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por lo que su desconexi&#243;n debe realizarse tan pronto como el paciente sea capaz de sostener su respiraci&#243;n espont&#225;nea&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La desconexi&#243;n del respirador mec&#225;nico incluye en un sentido amplio dos situaciones completamente diferentes aunque relacionadas&#58; el descenso progresivo de la asistencia respiratoria &#40;destete&#41; y la remoci&#243;n del tubo endotraqueal &#40;extubaci&#243;n&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El <span class="elsevierStyleItalic">destete</span> puede ser definido como la reducci&#243;n gradual del soporte respiratorio&#44; asignando un tiempo de respiraci&#243;n espont&#225;nea que permita al paciente asumir la responsabilidad de un intercambio gaseoso aceptable<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Este proceso puede durar entre el 40 al 50&#37; del tiempo total de la estancia en VM&#46; Sin embargo&#44; algunos pacientes fracasan&#44; prolongando la permanencia en el respirador&#46; Diversas condiciones fisiopatol&#243;gicas han sido vinculadas a dicho fracaso&#44; como sobrecarga ventilatoria&#44; disfunci&#243;n hemodin&#225;mica&#44; incompetencia neuromuscular &#40;central y&#47;o perif&#233;rica&#41;&#44; debilidad muscular diafragm&#225;tica&#44; alteraciones nutricionales y trastornos metab&#243;licos&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; No obstante&#44; identificar el mecanismo predominante sigue representando un desaf&#237;o para el equipo tratante&#44; ya que este habitualmente es complejo y multifactorial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La <span class="elsevierStyleItalic">extubaci&#243;n</span> consiste en la remoci&#243;n del tubo endotraqueal&#46; Generalmente este momento coincide con la determinaci&#243;n de que el paciente es capaz de mantener un intercambio gaseoso efectivo sin soporte del respirador o con un soporte adicional m&#237;nimo&#46; Sin embargo&#44; la extubaci&#243;n presenta predictores de &#233;xito y&#47;o fracaso espec&#237;ficos&#44; los cuales habitualmente est&#225;n relacionados con la habilidad de protecci&#243;n de la v&#237;a a&#233;rea&#44; el manejo de secreciones y la permeabilidad de la v&#237;a a&#233;rea superior<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El t&#233;rmino <span class="elsevierStyleItalic">fracaso de extubaci&#243;n</span> &#40;FE&#41; representa un conjunto de condiciones que determinan la necesidad de reintubaci&#243;n y restablecimiento de la VM dentro de las primeras 24 a 72<span class="elsevierStyleHsp" style=""></span>h posteriores al retiro del tubo endotraqueal<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; En adultos&#44; cerca de 55 estudios &#40;33&#46;000 pacientes aproximadamente&#41; reportan una tasa media de FE del 12&#44;5&#37; &#40;rango&#44; 2-25&#37;&#41;&#46; En pediatr&#237;a&#44; la tasa de FE es igual de heterog&#233;nea&#44; y var&#237;a entre el 4&#44;9 y el 29&#37;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Existe controversia acerca de la tasa de FE &#243;ptima&#44; ya que valores muy reducidos pudieran reflejar la prolongaci&#243;n innecesaria de la VM&#44; lo que derivar&#237;a en un aumento del riesgo de neumon&#237;a asociada a VM&#44; de la estancia hospitalaria y de la mortalidad&#46; En este sentido&#44; Kurachek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reportaron que el 62&#44;5&#37; de 136 extubaciones no planificadas no requirieron reintubaci&#243;n&#44; por lo que muchos de estos ni&#241;os pudieron ser extubados antes de lo planeado&#46; En contraposici&#243;n&#44; valores muy elevados indicar&#237;an una extubaci&#243;n prematura&#44; la que se asocia a potenciales morbilidades catastr&#243;ficas&#44; fundamentalmente hemodin&#225;micas y respiratorias<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; De todas maneras&#44; ambas situaciones pueden incrementar la duraci&#243;n de la VM&#44; la estancia en la UCI y hospitalaria y&#44; por ende&#44; los costos en salud<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; De este modo&#44; la decisi&#243;n tanto de iniciar el proceso de destete as&#237; como la extubaci&#243;n deben estar basados en criterios objetivos y reproducibles&#44; lo que en pediatr&#237;a cuenta con un nivel de evidencia a&#250;n limitado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de esta revisi&#243;n fue analizar la informaci&#243;n disponible sobre el destete y la extubaci&#243;n en pediatr&#237;a&#44; realizando una comparaci&#243;n con los principales estudios de la misma tem&#225;tica en la poblaci&#243;n adulta&#46; Bas&#225;ndonos en la informaci&#243;n actual&#44; sugerimos una forma de abordar esta decisi&#243;n en ni&#241;os gravemente enfermos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protocolos de destete</span><p id="par0035" class="elsevierStylePara elsevierViewall">La decisi&#243;n de iniciar el destete depende del cumplimiento de ciertos criterios cl&#237;nicos&#44; tales como el control de la causa que motiv&#243; la conexi&#243;n a VM&#44; el intercambio gaseoso efectivo&#44; la condici&#243;n neuromuscular apropiada&#44; el nivel de conciencia adecuado que permita la protecci&#243;n de la v&#237;a a&#233;rea y un estado hemodin&#225;mico estable<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Habitualmente esta decisi&#243;n recae en el m&#233;dico intensivista&#44; quien inicia el proceso cuando sospecha que el destete puede ser exitoso<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Sin embargo&#44; la aplicaci&#243;n de protocolos de destete guiados tanto por enfermeras como por terapeutas respiratorios sugiere que la identificaci&#243;n precoz de pacientes en condiciones de realizar un ensayo de respiraci&#243;n espont&#225;nea &#40;ERE&#41;&#44; a trav&#233;s de la evaluaci&#243;n de criterios cl&#237;nicos espec&#237;ficos&#44; logra reducir el tiempo de destete&#44; la duraci&#243;n de la VM y la estancia en la UCI en pacientes adultos<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;21</span></a>&#46; Uno de los primeros reportes sobre la tem&#225;tica fue realizado por Ely et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; quienes mostraron que el empleo de una evaluaci&#243;n diaria de ciertos criterios &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200&#44; presi&#243;n positiva al final de la espiraci&#243;n &#40;<span class="elsevierStyleItalic">positive pressure end-expiratory</span> &#91;PEEP&#93;&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; presencia del reflejo de tos&#44; relaci&#243;n frecuencia respiratoria&#47;volumen tidal &#40;FR&#47;V<span class="elsevierStyleInf">T</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>105&#44; sin vasopresores y agentes sedantes&#41; junto a la aplicaci&#243;n del ERE redujo la duraci&#243;n y las complicaciones asociadas a la VM&#44; disminuyendo los costos en salud&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En pediatr&#237;a&#44; la eficacia de los protocolos de destete a&#250;n es controvertida<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; Schultz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> expusieron que el empleo de un protocolo redujo el tiempo destinado al destete respecto a la intervenci&#243;n guiada por el m&#233;dico intensivista&#46; Sin embargo&#44; tanto la duraci&#243;n de la VM como el tiempo de extubaci&#243;n no mostraron diferencias significativas entre ambos grupos&#46; Un estudio multic&#233;ntrico y prospectivo realizado por el grupo de investigaci&#243;n PALISI mostr&#243; que el empleo de un protocolo de destete en pacientes pedi&#225;tricos sometidos a VM&#44; quienes hab&#237;an experimentado un fracaso de destete previo&#44; no redujo de forma significativa el tiempo de destete&#44; as&#237; como tampoco la tasa de FE&#44; en comparaci&#243;n con la intervenci&#243;n est&#225;ndar&#46; Adem&#225;s&#44; los autores advirtieron que el sobreempleo de f&#225;rmacos sedantes retrasaba el tiempo de destete&#46; En este estudio sugieren que la evaluaci&#243;n de criterios cl&#237;nicos espec&#237;ficos&#44; sumada a la interrupci&#243;n diaria de la sedaci&#243;n&#44; podr&#237;an ser medidas efectivas para reducir la duraci&#243;n de la VM en pacientes pedi&#225;tricos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En este sentido&#44; la administraci&#243;n excesiva de f&#225;rmacos sedantes durante la VM representa una problem&#225;tica importante&#44; prolongando la estancia en el respirador&#46; En adultos&#44; Kress et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> observaron que la interrupci&#243;n diaria de la sedaci&#243;n no solo redujo la duraci&#243;n de la VM y la estancia en la UCI&#44; sino que adem&#225;s no aument&#243; la tasa de eventos adversos y posibilit&#243; una mejor evaluaci&#243;n neurol&#243;gica&#46; En pediatr&#237;a&#44; Jin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> reportaron que la implementaci&#243;n de un protocolo de sedaci&#243;n&#44; el cual incluy&#243; la escala COMFORT&#44; redujo la duraci&#243;n de la VM&#44; la estancia en la UCI&#44; la dosis total de sedantes y la incidencia de s&#237;ndrome de abstinencia&#46; Recientemente&#44; Foronda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> implementaron la estrategia de la evaluaci&#243;n diaria sumada a la aplicaci&#243;n de un ERE en 294 ni&#241;os sometidos a VM por m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#44; logrando reducir la duraci&#243;n de la VM sin aumentar la tasa de FE&#46; Seg&#250;n los autores&#44; las diferencias con los resultados obtenidos por Randolph et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> se asociaron a la selecci&#243;n de pacientes&#44; ya que en este &#250;ltimo trabajo solo se incluyeron pacientes que hab&#237;an experimentado un fracaso de destete previo&#46; Por otra parte&#44; cabe se&#241;alar que en el estudio de Foronda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#44; a pesar de que los par&#225;metros programados en el respirador previo a la aplicaci&#243;n del ERE eran relativamente elevados&#44; no representaron un factor de riesgo de FE&#44; por lo que los autores especulan que las diferencias obtenidas entre ambos grupos se podr&#237;an atribuir a la aplicaci&#243;n de una evaluaci&#243;n diaria con criterios conservadores y a la reticencia a realizar un ERE en pacientes con asistencia respiratoria elevada&#44; como ocurri&#243; en el grupo control&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En este sentido&#44; creemos que la evaluaci&#243;n diaria a trav&#233;s de par&#225;metros cl&#237;nicos y funcionales integrados podr&#237;a abreviar la identificaci&#243;n de pacientes aptos para realizar un ERE<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; A pesar de la disparidad en los criterios empleados por diversos autores&#44; en nuestra unidad utilizamos los criterios descritos en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">T&#233;cnicas de destete</span><p id="par0055" class="elsevierStylePara elsevierViewall">El m&#233;todo de destete m&#225;s empleado en pediatr&#237;a es la reducci&#243;n gradual de los par&#225;metros del respirador durante una modalidad de ventilaci&#243;n intermitente mandatorio sincronizado &#40;<span class="elsevierStyleItalic">synchronized intermittent mandatory ventilation</span> &#91;SIMV&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; A trav&#233;s de esta pr&#225;ctica&#44; el retiro de la VM se realiza cuando se alcanzan bajos niveles de frecuencia