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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Chronic airflow limitation &#40;CAL&#41; is a significant cause of illness and death&#46; Inspiratory muscle training has been described as a technique for managing CAL&#46; The aim of the present study was to evaluate the effectiveness of inspiratory muscle training on improving physiological and functional variables&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Randomized controlled trial in which 35 patients with CAL were assigned to receive either an experimental &#40;n&#61;17&#41; or control &#40;n&#61;18&#41; intervention&#46; The experimental intervention consisted of 2 months of inspiratory muscle training using a device that administered a resistive load of 40&#37; of maximal static inspiratory mouth pressure &#40;PI<span class="elsevierStyleInf">max</span>&#41;&#46; Inspiratory muscle strength&#44; exercise tolerance&#44; respiratory function&#44; and quality of life were assessed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Significant improvement in inspiratory muscle strength was observed in the experimental training group &#40;P&#61;&#46;02&#41;&#46; All patients improved over time in both groups &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; PI<span class="elsevierStyleInf">max</span> increased by 8&#46;9 cm H<span class="elsevierStyleInf">2</span>O per month of training&#46; Likewise&#44; the health-related quality of life scores improved by 0&#46;56 points&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStyleSimplePara elsevierViewall">Use of a threshold loading device is effective for strengthening inspiratory muscles as measured by PI<span class="elsevierStyleInf">max</span> after the first month of training in patients with CAL&#46; The long-term effectiveness of such training and its impact on quality of life should be studied in a larger number of patients&#46;</p>"
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                          "autores" => array:1 [
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                        "tituloSerie" => "Rev Ch Enf Respir"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "77"
                        "paginaFinal" => "82"
                      ]
                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "ATS statement&#46; Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B Celli"
                            1 => "G Snider"
                            2 => "J Heffner"
                            3 => "B Tiep"
                            4 => "I Ziment"
                            5 => "B Make"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "152"
                        "numero" => "Supl 1"
                        "paginaInicial" => "78"
                        "paginaFinal" => "121"
                      ]
                    ]
                  ]
                ]
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                          "autores" => array:1 [
                            0 => "H Saroea"
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                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Postgrad Med"
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                        "volumen" => "94"
                        "paginaInicial" => "113"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8341621"
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                ]
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                          "autores" => array:1 [
                            0 => "R Barr"
                          ]
                        ]
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                        "titulo" => "Essentials of cardiopulmonary physical therapy"
                        "paginaInicial" => "677"
                        "paginaFinal" => "701"
                        "serieFecha" => "1994"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "5"
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                          "autores" => array:3 [
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                            2 => "RS Goldstein"
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                  ]
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                    0 => array:1 [
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                        "tituloSerie" => "Chest"
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                        "paginaFinal" => "1088"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9106590"
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                          "autores" => array:5 [
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                            3 => "AR van Keimpema"
                            4 => "HC Kemper"
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                      "Revista" => array:5 [
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                        "paginaFinal" => "111"
                      ]
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                  ]
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                          "autores" => array:4 [
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                            2 => "BW Beasley"
                            3 => "DR Calkins"
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                        ]
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                    ]
                  ]
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                        "tituloSerie" => "J Gen Intern Med"
                        "fecha" => "2003"
                        "volumen" => "18"
                        "paginaInicial" => "213"
                        "paginaFinal" => "221"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12648254"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Lacasse Y&#44; Brosseau L&#44; Milne S&#44; Martin S&#44; Wong E&#44; Guyatt GH&#44; et al&#46; Pulmonary rehabilitation for chronic obstructive pulmonary disease &#40;Cochrane Review&#41;&#46; In&#58; The Cochrane Library&#44; Issue 4&#44; 2004&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Controlled trial of respiratory muscle training in chronic airflow limitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G Guyatt"
                            1 => "J Keller"
                            2 => "J Singer"
                            3 => "S Halcrow"
                            4 => "M Newhouse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1992"
                        "volumen" => "47"
                        "paginaInicial" => "598"
                        "paginaFinal" => "602"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1412115"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J Larson"
                            1 => "M Kim"
                            2 => "J Sharp"
                            3 => "D Larson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/138.3.689"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1988"
