R109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24887034"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0013"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome&#58; updated study-level meta-analysis of 11 randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JM Lee"
                            1 => "W Bae"
                            2 => "YJ Lee"
                            3 => "YJ&#46; Cho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000000122"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "42"
                        "numero" => "5"
                        "paginaInicial" => "1252"
                        "paginaFinal" => "1262"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0014"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning reduces mortality from acute respiratory distress syndrome in the low tidal volume era&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "JR Beitler"
                            1 => "S Shaefi"
                            2 => "SB Montesi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-3194-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2014"
                        "volumen" => "40"
                        "numero" => "3"
                        "paginaInicial" => "332"
                        "paginaFinal" => "341"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24435203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "SY Park"
                            1 => "HJ Kim"
                            2 => "KH Yoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2072-1439.2014.12.49"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "numero" => "3"
                        "paginaInicial" => "356"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25922713"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0016"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of prone position ventilation in patients with acute respiratory distress syndrome&#46; A systematic review and metaanalysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JA Mora-Arteaga"
                            1 => "OJ Bernal-Ramirez"
                            2 => "SJ&#46; Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2014.11.003"
                      "Revista" => array:7 [
                        "tituloSerie" => "Medicina Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "numero" => "6"
                        "paginaInicial" => "359"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25599942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0017"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multivariate meta-analysis of the mortality effect of prone positioning in the acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JL Moran"
                            1 => "PL&#46; Graham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/08850666211014479"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2021"
                        "volumen" => "36"
                        "numero" => "11"
                        "paginaInicial" => "1323"
                        "paginaFinal" => "1330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33942659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0018"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of prone position on inflammatory markers in patients with ARDS due to community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MC Chan"
                            1 => "JY Hsu"
                            2 => "HH Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0929-6646(08)60032-7"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Formos Med Assoc"
                        "fecha" => "2007"
                        "volumen" => "106"
                        "numero" => "9"
                        "paginaInicial" => "708"
                        "paginaFinal" => "716"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17908660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0019"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of prone positioning on clinical outcomes in children with acute lung injury&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "MA Curley"
                            1 => "PL Hibberd"
                            2 => "LD Fineman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.294.2.229"
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2005"
                        "volumen" => "294"
                        "numero" => "2"
                        "paginaInicial" => "229"
                        "paginaFinal" => "237"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16014597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-frequency oscillatory ventilation following prone positioning prevents a further impairment in oxygenation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D Demory"
                            1 => "P Michelet"
                            2 => "JM Arnal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000251128.60336.FE"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "numero" => "1"
                        "paginaInicial" => "106"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17133185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0021"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in acute respiratory distress syndrome&#58; a multicenter randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R Fernandez"
                            1 => "X Trenchs"
                            2 => "J Klamburg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-008-1119-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "numero" => "8"
                        "paginaInicial" => "1487"
                        "paginaFinal" => "1491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18427774"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0022"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning improves oxygenation in post-traumatic lung injury&#8211;a prospective randomized trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G Voggenreiter"
                            1 => "M Aufmkolk"
                            2 => "RJ Stiletto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2005"
                        "volumen" => "59"
                        "numero" => "2"
                        "paginaInicial" => "333"
                        "paginaFinal" => "341"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0023"
              "etiqueta" => "23"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone position as prevention of lung injury in comatose patients&#58; a prospective&#44; randomized&#44; controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P Beuret"
                            1 => "MJ Carton"
                            2 => "K Nourdine"
                            3 => "M Kaaki"
                            4 => "G Tramoni"
                            5 => "JC&#46; Ducreux"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-002-1266-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "numero" => "5"
                        "paginaInicial" => "564"
                        "paginaFinal" => "569"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12029403"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0024"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of prone positioning and high-frequency oscillatory ventilation in patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "L Papazian"
                            1 => "M Gainnier"
                            2 => "V Marin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ccm.0000181298.05474.2b"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "numero" => "10"
                        "paginaInicial" => "2162"
                        "paginaFinal" => "2171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16215365"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beneficial effect of a prone position for patients with hypoxemia after transthoracic esophagectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "I Watanabe"
                            1 => "H Fujihara"
                            2 => "K Sato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00003246-200208000-00021"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "numero" => "8"
                        "paginaInicial" => "1799"
                        "paginaFinal" => "1802"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12163796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0026"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cumulative meta-analysis of therapeutic trials for myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J Lau"
                            1 => "EM Antman"
                            2 => "J Jimenez-Silva"
                            3 => "B Kupelnick"
                            4 => "F Mosteller"
                            5 => "TC&#46; Chalmers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199207233270406"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1992"
                        "volumen" => "327"
                        "numero" => "4"
                        "paginaInicial" => "248"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1614465"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0027"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of study size on meta-analyses&#58; examination of underpowered studies in Cochrane reviews"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "RM Turner"
                            1 => "SM Bird"
                            2 => "JP&#46; Higgins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0059202"
                      "Revista" => array:6 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "numero" => "3"
                        "paginaInicial" => "e59202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23544056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0028"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why most discovered true associations are inflated"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "JP&#46; Ioannidis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EDE.0b013e31818131e7"
                      "Revista" => array:7 [
                        "tituloSerie" => "Epidemiology"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "numero" => "5"
                        "paginaInicial" => "640"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18633328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0029"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Publication and related bias in meta-analysis&#58; power of statistical tests and prevalence in the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "JA Sterne"
                            1 => "D Gavaghan"