respiratoria&#46; Adem&#225;s&#44; este modo suele programarse con una presi&#243;n de soporte&#44; la cual garantiza un volumen tidal espec&#237;fico de acuerdo con las necesidades del paciente y eventualmente tendr&#237;a la ventaja de aminorar el trabajo respiratorio adicional impuesto por el tubo endotraqueal y el circuito del respirador mec&#225;nico<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;29</span></a>&#46; Sin embargo&#44; en adultos se ha evidenciado que este m&#233;todo prolonga la estancia en VM comparado con el empleo del ERE diario y presi&#243;n de soporte<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a>&#46; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> reportaron que la duraci&#243;n del destete depende de la t&#233;cnica utilizada&#44; donde la realizaci&#243;n diaria de un ERE reduce el tiempo de destete en comparaci&#243;n con el modo de SIMV y presi&#243;n de soporte&#46; Concordantemente&#44; 2 estudios mostraron que no todos los ni&#241;os requieren esta reducci&#243;n gradual para lograr un destete exitoso<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;29</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos de ensayo de respiraci&#243;n espont&#225;nea</span><p id="par0060" class="elsevierStylePara elsevierViewall">El ERE es una prueba que se realiza mientras el paciente est&#225; intubado y eval&#250;a su tolerancia cardiorrespiratoria para sostener una respiraci&#243;n espont&#225;nea con soporte respiratorio m&#237;nimo o nulo&#44; permitiendo identificar a los pacientes en condiciones de ser extubados&#46; Durante esta prueba se miden variables asociadas a la fatiga muscular respiratoria y al logro de un intercambio gaseoso efectivo<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;29&#44;31</span></a>&#46; Diversos reportes en pacientes adultos han mostrado que entre el 60 y el 80&#37; de los pacientes en VM pueden ser extubados sin inconvenientes despu&#233;s de tolerar exitosamente un ERE<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;30&#8211;33</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los m&#233;todos de ERE m&#225;s empleados son&#58; la presi&#243;n positiva continua en la v&#237;a a&#233;rea &#40;<span class="elsevierStyleItalic">continuous positive airway pressure</span> &#91;CPAP&#93;&#41;&#44; el tubo T y la presi&#243;n de soporte&#46; En pediatr&#237;a&#44; la elecci&#243;n del m&#233;todo depender&#225; fundamentalmente de la experiencia del equipo tratante&#44; ya que no se ha evidenciado que un m&#233;todo sea superior a otro<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;34</span></a>&#46; Sin embargo&#44; un estudio reciente sugiere que el empleo de altos niveles de presi&#243;n de soporte programados seg&#250;n el di&#225;metro del tubo endotraqueal podr&#237;a sobrestimar el &#233;xito del ERE en pacientes pedi&#225;tricos&#44; contribuyendo a elevar la tasa de FE<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> compararon la t&#233;cnica de CPAP y tubo T durante 60<span class="elsevierStyleHsp" style=""></span>min en 106 pacientes adultos&#44; no encontrando diferencias en la tasa de FE&#46; Concordantemente&#44; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> no encontraron diferencias entre tubo T y presi&#243;n de soporte de 7<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O durante 120<span class="elsevierStyleHsp" style=""></span>min&#46; Estos resultados fueron adem&#225;s corroborados recientemente por Molina-Saldarriaga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> en pacientes con enfermedad pulmonar obstructiva cr&#243;nica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Farias et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> replicaron estos estudios en 257 pacientes pedi&#225;tricos sometidos a VM por al menos 48<span class="elsevierStyleHsp" style=""></span>h&#44; sin encontrar diferencias entre tubo T y presi&#243;n de soporte de 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; tanto en la tolerancia al ERE como en la tasa de FE&#46; Posteriormente&#44; los mismos autores evaluaron a trav&#233;s de un m&#233;todo similar a 418 pacientes pedi&#225;tricos&#44; observando que la frecuencia respiratoria &#40;FR&#41;&#44; el volumen tidal &#40;V<span class="elsevierStyleInf">T</span>&#41;&#44; la relaci&#243;n entre FR y V<span class="elsevierStyleInf">T</span> indexada al peso &#40;FR&#47;V<span class="elsevierStyleInf">T</span>&#41; y presi&#243;n inspiratoria m&#225;xima &#40;PI<span class="elsevierStyleInf">max</span>&#41; medidos durante el ERE eran pobres predictores de FE<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La duraci&#243;n del ERE tambi&#233;n es un tema controvertido&#46; La mayor&#237;a de los trabajos ha establecido una duraci&#243;n del ERE de 120<span class="elsevierStyleHsp" style=""></span>min<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;29&#44;30&#44;32</span></a>&#46; Sin embargo&#44; un estudio prospectivo&#44; aleatorio y multic&#233;ntrico de 526 pacientes adultos mostr&#243; que un ERE de 30<span class="elsevierStyleHsp" style=""></span>min permite identificar de manera equivalente a un ERE de 120<span class="elsevierStyleHsp" style=""></span>min a los pacientes en condiciones de extubarse&#44; sin diferencias en la tasa de FE<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Por otra parte&#44; Chavez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> utilizaron una modalidad novedosa de ERE&#44; adaptando una bolsa de anestesia de flujo continuo &#40;3<span class="elsevierStyleHsp" style=""></span>l&#47;min para lactantes y 10<span class="elsevierStyleHsp" style=""></span>l&#47;min para ni&#241;os mayores&#41; ajustada para otorgar 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O de CPAP durante 15<span class="elsevierStyleHsp" style=""></span>min&#44; observando que de 70 pacientes pedi&#225;tricos&#44; el 7&#44;8&#37; experimentaron FE&#46; Sin embargo&#44; cabe mencionar que los pacientes sometidos a ERE ya se encontraban en condiciones de ser extubados seg&#250;n el criterio del m&#233;dico intensivista a cargo&#44; por lo que la aplicaci&#243;n del ERE podr&#237;a haber sido innecesaria&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#205;ndices predictores de fracaso de extubaci&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">En adultos se han estudiado m&#225;s de 50 predictores de destete&#44; sin embargo solo 5 han mostrado una modesta capacidad de predecir el retiro de la VM &#40;PI<span class="elsevierStyleInf">max</span>&#44; volumen minuto &#91;V<span class="elsevierStyleInf">m</span>&#93;&#44; FR&#44; V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; En este sentido&#44; la medici&#243;n de &#237;ndices que integran m&#225;s de una variable&#44; como el FR&#47;V<span class="elsevierStyleInf">T</span> y el &#237;ndice CROP &#40;del ingl&#233;s <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index</span>&#41; han mostrado ser m&#225;s precisos respecto a mediciones como la PI<span class="elsevierStyleInf">max</span> y el V<span class="elsevierStyleInf">m</span>&#44; con una capacidad predictiva moderada en adultos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; Sin embargo&#44; estudios en pediatr&#237;a han reportado que tanto el FR&#47;V<span class="elsevierStyleInf">T</span> como el &#237;ndice CROP presentan un bajo poder predictivo<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;40&#44;41</span></a>&#44; y solo un trabajo ha mostrado que el &#237;ndice CROP podr&#237;a ser &#250;til para predecir el resultado de la extubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#46; Esta discrepancia podr&#237;a atribuirse tanto al amplio rango de edad y peso de los pacientes pedi&#225;tricos&#44; como a la disparidad en el empleo de estos predictores en pediatr&#237;a respecto a la poblaci&#243;n adulta<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;39</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Thiagarajan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> mostraron que una FR<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>respiraciones&#47;min &#40;rpm&#41;&#44; un V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#44; FR&#47;V<span class="elsevierStyleInf">T</span> indexado al peso<span class="elsevierStyleHsp" style=""></span>&#8804;8<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kg e &#237;ndice CROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;15<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm fueron valores de corte para predecir el &#233;xito de la extubaci&#243;n&#46; Por otra parte&#44; Baumeister et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> emplearon el FR&#47;V<span class="elsevierStyleInf">T</span> y el &#237;ndice CROP para predecir el &#233;xito de la extubaci&#243;n&#44; mostrando diferentes valores de corte respecto a los reportados por Thiagarajan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> &#40;FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kg y el &#237;ndice CROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;1<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&#41;&#46; Contrariamente&#44; Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> reportaron que las mediciones tanto del V<span class="elsevierStyleInf">T</span> como del V<span class="elsevierStyleInf">m</span> previo a la extubaci&#243;n fueron m&#225;s sensibles y espec&#237;ficas respecto a mediciones multivariables para determinar el pron&#243;stico de la extubaci&#243;n en pacientes pedi&#225;tricos&#46; Venkataraman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> expusieron que el an&#225;lisis de variables como el V<span class="elsevierStyleInf">T</span>&#44; la presi&#243;n inspiratoria pico&#44; la elasticidad din&#225;mica&#44; el cociente entre el V<span class="elsevierStyleInf">T</span> y el tiempo inspiratorio previo a la extubaci&#243;n lograron predecir FE en 312 pacientes pedi&#225;tricos ventilados por m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#46; En concordancia con Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#44; los autores observaron que tanto el FR&#47;V<span class="elsevierStyleInf">T</span> como el &#237;ndice CROP no eran &#237;ndices &#250;tiles para predecir el resultado de la extubaci&#243;n&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se ha evidenciado que la habilidad para sostener una respiraci&#243;n espont&#225;nea durante el destete depende del control respiratorio central&#44; de la capacidad de los m&#250;sculos inspiratorios y de la carga impuesta sobre ellos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#8211;49</span></a>&#46; Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> observaron que la presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s &#40;P<span class="elsevierStyleInf">0&#44;1</span>&#41; fue m&#225;s baja en los pacientes pedi&#225;tricos que experimentaron FE&#46; Este resultado fue atribuido a un pobre control respiratorio central&#44; a la disminuci&#243;n de la fuerza muscular inspiratoria y a la hiperinflaci&#243;n&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As&#237; mismo&#44; trabajos en adultos han mostrado que el &#237;ndice tensi&#243;n-tiempo &#40;TTI&#41; y el balance carga&#47;fuerza&#44; que son mediciones relacionadas con la resistencia a la fatiga de los m&#250;sculos respiratorios&#44; permiten optimizar la precisi&#243;n en el pron&#243;stico del destete<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48</span></a>&#46; Sin embargo&#44; estudios en pediatr&#237;a han revelado resultados contradictorios