                        "volumen" => "138"
                        "paginaInicial" => "689"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3202422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "MJ Belman"
                            1 => "R Shadmehr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol"
                        "fecha" => "1988"
                        "volumen" => "65"
                        "paginaInicial" => "2726"
                        "paginaFinal" => "2735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3215873"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted inspiratory muscle training improves respiratory muscle function and reduces dyspnea in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A Harver"
                            1 => "D Mahler"
                            2 => "A Daubenspeck"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1989"
                        "volumen" => "111"
                        "paginaInicial" => "117"
                        "paginaFinal" => "124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2742247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Applicability of a threshold loading device for inspiratory muscle testing and training in patients with COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Goldstein"
                            1 => "J Derosie"
                            2 => "S Long"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1989"
                        "volumen" => "96"
                        "paginaInicial" => "564"
                        "paginaFinal" => "571"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2766815"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Target-flow inspiratory muscle training during pulmonary rehabilitation in patients with COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "PN Dekhuijzen"
                            1 => "HT Folgerin"
                            2 => "CL van Herwaarden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "99"
                        "paginaInicial" => "128"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1984942"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inspiratory muscle training in chronic airflow limitation&#58; effect on exercise performance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C Lisboa"
                            1 => "C Villafranca"
                            2 => "A Leiva"
                            3 => "E Cruz"
                            4 => "J Pertuz&#233;"
                            5 => "G Borzone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1997"
                        "volumen" => "10"
                        "paginaInicial" => "537"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9072981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Entrenamiento muscular inspiratorio en pacientes con enfermedad pulmonar obstructiva cr&#243;nica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C Lisboa"
                            1 => "G Borzone"
                            2 => "E Cruz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "1998"
                        "volumen" => "126"
                        "paginaInicial" => "563"
                        "paginaFinal" => "568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9731440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory muscles&#58; functional evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B Celli"
                            1 => "A Grassino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sem Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "367"
                        "paginaFinal" => "381"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of respiratory muscle function and strength"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N Syabbalo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Postgrad Med"
                        "fecha" => "1998"
                        "volumen" => "74"
                        "paginaInicial" => "208"
                        "paginaFinal" => "215"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Six-minute walk testing"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F Sciurba"
                            1 => "W Slivka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Sem Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "383"
                        "paginaFinal" => "392"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Determinaci&#243;n de valores espirom&#233;tricos en una poblaci&#243;n chilena normal mayor de 5 a&#241;os&#44; anivel del mar"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M Guti&#233;rrez"
                            1 => "F Rioseco"
                            2 => "A Rojas"
                            3 => "D Casanova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "1996"
                        "volumen" => "124"
                        "paginaInicial" => "1295"
                        "paginaFinal" => "1306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9293093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality of life in patients with chronic respiratory disease&#58; the Spanish version of the Chronic Respiratory Questionnaire &#40;CRQ&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R G&#250;ell"
                            1 => "P Casan"
                            2 => "M Sangen&#237;s"
                            3 => "F Morante"
                            4 => "J Belda"
                            5 => "G Guyatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1998"
                        "volumen" => "11"
                        "paginaInicial" => "55"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9543270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A measure of quality of life for clinical trials in chronic lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G Guyatt"
                            1 => "L Berman"
                            2 => "M Towsend"
                            3 => "S Pugsley"
                            4 => "L Chambers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1987"
                        "volumen" => "42"
                        "paginaInicial" => "773"
                        "paginaFinal" => "778"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3321537"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of discriminative properties among Disease-specific Questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T Hajiro"
                            1 => "K Nishimura"
                            2 => "M Tsukino"
                            3 => "A Ikeda"
                            4 => "H Koyama"
                            5 => "T Izumi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.157.3.9703055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "785"
                        "paginaFinal" => "790"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9517591"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reliability and validity of the chronic respiratory questionnaire &#40;CRQ&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P Wijstra"