                            2 => "M&#46; Egger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0895-4356(00)00242-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "2000"
                        "volumen" => "53"
                        "numero" => "11"
                        "paginaInicial" => "1119"
                        "paginaFinal" => "1129"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conducting meta-analyses in R with the metafor package"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46; Viechtbauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Statistic Software"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "numero" => "3"
                        "paginaInicial" => "1"
                        "paginaFinal" => "48"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0031"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A graphical method for exploring heterogeneity in meta-analyses&#58; application to a meta-analysis of 65 trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B Baujat"
                            1 => "C Mahe"
                            2 => "JP Pignon"
                            3 => "C&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/sim.1221"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stat Med"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "numero" => "18"
                        "paginaInicial" => "2641"
                        "paginaFinal" => "2652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12228882"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0032"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interaction revisited&#58; the difference between two estimates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "DG Altman"
                            1 => "JM&#46; Bland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.326.7382.219"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "326"
                        "numero" => "7382"
                        "paginaInicial" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12543843"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0033"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The combination of estimates from different experiments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46; Cochran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Biometrics"
                        "fecha" => "1954"
                        "volumen" => "10"
                        "paginaInicial" => "101"
                        "paginaFinal" => "129"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0034"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring inconsistency in meta-analyses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JP Higgins"
                            1 => "SG Thompson"
                            2 => "JJ Deeks"
                            3 => "DG&#46; Altman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.327.7414.557"
                      "Revista" => array:7 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "327"
                        "numero" => "7414"
                        "paginaInicial" => "557"
                        "paginaFinal" => "560"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12958120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quantifying heterogeneity in a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "JP Higgins"
                            1 => "SG&#46; Thompson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/sim.1186"
                      "Revista" => array:7 [
                        "tituloSerie" => "Stat Med"
                        "fecha" => "2002"
                        "volumen" => "21"
                        "numero" => "11"
                        "paginaInicial" => "1539"
                        "paginaFinal" => "1558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12111919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0036"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "R&#58; A Language and Environment for Statistical Computing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "R Core Team"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2015"
                        "editorial" => "R Foundation for Statistical Computing"
                        "editorialLocalizacion" => "Vienna&#44; Austria"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;www&#46;R-project&#46;org&#47;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0037"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American thoracic society&#47;European Society of intensive care medicine&#47;society of critical care medicine clinical practice guideline&#58; mechanical ventilation in adult patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E Fan"
                            1 => "L Del Sorbo"
                            2 => "EC Goligher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201703-0548ST"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "195"
                        "numero" => "9"
                        "paginaInicial" => "1253"
                        "paginaFinal" => "1263"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28459336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0038"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning improves survival in severe ARDS&#58; a pathophysiologic review and individual patient meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L Gattinoni"
                            1 => "E Carlesso"
                            2 => "P Taccone"
                            3 => "F Polli"
                            4 => "C Guerin"
                            5 => "J&#46; Mancebo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2010"
                        "volumen" => "76"
                        "numero" => "6"
                        "paginaInicial" => "448"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20473258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0039"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outlier and influence diagnostics for meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W Viechtbauer"
                            1 => "MW&#46; Cheung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jrsm.11"
                      "Revista" => array:6 [
                        "tituloSerie" => "Res Synthesis Methods"
                        "fecha" => "2010"
                        "volumen" => "1"
                        "numero" => "2"
                        "paginaInicial" => "112"
                        "paginaFinal" => "125"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone positioning in acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L Gattinoni"
                            1 => "M Busana"
                            2 => "L Giosa"
                            3 => "MM Macri"
                            4 => "M&#46; Quintel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0039-1685180"
                      "Revista" => array:7 [
                        "tituloSerie" => "Semin Respir Crit Care Med"
                        "fecha" => "2019"
                        "volumen" => "40"
                        "numero" => "1"
                        "paginaInicial" => "94"
                        "paginaFinal" => "100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31060091"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0041"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S Sud"
                            1 => "JO Friedrich"
                            2 => "P Taccone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-009-1748-1"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "numero" => "4"
                        "paginaInicial" => "585"
                        "paginaFinal" => "599"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20130832"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0042"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interpretation of tests of heterogeneity and bias in meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "JP&#46; Ioannidis"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2753.2008.00986.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Eval Clin Pract"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "numero" => "5"
                        "paginaInicial" => "951"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19018930"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0043"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of parsimonious algorithms to classify acute respiratory distress syndrome phenotypes&#58; a secondary analysis of randomised controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P Sinha"
                            1 => "KL Delucchi"
                            2 => "DF McAuley"
                            3 => "CM O&#39;Kane"
                            4 => "MA Matthay"
                            5 => "CS&#46; Calfee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(19)30369-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2020"
                        "volumen" => "8"
                        "numero" => "3"
                        "paginaInicial" => "247"
                        "paginaFinal" => "257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31948926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0044"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to improve assessment of balance in baseline characteristics of clinical trial participants-example from PROSEVA trial data&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E Festic"
                            1 => "B Rawal"
                            2 => "O&#46; Gajic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2305-5839.2016.01.30"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Transl Med"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "numero" => "4"
                        "paginaInicial" => "79"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0045"
              "etiqueta" => "45"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Epidemiology&#44; patterns of care&#44; and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
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                            1 => "JG Laffey"
                            2 => "T Pham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2016.0291"
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                        "tituloSerie" => "JAMA"
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                        "volumen" => "315"
                        "numero" => "8"
                        "paginaInicial" => "788"
                        "paginaFinal" => "800"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26903337"
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