respecto a la utilidad de estos &#237;ndices<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46&#44;49&#44;50</span></a>&#46; Harikumar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> reportaron que la medici&#243;n de TTI logr&#243; una sensibilidad y una especificidad del 100&#37; para predecir FE&#44; con un punto de corte de 0&#44;18&#46; En contraposici&#243;n&#44; Noizet et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> se&#241;alaron que el TTI&#44; entre otros &#237;ndices multivariables&#44; fue incapaz de predecir el FE&#44; aludiendo que la principal causa de ineficacia de estos &#237;ndices se relaciona con el momento de la medici&#243;n&#44; la cual se realiza cuando el paciente ya se encuentra con criterios para lograr un destete exitoso&#46; Recientemente&#44; Johnston et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> reportaron que las mediciones de V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&#44; PI<span class="elsevierStyleInf">max</span> y el balance carga&#47;fuerza permitieron predecir FE en pacientes con diagn&#243;stico de bronquiolitis aguda severa&#46; Los valores del balance carga&#47;fuerza fueron significativamente inferiores en el grupo extubado exitosamente respecto al grupo que present&#243; FE&#44; aunque la capacidad predictiva de este &#237;ndice fue baja&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En este contexto&#44; los &#237;ndices univariables aparecen como una mejor alternativa respecto de los &#237;ndices integrados para predecir el FE&#46; Sin embargo&#44; a&#250;n quedan por establecer valores de corte que engloben a la totalidad de la poblaci&#243;n pedi&#225;trica&#44; as&#237; como tambi&#233;n determinar el momento id&#243;neo para realizar estas mediciones&#46; Los &#237;ndices predictores seg&#250;n el resultado de la extubaci&#243;n y sus valores de corte en pacientes pedi&#225;tricos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fracaso de extubaci&#243;n en pediatr&#237;a</span><p id="par0110" class="elsevierStylePara elsevierViewall">En adultos&#44; el FE ha sido asociado con aumento en la duraci&#243;n de la VM&#44; en la estancia en UCI&#44; en los costos en salud y en la tasa de mortalidad&#44; por lo que su prevenci&#243;n es de vital relevancia&#46; No obstante&#44; hasta la fecha no existen mediciones que permitan prevenir el FE con exactitud&#44; lo que nos lleva a estar alerta a los factores de riesgo asociados al FE con el fin de optimizar la decisi&#243;n de extubar a un paciente sometido a VM<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre las causas m&#225;s frecuentes de FE se encuentra la obstrucci&#243;n de la v&#237;a a&#233;rea superior posterior a la extubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;50&#8211;52</span></a>&#46; Predecir esta condici&#243;n es complejo&#44; ya que un ERE solo indaga la tolerancia cardiorrespiratoria para respirar espont&#225;neamente&#46; Wratney et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> reportaron que la medici&#243;n de un test de fuga previo al retiro del tubo endotraqueal no deber&#237;a emplearse como criterio &#250;nico para decidir la extubaci&#243;n del paciente pedi&#225;trico&#44; ya que la ausencia de fuga al aplicar una presi&#243;n de v&#237;a a&#233;rea igual o superior a 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;test de fuga negativo&#41; fue com&#250;n en esta poblaci&#243;n y no se observ&#243; asociaci&#243;n con la presencia de estridor lar&#237;ngeo y&#47;o necesidad de reintubaci&#243;n&#46; No obstante&#44; frente a la posibilidad de FE por obstrucci&#243;n de v&#237;a a&#233;rea superior&#44; la administraci&#243;n profil&#225;ctica de esteroides ha demostrado reducir la incidencia de estridor posterior a la extubaci&#243;n en la poblaci&#243;n neonatal y pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Estudios en pediatr&#237;a han mostrado resultados dis&#237;miles respecto a la tasa de FE y sus factores de riesgo asociados<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;24&#44;54&#8211;57</span></a>&#46; Esto ha sido atribuido en parte al dise&#241;o de los trabajos &#40;retrospectivo vs&#46; prospectivo&#41;&#44; a los criterios de inclusi&#243;n y a la cantidad de centros involucrados<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En un estudio retrospectivo&#44; Baisch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> observaron una tasa de FE del 4&#44;1&#37; en 3&#46;193 pacientes pedi&#225;tricos retirados de VM&#46; Las causas de FE fueron multifactoriales&#44; predominando la obstrucci&#243;n de la v&#237;a a&#233;rea superior&#46; Los factores de riesgo asociados a FE fueron la corta edad&#44; la permanencia en VM&#44; la estancia en la UCI y hospitalaria&#44; sin asociaci&#243;n con el riesgo de mortalidad hospitalaria&#46; Por su parte&#44; Edmunds et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> mostraron una tasa de FE del 7&#44;9&#37; en 280 pacientes intubados por al menos 48<span class="elsevierStyleHsp" style=""></span>h&#46; La obstrucci&#243;n de v&#237;a a&#233;rea superior nuevamente fue la causa m&#225;s com&#250;n de FE&#44; estableciendo adem&#225;s una asociaci&#243;n entre la duraci&#243;n de la VM y FE&#46; Fontela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> reportaron una tasa de FE del 10&#44;5&#37;&#44; observando que la principal causa de FE fue el fallo respiratorio&#46; En este estudio&#44; los factores de riesgo asociados a FE fueron la corta edad&#44; la estancia en VM<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>d&#237;as&#44; el &#237;ndice de oxigenaci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>5&#44; el uso de in&#243;tropos y la administraci&#243;n de f&#225;rmacos sedantes intravenosos &#62;<span class="elsevierStyleHsp" style=""></span>10 d&#237;as&#46; Kurachek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; en un estudio prospectivo y multic&#233;ntrico que incluy&#243; a 16<span class="elsevierStyleHsp" style=""></span>UCI&#44; reportaron una tasa de FE del 6&#44;2&#37; &#40;rango&#44; 1&#44;5-8&#44;8&#37;&#41; y una estancia promedio en VM de 4&#44;8<span class="elsevierStyleHsp" style=""></span>d&#237;as en 1&#46;459 pacientes pedi&#225;tricos intubados por al menos 24<span class="elsevierStyleHsp" style=""></span>h&#44; estableciendo que los factores de riesgo de FE fueron una edad menor de 24<span class="elsevierStyleHsp" style=""></span>meses&#44; s&#237;ndrome gen&#233;tico&#44; alteraci&#243;n respiratoria y neurol&#243;gica cr&#243;nica&#44; adem&#225;s de la necesidad de reemplazar el tubo endotraqueal al ingreso&#46; La incidencia de obstrucci&#243;n de v&#237;a a&#233;rea superior posterior a la extubaci&#243;n fue del 37&#37;&#44; y los autores no observaron asociaci&#243;n entre la duraci&#243;n de la VM y la tasa de FE&#46; Sin embargo&#44; al realizar un an&#225;lisis m&#225;s riguroso de la tasa de FE&#44; esta aument&#243; al incluir solo a pacientes que permanecieron m&#225;s de 48<span class="elsevierStyleHsp" style=""></span>h en VM &#40;del 4&#44;2 al 8&#37;&#41;&#46; Nuestra experiencia coincide con los estudios mencionados previamente&#44; ya que observamos una tasa de FE del 5&#44;3&#37; asociada directamente con la estancia en VM y la duraci&#243;n de la administraci&#243;n continua de opi&#225;ceos y benzodiacepinas<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Rol de la ventilaci&#243;n no invasiva en el destete</span><p id="par0125" class="elsevierStylePara elsevierViewall">En adultos&#44; se han descrito 3 indicaciones comunes de ventilaci&#243;n no invasiva &#40;VNI&#41; durante el destete&#58; a&#41;<span class="elsevierStyleHsp" style=""></span>modalidad alternativa de destete en pacientes con fracaso del ERE&#59; b&#41;<span class="elsevierStyleHsp" style=""></span>profilaxis posterior a la extubaci&#243;n en pacientes con alto riesgo de reintubaci&#243;n pero sin fallo respiratorio&#44; y c&#41;<span class="elsevierStyleHsp" style=""></span>soporte en pacientes extubados con fallo respiratorio dentro de las primeras 48<span class="elsevierStyleHsp" style=""></span>h posterior a la extubaci&#243;n&#46; La primera estrategia tiene como objetivo facilitar el destete&#44; y las 2 &#250;ltimas intentan evitar la reintubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;58</span></a>&#46; Sin embargo&#44; los estudios relacionados con la tem&#225;tica han mostrado resultados contradictorios respecto a la utilidad de la VNI durante el destete<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#8211;62</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En un metaan&#225;lisis&#44; Burns et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> evaluaron el empleo de la VNI como modalidad alternativa para facilitar el destete temprano&#44; observando que esta estrategia se asoci&#243; a una significativa reducci&#243;n de la mortalidad&#44; incidencia de neumon&#237;a y duraci&#243;n de la VM&#46; Adem&#225;s&#44; en el an&#225;lisis de subgrupos&#44; los autores se&#241;alaron que los beneficios de la VNI en la mortalidad fueron mayores en pacientes con enfermedad pulmonar obstructiva cr&#243;nica&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Por su parte&#44; Ferrer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> mostraron que la VNI utilizada como terapia de rescate inmediatamente posterior a la extubaci&#243;n redujo el riesgo de fallo respiratorio agudo en pacientes con insuficiencia respiratoria cr&#243;nica hiperc&#225;pnica durante el ERE&#44; logrando incluso disminuir la mortalidad a los 90<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46; Contrariamente&#44; 2 estudios no reportaron diferencias en la tasa de reintubaci&#243;n al comparar el uso de VNI respecto a la terapia est&#225;ndar en pacientes con fallo respiratorio posterior a la extubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">61&#44;62</span></a>&#46; Adem&#225;s&#44; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> describieron una mayor mortalidad en el grupo de pacientes que recibieron VNI&#44; probablemente asociada al retraso de la reintubaci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En pediatr&#237;a&#44; la experiencia sobre el uso de VNI durante el destete es limitada&#44; debido a que la informaci&#243;n disponible proviene de estudios no controlados y series de casos con pocos pacientes<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&#46; Mayordomo-Colunga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> reportaron que la VNI fue m&#225;s efectiva evitando la reintubaci&#243;n cuando se emple&#243; precozmente en pacientes con alto riesgo de FE respecto a su uso como terapia de rescate en pacientes con fallo respiratorio establecido&#46; Adem&#225;s&#44; los autores observaron que la reducci&#243;n de FR y FiO<span class="elsevierStyleInf">2</span> al cabo de 6<span class="elsevierStyleHsp" style=""></span>h se asoci&#243; al &#233;xito de la VNI&#46; As&#237; mismo&#44; James et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> coincidieron en que ambas mediciones&#44; sumadas al pH y a la patolog&#237;a subyacente&#44; son criterios a tomar en cuenta cuando se desea predecir la efectividad de la VNI en pacientes pedi&#225;tricos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En otra interesante faceta de la VNI&#44; Fauroux et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> reportaron recientemente efectos beneficiosos durante el proceso de decanulaci&#243;n en un grupo selecto de pacientes pedi&#225;tricos con obstrucci&#243;n grave de la v&#237;a a&#233;rea