                            1 => "E Tenvergert"
                            2 => "R Vanaltena"
                            3 => "V Otten"
                            4 => "D Postma"
                            5 => "J Kraan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "1994"
                        "volumen" => "49"
                        "paginaInicial" => "465"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8016767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Valoraci&#243;n de la calidad de vida de los pacientes con EPOC e hipoxemia cr&#243;nica mediante la versi&#243;n espa&#241;ola del Chronic Respiratory Disease Questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J Sans-Torres"
                            1 => "C Domingo"
                            2 => "M Rue"
                            3 => "E Dur&#225;n-Tauleria"
                            4 => "A Mar&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "1999"
                        "volumen" => "35"
                        "paginaInicial" => "428"
                        "paginaFinal" => "434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10596339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calidad de vida en pacientes con enfermedad pulmonar obstructiva cr&#243;nica e impacto del entrenamiento f&#237;sico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C Lisboa"
                            1 => "C Villafranca"
                            2 => "G Caiozzi"
                            3 => "C Berrocal"
                            4 => "A Leiva"
                            5 => "R Pinochet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "2001"
                        "volumen" => "129"
                        "paginaInicial" => "359"
                        "paginaFinal" => "366"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11413987"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validaci&#243;n del Cuestionario de la Enfermedad Respiratoria Cr&#243;nica en pacientes chilenos con limitaci&#243;n cr&#243;nica del flujo a&#233;reo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P Ser&#243;n"
                            1 => "P Riedemann"
                            2 => "A Sanhueza"
                            3 => "A Doussoulin"
                            4 => "P Villarroel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Chil"
                        "fecha" => "2003"
                        "volumen" => "131"
                        "paginaInicial" => "1243"
                        "paginaFinal" => "1250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14743684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "DG Kleinbaum"
                            1 => "LL Kupper"
                            2 => "KE Muller"
                            3 => "A Nizam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "3rd ed&#46;"
                        "titulo" => "Applied regression analysis and multivariable methods"
                        "fecha" => "1998"
                        "editorial" => "Duxbury Press"
                        "editorialLocalizacion" => "California"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory muscle training in chronic airflow limitation&#58; a meta-analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K Smith"
                            1 => "D Cook"
                            2 => "G Guyatt"
                            3 => "J Madhaven"
                            4 => "A Oxman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/145.3.533"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1992"
                        "volumen" => "145"
                        "paginaInicial" => "533"
                        "paginaFinal" => "539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1532118"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement in volitional tests of muscle function alone may not be adequate evidence that inspiratory muscle training is effective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "MI Polkey"
                            1 => "J Moxham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2004"
                        "volumen" => "23"
                        "paginaInicial" => "5"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14738222"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Berman LB&#44; Goldsmith CH&#44; Jones NL&#44; McIntosh JM&#46; Resistive Inspiratory Breathing and Cycle Ergometer in Chronic Airflow Obstruction&#46; Final report &#40;DM545&#41; Ontario Ministry of Health- and Ontario Thoracic Society&#44; 1986-08&#44; p&#46; 37 &#43; 9 appendices&#46;"
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measurement of health status&#46; Ascertaining the minimal clinically important difference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R Jaeschke"
                            1 => "J Singer"
                            2 => "G Guyatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Control Clin Trials"
                        "fecha" => "1989"
                        "volumen" => "10"
                        "paginaInicial" => "407"
                        "paginaFinal" => "415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2691207"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing the minimal important difference in symptoms&#58; a comparison of two techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "DA Redelmeier"
                            1 => "GH Guyatt"
                            2 => "RS Goldstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Epidemiol"
                        "fecha" => "1996"
                        "volumen" => "49"
                        "paginaInicial" => "1215"
                        "paginaFinal" => "1219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8892486"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of breathlessness and pulmonary rehabilitation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A Hough"
                          ]
                        ]
                      ]
                    ]
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                        "edicion" => "2nd ed&#46;"
                        "titulo" => "Physiotherapy in Respiratory Care&#46; A problem-solving approach to respiratory and cardiac management"
                        "fecha" => "1996"
                        "editorial" => "Stanley Thornes"
                        "editorialLocalizacion" => "Cheltenham"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 41. Issue 11.
Pages 601-606 (November 2005)
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Vol. 41. Issue 11.
Pages 601-606 (November 2005)
Original Articles
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Effect of Inspiratory Muscle Training on Muscle Strength and Quality of Life in Patients With Chronic Airflow Limitation: a Randomized Controlled Trial
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P. Seróna,
Corresponding author
pseron@ufro.cl