superior&#44; as&#237; como en el tratamiento del fallo respiratorio posterior a la decanulaci&#243;n&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">De todas maneras&#44; la integraci&#243;n de la VNI en el destete requiere de criterios preestablecidos de inicio y de fracaso que a&#250;n no est&#225;n completamente definidos y validados en pediatr&#237;a&#46; En el futuro&#44; el uso transitorio de VNI en un proceso de retirada de la VM podr&#237;a considerarse exitoso si facilita el destete y&#47;o evita la reintubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusiones</span><p id="par0155" class="elsevierStylePara elsevierViewall">Bas&#225;ndonos en la informaci&#243;n previamente expuesta&#44; creemos que la evaluaci&#243;n diaria de criterios cl&#237;nicos y funcionales espec&#237;ficos junto a la aplicaci&#243;n de un ERE es una metodolog&#237;a que permite identificar precozmente a los pacientes en condiciones de ser destetados del respirador mec&#225;nico&#46; La suspensi&#243;n diaria de la sedaci&#243;n permite acortar la duraci&#243;n de la VM&#44; y la evaluaci&#243;n a trav&#233;s de la escala COMFORT evita la sedaci&#243;n excesiva en los pacientes pedi&#225;tricos&#46; La medici&#243;n de predictores univariables previo al retiro del respirador parece ser m&#225;s efectiva para determinar el pron&#243;stico de la extubaci&#243;n&#46; No todos los pacientes pedi&#225;tricos requieren una estrategia de destete protocolizada&#46; Esta medida puede ser m&#225;s efectiva en pacientes pedi&#225;tricos que presentan factores de riesgo&#44; como por ejemplo corta edad&#44; mayor duraci&#243;n de la VM&#44; s&#237;ndromes gen&#233;ticos&#44; alteraciones respiratorias y neurol&#243;gicas cr&#243;nicas&#44; pacientes habitualmente excluidos en los estudios pedi&#225;tricos de destete&#46; A pesar de la elevada incidencia de FE por obstrucci&#243;n de la v&#237;a a&#233;rea superior&#44; la ausencia de fuga audible alrededor del tubo endotraqueal aplicando una presi&#243;n de v&#237;a a&#233;rea superior a 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O no deber&#237;a retrasar la decisi&#243;n de extubar&#44; ya que la administraci&#243;n profil&#225;ctica de esteroides ha demostrado resultados positivos&#44; atenuando esta condici&#243;n&#46; No existen suficientes estudios para recomendar de forma rutinaria el uso de VNI posterior a la extubaci&#243;n&#44; aunque se han establecido algunas indicaciones prometedoras en grupos seleccionados de pacientes pedi&#225;tricos&#46; En pacientes con fallo respiratorio establecido que requieran VNI se deber&#237;a objetivar la respuesta cl&#237;nica&#44; considerando la posibilidad de aumento de la mortalidad debido al retraso de la reintubaci&#243;n&#46; Nuestra propuesta de algoritmo de retirada de la VM en pacientes pedi&#225;tricos se detalla en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Finalmente&#44; creemos en la necesidad de realizar nuevos estudios que comparen m&#233;todos y protocolos de destete en pacientes m&#225;s complejos&#44; ya que probablemente ser&#225;n ellos los m&#225;s beneficiados de una elecci&#243;n adecuada de estrategia de retirada&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">No se ha contado con financiaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener potenciales conflictos de intereses&#46;</p></span></span>"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "M&#233;todos de ensayo de respiraci&#243;n espont&#225;nea"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "&#205;ndices predictores de fracaso de extubaci&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Fracaso de extubaci&#243;n en pediatr&#237;a"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Rol de la ventilaci&#243;n no invasiva en el destete"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclusiones"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Financiaci&#243;n"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicto de intereses"
        ]
        14 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-11-18"
    "fechaAceptado" => "2013-02-04"
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      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec297894"
          "palabras" => array:4 [
            0 => "Ventilaci&#243;n mec&#225;nica"
            1 => "Destete"
            2 => "Extubaci&#243;n"
            3 => "Pediatr&#237;a"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Mechanical ventilation"
            1 => "Weaning"
            2 => "Extubation"
            3 => "Paediatric"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La retirada de la ventilaci&#243;n mec&#225;nica es una de las tem&#225;ticas con mayor volumen y solidez en medicina basada en la evidencia en adultos gravemente enfermos&#46; La protocolizaci&#243;n del destete y la interrupci&#243;n diaria de la sedaci&#243;n han sido instauradas&#44; reduciendo la duraci&#243;n de la ventilaci&#243;n mec&#225;nica y la morbilidad asociada en esta poblaci&#243;n&#46; En pediatr&#237;a la informaci&#243;n reportada es menos consistente&#44; propiciando que el destete y la extubaci&#243;n no cuenten a&#250;n con criterios de inicio objetivos y reproducibles&#46; Diversos &#237;ndices han sido desarrollados para predecir el resultado del destete&#59; sin embargo&#44; estos no han logrado reemplazar el juicio cl&#237;nico&#44; aunque algunas mediciones complementarias pudieran facilitar esta decisi&#243;n&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults&#46; In these patients&#44; weaning protocols and daily interruption of sedation have been implemented&#44; reducing the duration of mechanical ventilation and associated morbidity&#46; In paediatrics&#44; the information reported is less consistent&#44; so that as yet there are no reliable criteria for weaning and extubation in this patient group&#46; Several indices have been developed to predict the outcome of weaning&#46; However&#44; these have failed to replace clinical judgement&#44; although some additional measurements could facilitate this decision&#46;</p>"
      ]
    ]
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo que representa el proceso de retirada de la ventilaci&#243;n mec&#225;nica en pediatr&#237;a&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n o mejor&#237;a de la causa de fallo respiratorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estabilidad hemodin&#225;mica&#58; ausencia o disminuci&#243;n progresiva de f&#225;rmacos vasoactivos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nivel de conciencia adecuado &#40;COMFORT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esfuerzo respiratorio espont&#225;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspensi&#243;n de la sedaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspensi&#243;n de los relajantes musculares al menos 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausencia de signos cl&#237;nicos de sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reflejo de tos presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Correcci&#243;n de desequilibrios metab&#243;licos y electrol&#237;ticos importantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intercambio gaseoso adecuado con PEEP<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O y FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Criterios cl&#237;nicos para iniciar el destete en pacientes pedi&#225;tricos sometidos a ventilaci&#243;n mec&#225;nica</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CROP&#58; <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index&#59;</span> FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno&#59; PI<span class="elsevierStyleInf">max</span>&#58; presi&#243;n inspiratoria m&#225;xima&#59; P<span class="elsevierStyleInf">0&#44;1</span>&#58; presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; rpm&#58; respiraciones por minuto&#59; V<span class="elsevierStyleInf">m</span>&#58; volumen minuto&#59; V<span class="elsevierStyleInf">T</span>&#58; volumen tidal&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Referencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Autor principal &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Predicci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#205;ndices&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baumeister &#40;1997&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#201;xito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#60;11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgCROP<span class="elsevierStyleHsp" style=""></span>&#8805;0&#44;1<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;1998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;4<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiagarajan &#40;1999&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#201;xito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR<span class="elsevierStyleHsp" style=""></span>&#8804;45<span class="elsevierStyleHsp" style=""></span>rpmV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kgFR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;8<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgCROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;15<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#60;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kgV<span class="elsevierStyleInf">m</span><span class="elsevierStyleHsp" style=""></span>&#60;180<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venkataraman &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>rpmV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;4<span class="elsevierStyleHsp" style=""></span>ml&#47;kgFR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgPI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OPaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harikumar &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>32&#44;6<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OP<span class="elsevierStyleInf">0&#44;1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#44;45<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnston &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;7<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgPI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OV<span class="elsevierStyleInf">m</span><span class="elsevierStyleHsp" style=""></span>&#60;0&#44;8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#205;ndices predictores seg&#250;n el resultado de la extubaci&#243;n y sus valores de corte en pacientes pedi&#225;tricos</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CPAP&#58; presi&#243;n continua en la v&#237;a a&#233;rea&#59; CRF&#47;kg&#58; capacidad residual funcional indexada al peso del paciente&#59; CROP&#58; <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index&#59;</span> E<span class="elsevierStyleInf">din</span>&#58; elasticidad din&#225;mica&#59; ERE&#58; ensayo de respiraci&#243;n espont&#225;nea&#59; FE&#58; fracaso de extubaci&#243;n&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; FrVe&#58; fracci&#243;n de la ventilaci&#243;n minuto total entregada por el respirador&#59; IO&#58; &#237;ndice de oxigenaci&#243;n&#59; IPT&#58; &#237;ndice presi&#243;n tiempo&#59; ND&#58; no hay datos&#59; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#58; cociente presi&#243;n arterial de ox&#237;geno&#47;fracci&#243;n inspirada de ox&#237;geno&#59; PI<span class="elsevierStyleInf">max</span>&#58; presi&#243;n inspiratoria m&#225;xima&#59; PI&#47;PI<span class="elsevierStyleInf">max</span>&#58; cociente entre la presi&#243;n inspiratoria de la v&#237;a a&#233;rea y la presi&#243;n inspiratoria m&#225;xima&#59; PIP&#58; presi&#243;n inspiratoria pico&#59; PMVA&#58; presi&#243;n media de la v&#237;a a&#233;rea&#59; P<span class="elsevierStyleInf">0&#44;1</span>&#58; presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; P<span class="elsevierStyleInf">0&#44;1max</span>&#58; presi&#243;n negativa m&#225;xima medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; PS&#58; presi&#243;n de soporte&#59; TET&#58; tubo endotraqueal&#59; TTI<span class="elsevierStyleInf">1</span>&#58; &#237;ndice tensi&#243;n tiempo obtenido desde P<span class="elsevierStyleInf">0&#44;1</span>&#59; TTI<span class="elsevierStyleInf">2</span>&#58; &#237;ndice tensi&#243;n tiempo obtenido desde la PMVA&#59; T<span class="elsevierStyleInf">I</span>&#47;T<span class="elsevierStyleInf">TOT</span>&#58; cociente tiempo inspiratorio&#47;tiempo total del ciclo respiratorio&#59; TT<span class="elsevierStyleInf">mus</span>&#58; &#237;ndice tensi&#243;n tiempo muscular&#59; VM&#58; ventilaci&#243;n mec&#225;nica&#59; V<span class="elsevierStyleInf">m</span>&#58; volumen minuto&#59; V<span class="elsevierStyleInf">T</span>&#58; volumen tidal&#59; V<span class="elsevierStyleInf">T</span>&#47;Ti&#58; flujo inspiratorio promedio&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autor principal &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad promedio &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Protocolo destete</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n VM &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fracaso de extubaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Motivo principal FE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Evaluaci&#243;n diaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ERE - Tipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#205;ndices predictores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tasa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khan &#40;1996&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baumeister &#40;1997&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span>&#44; CROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;1998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T&#44; 120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n del nivel de conciencia &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiagarajan &#40;1999&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#44; V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; CROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;42&#44;9&#41;&#44; hipoventilaci&#243;n &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venkataraman &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FiO<span class="elsevierStyleInf">2</span> pre extubaci&#243;n&#44; PMVA&#44; IO&#44; FrVe&#44; PIP&#44; E<span class="elsevierStyleInf">din</span>&#44; V<span class="elsevierStyleInf">T</span>&#47;Ti&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P<span class="elsevierStyleInf">0&#46;1</span>&#44; P<span class="elsevierStyleInf">0&#46;1</span>&#47;P<span class="elsevierStyleInf">0&#46;1</span><span class="elsevierStyleInf">max</span>&#44; P<span class="elsevierStyleInf">0&#46;1</span>&#47;PI<span class="elsevierStyleInf">max</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schultz &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farias &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T o PS 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multifactorial &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edmunds &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estridor &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randolph &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Si&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS&#44; 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio agudo bajo &#40;54&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farias &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T o PS 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#44; PI<span class="elsevierStyleInf">max</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kurachek &#40;2003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstrucci&#243;n de v&#237;a a&#233;rea superior &#40;37&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Restrepo &#40;2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noizet &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T&#44; 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; P<span class="elsevierStyleInf">0&#44;1</span> &#215; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; IPT&#44; TTI<span class="elsevierStyleInf">1</span>&#44; TTI<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baisch &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multifactorial &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fontela &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chavez &#40;2006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;5<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bolsa anestesia de flujo continuo&#44; 15<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;27<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cruces &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estridor &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harikumar &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T<span class="elsevierStyleInf">I</span>&#47;T<span class="elsevierStyleInf">TOT</span>&#44; P<span class="elsevierStyleInf">0&#44;1</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; PI&#47;PI<span class="elsevierStyleInf">max</span>&#44; CRF&#47;kg&#44; TT<span class="elsevierStyleInf">mus</span>&#44; PIP&#44; FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnston &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; balance carga&#47;fuerza&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Foronda &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstrucci&#243;n v&#237;a a&#233;rea superior &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ferguson &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">538&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS seg&#250;n di&#225;metro del TET&#44; 120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fallo respiratorio bajo &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "What is the daily practice of mechanical ventilation in pediatric intensive care units&#46; A multicenter study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Farias"
                            1 => "F&#46; Frutos"
                            2 => "A&#46; Esteban"
                            3 => "J&#46;C&#46; Flores"
                            4 => "A&#46; Retta"
                            5 => "A&#46; Baltodano"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00134-004-2225-5"
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                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "918"
                        "paginaFinal" => "925"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15029473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilator-induced lung injury&#58; From barotrauma to biotrauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;S&#46; Slutsky"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2005"
                        "volumen" => "50"
                        "paginaInicial" => "646"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15912625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation associated pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Diaz"
                            1 => "L&#46; Lorente"
                            2 => "J&#46; Valles"
                            3 => "J&#46; Rello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2010.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "318"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466456"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Breathing as exercise&#58; The cardiovascular response to weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;R&#46; Pinsky"
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2000"
                        "volumen" => "26"
                        "paginaInicial" => "1164"
                        "paginaFinal" => "1166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11089735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning and extubation readiness in pediatric patients"
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                        0 => array:2 [
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                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Newth"
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                            2 => "D&#46;F&#46; Willson"
                            3 => "K&#46;L&#46; Meert"
                            4 => "R&#46; Harrison"
                            5 => "J&#46;M&#46; Dean"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318193724d"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057432"
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                          ]
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              "identificador" => "bib0030"
              "etiqueta" => "6"
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                    0 => array:2 [
                      "titulo" => "Weaning from mechanical ventilation"
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                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Boles"
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                            2 => "A&#46; Connors"
                            3 => "M&#46; Herridge"
                            4 => "B&#46; Marsh"
                            5 => "C&#46; Melot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00010206"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "1033"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17470624"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extubation failure in pediatric intensive care&#58; A multiple-center study of risk factors and outcomes"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;C&#46; Kurachek"
                            1 => "C&#46;J&#46; Newth"
                            2 => "M&#46;W&#46; Quasney"
                            3 => "T&#46; Rice"
                            4 => "R&#46;C&#46; Sachdeva"
                            5 => "N&#46;R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000094228.90557.85"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "2657"
                        "paginaFinal" => "2664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605539"
                            "web" => "Medline"
                          ]
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                ]
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning from mechanical ventilation in pediatric intensive care patients"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;A&#46; Farias"
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                            2 => "A&#46; Esteban"
                            3 => "A&#46;N&#46; Golubicki"
                            4 => "F&#46;A&#46; Olazarri"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1998"
                        "volumen" => "24"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9840242"
                            "web" => "Medline"
                          ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0045"
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                    0 => array:2 [