Correspondence: Prof.a P. Serón. Facultad de Medicina. Universidad de La Frontera. Manuel Montt, 112. Temuco. Chile
, P. Riedemannb, S. Muñozc, A. Doussoulinb,d, P. Villarroelb,c, X. Ceab
a Departamento de Cirugía y Traumatología, Capacitación, Investigación y Gestión para la Salud Basada en Evidencias (CIGES), Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
b Departamento de Medicina Interna, CIGES, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
c Departamento de Salud Pública, CIGES, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
d Departamento de Pediatría, CIGES, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
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Article information
Objective

Chronic airflow limitation (CAL) is a significant cause of illness and death. Inspiratory muscle training has been described as a technique for managing CAL. The aim of the present study was to evaluate the effectiveness of inspiratory muscle training on improving physiological and functional variables.

Patients and methods

Randomized controlled trial in which 35 patients with CAL were assigned to receive either an experimental (n=17) or control (n=18) intervention. The experimental intervention consisted of 2 months of inspiratory muscle training using a device that administered a resistive load of 40% of maximal static inspiratory mouth pressure (PImax). Inspiratory muscle strength, exercise tolerance, respiratory function, and quality of life were assessed.

Results

Significant improvement in inspiratory muscle strength was observed in the experimental training group (P=.02). All patients improved over time in both groups (P<.001). PImax increased by 8.9 cm H2O per month of training. Likewise, the health-related quality of life scores improved by 0.56 points.

Conclusion

Use of a threshold loading device is effective for strengthening inspiratory muscles as measured by PImax after the first month of training in patients with CAL. The long-term effectiveness of such training and its impact on quality of life should be studied in a larger number of patients.

Key Words:
Health-related quality of life
Chronic airflow limitation
Respiratory rehabilitation
Respiratory muscles
Randomized controlled trial
Objetivo

La limitación crónica del flujo aéreo (LCFA) es causa importante de morbimortalidad. Para su manejo se describe la rehabilitación pulmonar, que incluye el entrenamiento muscular inspiratorio. El objetivo del presente estu-dio fue evaluar la efectividad del entrenamiento muscular inspiratorio par mejorar variables fisiológicas y funcionales.

Pacientes y métodos

Ensayo clínico controlado y aleatorizado en 35 pacientes con LCFA, de los que 17 recibieron una intervención experimental y 18 una de control. La intervención experimental consistió en un programa de 2 meses de entrenamiento de músculos inspiratorios usando un dis-positivo que administraba una resistencia de un 40% de la presión inspiratoria máxima. Se evaluaron la fuerza muscular inspiratoria, la tolerancia al ejercicio, la función respira-toria y la calidad de vida.

Resultados

El tratamiento experimental mostró una mejoría significativa en la fuerza muscular inspiratoria (p = 0,02). Todos los pacientes mejoraron a lo largo del tiempo independientemente del tratamiento experimental (p < 0,001); la presión inspiratoria máxima aumentó en 8,9 cm H2O por mes de entrenamiento; asimismo, hubo un aumento de 0,56 puntos en el cuestionario que evaluó la calidad de vida relacionada con la salud.