                      "titulo" => "We need to predict extubation failure"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Farias"
                            1 => "E&#46; Monteverde"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "paginaInicial" => "322"
                        "paginaFinal" => "324"
                      ]
                    ]
                  ]
                ]
              ]
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            9 => array:3 [
              "identificador" => "bib0050"
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              "referencia" => array:1 [
                0 => array:2 [
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                      "titulo" => "Weaning from ventilatory support"
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                            0 => "S&#46;K&#46; Epstein"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e3283220e07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "36"
                        "paginaFinal" => "43"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19179869"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of failed extubation on the outcome of mechanical ventilation"
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                          "autores" => array:3 [
                            0 => "S&#46;K&#46; Epstein"
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                            2 => "J&#46;B&#46; Wong"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1997"
                        "volumen" => "112"
                        "paginaInicial" => "186"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9228375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Torres"
                            1 => "J&#46;M&#46; Gatell"
                            2 => "E&#46; Aznar"
                            3 => "M&#46; el-Ebiary"
                            4 => "J&#46; Puig de la Bellacasa"
                            5 => "J&#46; Gonz&#225;lez"
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.152.1.7599812"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "152"
                        "paginaInicial" => "137"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7599812"
                            "web" => "Medline"
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              "identificador" => "bib0065"
              "etiqueta" => "13"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation&#46; The Spanish Lung Failure Collaborative Group"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "F&#46; Gordo"
                            3 => "R&#46; Fern&#225;ndez"
                            4 => "J&#46;F&#46; Solsona"
                            5 => "I&#46; Vallverd&#250;"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.156.2.9610109"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "156"
                        "paginaInicial" => "459"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9279224"
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                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Weaning from mechanical ventilation"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc660"
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                        "tituloSerie" => "Crit Care"
                        "fecha" => "2000"
                        "volumen" => "4"
                        "paginaInicial" => "72"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11094496"
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                          ]
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                ]
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                    0 => array:2 [
                      "titulo" => "A randomized&#44; controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Kollef"
                            1 => "S&#46;D&#46; Shapiro"
                            2 => "P&#46; Silver"
                            3 => "R&#46;E&#46; St John"
                            4 => "D&#46; Prentice"
                            5 => "S&#46; Sauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "25"
                        "paginaInicial" => "567"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9142019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses&#58; Effect on weaning time and incidence of ventilator-associated pneumonia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;P&#46; Marelich"
                            1 => "S&#46; Murin"
                            2 => "F&#46; Battistella"
                            3 => "J&#46; Inciardi"
                            4 => "T&#46; Vierra"
                            5 => "M&#46; Roby"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "459"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10936141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0085"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilator weaning protocols driven by nonphysician health-care professionals&#58; Evidence-based clinical practice guidelines"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;W&#46; Ely"
                            1 => "M&#46;O&#46; Meade"
                            2 => "E&#46;F&#46; Haponik"
                            3 => "M&#46;H&#46; Kollef"
                            4 => "D&#46;J&#46; Cook"
                            5 => "G&#46;H&#46; Guyatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2001"
                        "volumen" => "120"
                        "paginaInicial" => "S454"
                        "paginaFinal" => "S463"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practising evidence-based medicine&#58; The design and implementation of a multidisciplinary team-driven extubation protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;K&#46; Chan"
                            1 => "S&#46; Fischer"
                            2 => "T&#46;E&#46; Stewart"
                            3 => "D&#46;C&#46; Hallett"
                            4 => "P&#46; Hynes-Gay"
                            5 => "S&#46;E&#46; Lapinsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2001"
                        "volumen" => "5"
                        "paginaInicial" => "349"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11737924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of a nurses&#8217; protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48<span class="elsevierStyleHsp" style=""></span>hours&#58; A prospective cohort study with a matched historical control group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Tonnelier"
                            1 => "G&#46; Prat"
                            2 => "G&#46; Le Gal"
                            3 => "C&#46; Gut-Gobert"
                            4 => "A&#46; Renault"
                            5 => "J&#46;M&#46; Boles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc3030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "R83"
                        "paginaFinal" => "R89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15774054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol-directed vs physician-directed weaning from ventilator in intra-abdominal surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46; Chaiwat"
                            1 => "N&#46; Sarima"
                            2 => "K&#46; Niyompanitpattana"
                            3 => "C&#46; Komoltri"
                            4 => "Y&#46; Udomphorn"
                            5 => "S&#46; Kongsayreepong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Assoc Thai"
                        "fecha" => "2010"
                        "volumen" => "93"
                        "paginaInicial" => "930"
                        "paginaFinal" => "936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20718169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;W&#46; Ely"
                            1 => "A&#46;M&#46; Baker"
                            2 => "D&#46;P&#46; Dunagan"
                            3 => "H&#46;L&#46; Burke"
                            4 => "A&#46;C&#46; Smith"
                            5 => "P&#46;T&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199612193352502"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1996"
                        "volumen" => "335"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8948561"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning children from mechanical ventilation&#58; A prospective randomized trial of protocol-directed versus physician-directed weaning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;R&#46; Schultz"
                            1 => "R&#46;J&#46; Lin"
                            2 => "H&#46;M&#46; Watzman"
                            3 => "S&#46;M&#46; Durning"
                            4 => "R&#46; Hales"
                            5 => "A&#46; Woodson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2001"
                        "volumen" => "46"
                        "paginaInicial" => "772"
                        "paginaFinal" => "782"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11463367"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol-driven ventilator management in children&#58; Comparison to nonprotocol care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;D&#46; Restrepo"
                            1 => "J&#46;D&#46; Fortenberry"
                            2 => "C&#46; Spainhour"
                            3 => "J&#46; Stockwell"
                            4 => "L&#46;T&#46; Goodfellow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066604267646"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "274"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15358946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children&#58; A randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Randolph"
                            1 => "D&#46; Wypij"
                            2 => "S&#46;T&#46; Venkataraman"
                            3 => "J&#46;H&#46; Hanson"
                            4 => "R&#46;G&#46; Gedeit"
                            5 => "K&#46;L&#46; Meert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2002"
                        "volumen" => "288"
                        "paginaInicial" => "2561"
                        "paginaFinal" => "2568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12444863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;P&#46; Kress"
                            1 => "A&#46;S&#46; Pohlman"
                            2 => "M&#46;F&#46; O&#8217;Connor"
                            3 => "J&#46;B&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200005183422002"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "342"
                        "paginaInicial" => "1471"
                        "paginaFinal" => "1477"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10816184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;S&#46; Jin"
                            1 => "M&#46;S&#46; Yum"
                            2 => "S&#46;L&#46; Kim"
                            3 => "H&#46;Y&#46; Shin"
                            4 => "E&#46;H&#46; Lee"
                            5 => "E&#46;J&#46; Ha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2007.22.4.693"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "693"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17728512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation&#58; A randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;K&#46; Foronda"
                            1 => "E&#46;J&#46; Troster"
                            2 => "J&#46;A&#46; Farias"
                            3 => "C&#46;S&#46; Barbas"
                            4 => "A&#46;A&#46; Ferraro"
                            5 => "L&#46;S&#46; Faria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3182257520"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "39"
                        "paginaInicial" => "2526"
                        "paginaFinal" => "2533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21705894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilaci&#243;n mec&#225;nica en pediatr&#237;a&#46; &#191;C&#243;mo y cu&#225;ndo extubar&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Mart&#237;nez de Azagra"
                            1 => "J&#46; Casado Flores"
                            2 => "R&#46; Jim&#233;nez Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2003"
                        "volumen" => "27"
                        "paginaInicial" => "673"
                        "paginaFinal" => "675"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Farias"
                            1 => "A&#46; Retta"
                            2 => "I&#46; Al&#237;a"
                            3 => "F&#46; Olazarri"
                            4 => "A&#46; Esteban"
                            5 => "A&#46; Golubicki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s001340101035"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2001"
                        "volumen" => "27"
                        "paginaInicial" => "1649"
                        "paginaFinal" => "1654"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11685307"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparision of four methods of weaning patients from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Esteban"
                            1 => "F&#46; Frutos"
                            2 => "M&#46;J&#46; Tobin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199502093320601"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1995"
                        "volumen" => "332"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7823995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Brochard"
                            1 => "A&#46; Rauss"
                            2 => "S&#46; Benito"
                            3 => "G&#46; Conti"
                            4 => "J&#46; Mancebo"
                            5 => "N&#46; Rekik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.150.4.7921460"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "150"
                        "paginaInicial" => "896"
                        "paginaFinal" => "903"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7921460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation&#46; Spanish Lung Failure Collaborative Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            3 => "A&#46; Gil"
                            4 => "F&#46; Gordo"
                            5 => "I&#46; Vallverd&#250;"
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "volumen" => "159"
                        "paginaInicial" => "512"
                        "paginaFinal" => "518"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9927366"
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                      "titulo" => "Positive end-expiratory pressure vs T-piece&#46; Extubation after mechanical ventilation"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;P&#46; Jones"
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                            2 => "C&#46; Morgan"
                            3 => "I&#46; Fraser"
                            4 => "R&#46; Hyland"
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                        "tituloSerie" => "Chest"
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                        "volumen" => "100"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1959410"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Differences in respiratory parameters during continuous positive airway pressure and pressure support ventilation in infants and children"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "R&#46; Hasegawa"
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                            4 => "S&#46; Satoh"
                            5 => "S&#46; Matsukawa"
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                        "tituloSerie" => "Tohoku J Exp Med"
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                        "paginaInicial" => "45"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11556733"
                            "web" => "Medline"
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                      "titulo" => "A spontaneous breathing trial with pressure support overestimates readiness for extubation in children"
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                            3 => "J&#46;H&#46; Arnold"
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                        "tituloSerie" => "Pediatr Crit Care Med"
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                        "paginaInicial" => "e330"
                        "paginaFinal" => "e335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21666529"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0180"
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                      "titulo" => "Spontaneous breathing trial in chronic obstructive pulmonary disease&#58; Continuous positive airway pressure &#40;CPAP&#41; versus T-piece"
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                        "tituloSerie" => "Med Intensiva"
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                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "An evaluation of extubation failure predictors in mechanically ventilated infants and children"
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                            3 => "F&#46; Olazarri"
                            4 => "A&#46; Fern&#225;ndez"
                            5 => "A&#46; Esteban"
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                    0 => array:2 [
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                        "tituloSerie" => "Intensive Care Med"
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                        "volumen" => "28"
                        "paginaInicial" => "752"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12107682"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous breathing trial predicts successful extubation in infants and children"
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                          "autores" => array:3 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
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                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation"
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                          "autores" => array:2 [
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                        "tituloSerie" => "N Engl J Med"
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                        "volumen" => "324"
                        "paginaInicial" => "1445"
                        "paginaFinal" => "1450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2023603"
                            "web" => "Medline"
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                0 => array:2 [
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                      "titulo" => "Predictors of extubation success and failure in mechanically ventilated infants and children"
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                        "tituloSerie" => "Crit Care Med"
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                        "paginaInicial" => "1568"
                        "paginaFinal" => "1579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8797633"
                            "web" => "Medline"
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              "identificador" => "bib0205"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of predictors of extubation from mechanical ventilation in children"
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                  "host" => array:1 [
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                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
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              "identificador" => "bib0210"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluation of predictors of weaning from mechanical ventilation in pediatric patients"
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                        "paginaInicial" => "344"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9407568"
                            "web" => "Medline"
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              "identificador" => "bib0215"
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                    0 => array:2 [
                      "titulo" => "Predictors of successful extubation in children"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "paginaFinal" => "1566"
                        "link" => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Validation of predictors of extubation success and failure in mechanically ventilated infants and children"
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                      "titulo" => "Tension-time index as a predictor of extubation outcome in ventilated children"
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                        "paginaFinal" => "988"
                        "link" => array:1 [
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                            4 => "M&#46;C&#46; Fonseca"
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                          "autores" => array:2 [
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                      "titulo" => "The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients"
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                        "paginaFinal" => "496"
                        "link" => array:1 [
                          0 => array:2 [
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                          "autores" => array:3 [
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                        "tituloSerie" => "Chest"
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                        "paginaFinal" => "900"
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                      "titulo" => "Risk factors for extubation failure in mechanically ventilated pediatric patients"
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                            3 => "P&#46;L&#46; Bered"
                            4 => "K&#46; Zilles"
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                      "titulo" => "A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation"
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                        "paginaFinal" => "315"
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Retirada de la ventilación mecánica en pediatría. Estado de la situación
Weaning From Mechanical Ventilation in Paediatrics. State of the Art
Jorge Valenzuelaa,b,
Corresponding author
jvalenzuela@hurtadohosp.cl
jvalenzuelavasq@gmail.com

Autor para correspondencia.