Conclusión

La utilización específica de un dispositivo de carga umbral es efectiva en el fortalecimiento muscular inspiratorio, medido a través de la presión inspiratoria máxima, al primer mes de entrenamiento en pacientes con LCFA. Es necesario estudiar su efecto a largo plazo y su impacto sobre la calidad de vida en un mayor número de pacientes.

Palabras clave:
Calidad de vida relacionada con la salud
Limitación crónica del flujo aéreo
Rehabilitación pulmonar
Músculos respiratorios
Ensayo clínico
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REFERENCES
[1]
P González.
Consenso Nacional en Enfermedad Pulmonar Obstructiva Crónica (EPOC).
Rev Ch Enf Respir, 14 (1998), pp. 77-82
[2]
B Celli, G Snider, J Heffner, B Tiep, I Ziment, B Make, et al.
ATS statement. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 152 (1995), pp. 78-121
[3]
H Saroea.
Chronic obstructive pulmonary disease. Major objectives of management.
Postgrad Med, 94 (1993), pp. 113-122
[4]
R Barr.
Pulmonary rehabilitation.
Essentials of cardiopulmonary physical therapy, pp. 677-701
[5]
Y Lacasse, GH Guyatt, RS Goldstein.
The components of a respiratory rehabilitation program: a systematic overview.
Chest, 111 (1997), pp. 1077-1088
[6]
W Cambach, RC Wagenaar, TW Koelman, AR van Keimpema, HC Kemper.
The long-term effects of pulmonary rehabilitation in patients with asthma and chronic obstructive pulmonary disease: a research synthesis.
Arch Phys Med Rehabil, 80 (1999), pp. 103-111
[7]
GF Salman, MC Mosier, BW Beasley, DR Calkins.
Rehabilitation for patients with chronic obstructive pulmonary disease: metaanalysis of randomized controlled trials.
J Gen Intern Med, 18 (2003), pp. 213-221
[8]
Lacasse Y, Brosseau L, Milne S, Martin S, Wong E, Guyatt GH, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease (Cochrane Review). In: The Cochrane Library, Issue 4, 2004.
[9]
G Guyatt, J Keller, J Singer, S Halcrow, M Newhouse.
Controlled trial of respiratory muscle training in chronic airflow limitation.
Thorax, 47 (1992), pp. 598-602
[10]
J Larson, M Kim, J Sharp, D Larson.
Inspiratory muscle training with a pressure threshold breathing device in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 138 (1988), pp. 689-696
[11]
MJ Belman, R Shadmehr.
Targeted resistive ventilatory muscle training in chronic obstructive pulmonary disease.
J Appl Physiol, 65 (1988), pp. 2726-2735
[12]
A Harver, D Mahler, A Daubenspeck.
Targeted inspiratory muscle training improves respiratory muscle function and reduces dyspnea in patients with chronic obstructive pulmonary disease.
Ann Intern Med, 111 (1989), pp. 117-124
[13]
R Goldstein, J Derosie, S Long.
Applicability of a threshold loading device for inspiratory muscle testing and training in patients with COPD.
Chest, 96 (1989), pp. 564-571
[14]
PN Dekhuijzen, HT Folgerin, CL van Herwaarden.
Target-flow inspiratory muscle training during pulmonary rehabilitation in patients with COPD.
Chest, 99 (1991), pp. 128-133
[15]
C Lisboa, C Villafranca, A Leiva, E Cruz, J Pertuzé, G Borzone.
Inspiratory muscle training in chronic airflow limitation: effect on exercise performance.
Eur Respir J, 10 (1997), pp. 537-542
[16]
C Lisboa, G Borzone, E Cruz.
Entrenamiento muscular inspiratorio en pacientes con enfermedad pulmonar obstructiva crónica.
Rev Med Chil, 126 (1998), pp. 563-568
[17]
B Celli, A Grassino.
Respiratory muscles: functional evaluation.
Sem Respir Crit Care Med, 19 (1998), pp. 367-381
[18]
N Syabbalo.
Assessment of respiratory muscle function and strength.
Postgrad Med, 74 (1998), pp. 208-215
[19]
F Sciurba, W Slivka.
Six-minute walk testing.
Sem Respir Crit Care Med, 19 (1998), pp. 383-392
[20]
M Gutiérrez, F Rioseco, A Rojas, D Casanova.
Determinación de valores espirométricos en una población chilena normal mayor de 5 años, anivel del mar.
Rev Med Chil, 124 (1996), pp. 1295-1306
[21]
R Gúell, P Casan, M Sangenís, F Morante, J Belda, G Guyatt.
Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ).
Eur Respir J, 11 (1998), pp. 55-60
[22]
G Guyatt, L Berman, M Towsend, S Pugsley, L Chambers.
A measure of quality of life for clinical trials in chronic lung disease.
Thorax, 42 (1987), pp. 773-778
[23]
T Hajiro, K Nishimura, M Tsukino, A Ikeda, H Koyama, T Izumi.
Comparison of discriminative properties among Disease-specific Questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 157 (1998), pp. 785-790
[24]
P Wijstra, E Tenvergert, R Vanaltena, V Otten, D Postma, J Kraan, et al.
Reliability and validity of the chronic respiratory questionnaire (CRQ).
Thorax, 49 (1994), pp. 465-467
[25]
J Sans-Torres, C Domingo, M Rue, E Durán-Tauleria, A Marín.
Valoración de la calidad de vida de los pacientes con EPOC e hipoxemia crónica mediante la versión española del Chronic Respiratory Disease Questionnaire.
Arch Bronconeumol, 35 (1999), pp. 428-434
[26]
C Lisboa, C Villafranca, G Caiozzi, C Berrocal, A Leiva, R Pinochet.
Calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica e impacto del entrenamiento físico.
Rev Med Chil, 129 (2001), pp. 359-366
[27]
P Serón, P Riedemann, A Sanhueza, A Doussoulin, P Villarroel.
Validación del Cuestionario de la Enfermedad Respiratoria Crónica en pacientes chilenos con limitación crónica del flujo aéreo.
Rev Med Chil, 131 (2003), pp. 1243-1250
[28]
DG Kleinbaum, LL Kupper, KE Muller, A Nizam.
Applied regression analysis and multivariable methods, 3rd ed., Duxbury Press, (1998),
[29]
K Smith, D Cook, G Guyatt, J Madhaven, A Oxman.
Respiratory muscle training in chronic airflow limitation: a meta-analysis.
Am Rev Respir Dis, 145 (1992), pp. 533-539
[30]
MI Polkey, J Moxham.
Improvement in volitional tests of muscle function alone may not be adequate evidence that inspiratory muscle training is effective.
Eur Respir J, 23 (2004), pp. 5-6
[31]
Berman LB, Goldsmith CH, Jones NL, McIntosh JM. Resistive Inspiratory Breathing and Cycle Ergometer in Chronic Airflow Obstruction. Final report (DM545) Ontario Ministry of Health- and Ontario Thoracic Society, 1986-08, p. 37 + 9 appendices.
[32]
R Jaeschke, J Singer, G Guyatt.
Measurement of health status. Ascertaining the minimal clinically important difference.
Control Clin Trials, 10 (1989), pp. 407-415
[33]
DA Redelmeier, GH Guyatt, RS Goldstein.
Assessing the minimal important difference in symptoms: a comparison of two techniques.
J Clin Epidemiol, 49 (1996), pp. 1215-1219
[34]
A Hough.
Management of breathlessness and pulmonary rehabilitation.
Physiotherapy in Respiratory Care. A problem-solving approach to respiratory and cardiac management, 2nd ed., Stanley Thornes, (1996),

This study was funded by the Department of Research and Development of Universidad de la Frontera, Temuco, Chile (project IN 00/01).

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