, Patricio Aranedab, Pablo Crucesb,c
a Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
b Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile
c Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ecología y Recursos Naturales, Universidad Andres Bello, Santiago, Chile
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por lo que su desconexi&#243;n debe realizarse tan pronto como el paciente sea capaz de sostener su respiraci&#243;n espont&#225;nea&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La desconexi&#243;n del respirador mec&#225;nico incluye en un sentido amplio dos situaciones completamente diferentes aunque relacionadas&#58; el descenso progresivo de la asistencia respiratoria &#40;destete&#41; y la remoci&#243;n del tubo endotraqueal &#40;extubaci&#243;n&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El <span class="elsevierStyleItalic">destete</span> puede ser definido como la reducci&#243;n gradual del soporte respiratorio&#44; asignando un tiempo de respiraci&#243;n espont&#225;nea que permita al paciente asumir la responsabilidad de un intercambio gaseoso aceptable<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; Este proceso puede durar entre el 40 al 50&#37; del tiempo total de la estancia en VM&#46; Sin embargo&#44; algunos pacientes fracasan&#44; prolongando la permanencia en el respirador&#46; Diversas condiciones fisiopatol&#243;gicas han sido vinculadas a dicho fracaso&#44; como sobrecarga ventilatoria&#44; disfunci&#243;n hemodin&#225;mica&#44; incompetencia neuromuscular &#40;central y&#47;o perif&#233;rica&#41;&#44; debilidad muscular diafragm&#225;tica&#44; alteraciones nutricionales y trastornos metab&#243;licos&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; No obstante&#44; identificar el mecanismo predominante sigue representando un desaf&#237;o para el equipo tratante&#44; ya que este habitualmente es complejo y multifactorial&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La <span class="elsevierStyleItalic">extubaci&#243;n</span> consiste en la remoci&#243;n del tubo endotraqueal&#46; Generalmente este momento coincide con la determinaci&#243;n de que el paciente es capaz de mantener un intercambio gaseoso efectivo sin soporte del respirador o con un soporte adicional m&#237;nimo&#46; Sin embargo&#44; la extubaci&#243;n presenta predictores de &#233;xito y&#47;o fracaso espec&#237;ficos&#44; los cuales habitualmente est&#225;n relacionados con la habilidad de protecci&#243;n de la v&#237;a a&#233;rea&#44; el manejo de secreciones y la permeabilidad de la v&#237;a a&#233;rea superior<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El t&#233;rmino <span class="elsevierStyleItalic">fracaso de extubaci&#243;n</span> &#40;FE&#41; representa un conjunto de condiciones que determinan la necesidad de reintubaci&#243;n y restablecimiento de la VM dentro de las primeras 24 a 72<span class="elsevierStyleHsp" style=""></span>h posteriores al retiro del tubo endotraqueal<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; En adultos&#44; cerca de 55 estudios &#40;33&#46;000 pacientes aproximadamente&#41; reportan una tasa media de FE del 12&#44;5&#37; &#40;rango&#44; 2-25&#37;&#41;&#46; En pediatr&#237;a&#44; la tasa de FE es igual de heterog&#233;nea&#44; y var&#237;a entre el 4&#44;9 y el 29&#37;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Existe controversia acerca de la tasa de FE &#243;ptima&#44; ya que valores muy reducidos pudieran reflejar la prolongaci&#243;n innecesaria de la VM&#44; lo que derivar&#237;a en un aumento del riesgo de neumon&#237;a asociada a VM&#44; de la estancia hospitalaria y de la mortalidad&#46; En este sentido&#44; Kurachek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> reportaron que el 62&#44;5&#37; de 136 extubaciones no planificadas no requirieron reintubaci&#243;n&#44; por lo que muchos de estos ni&#241;os pudieron ser extubados antes de lo planeado&#46; En contraposici&#243;n&#44; valores muy elevados indicar&#237;an una extubaci&#243;n prematura&#44; la que se asocia a potenciales morbilidades catastr&#243;ficas&#44; fundamentalmente hemodin&#225;micas y respiratorias<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; De todas maneras&#44; ambas situaciones pueden incrementar la duraci&#243;n de la VM&#44; la estancia en la UCI y hospitalaria y&#44; por ende&#44; los costos en salud<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a>&#46; De este modo&#44; la decisi&#243;n tanto de iniciar el proceso de destete as&#237; como la extubaci&#243;n deben estar basados en criterios objetivos y reproducibles&#44; lo que en pediatr&#237;a cuenta con un nivel de evidencia a&#250;n limitado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de esta revisi&#243;n fue analizar la informaci&#243;n disponible sobre el destete y la extubaci&#243;n en pediatr&#237;a&#44; realizando una comparaci&#243;n con los principales estudios de la misma tem&#225;tica en la poblaci&#243;n adulta&#46; Bas&#225;ndonos en la informaci&#243;n actual&#44; sugerimos una forma de abordar esta decisi&#243;n en ni&#241;os gravemente enfermos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protocolos de destete</span><p id="par0035" class="elsevierStylePara elsevierViewall">La decisi&#243;n de iniciar el destete depende del cumplimiento de ciertos criterios cl&#237;nicos&#44; tales como el control de la causa que motiv&#243; la conexi&#243;n a VM&#44; el intercambio gaseoso efectivo&#44; la condici&#243;n neuromuscular apropiada&#44; el nivel de conciencia adecuado que permita la protecci&#243;n de la v&#237;a a&#233;rea y un estado hemodin&#225;mico estable<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46; Habitualmente esta decisi&#243;n recae en el m&#233;dico intensivista&#44; quien inicia el proceso cuando sospecha que el destete puede ser exitoso<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Sin embargo&#44; la aplicaci&#243;n de protocolos de destete guiados tanto por enfermeras como por terapeutas respiratorios sugiere que la identificaci&#243;n precoz de pacientes en condiciones de realizar un ensayo de respiraci&#243;n espont&#225;nea &#40;ERE&#41;&#44; a trav&#233;s de la evaluaci&#243;n de criterios cl&#237;nicos espec&#237;ficos&#44; logra reducir el tiempo de destete&#44; la duraci&#243;n de la VM y la estancia en la UCI en pacientes adultos<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;21</span></a>&#46; Uno de los primeros reportes sobre la tem&#225;tica fue realizado por Ely et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; quienes mostraron que el empleo de una evaluaci&#243;n diaria de ciertos criterios &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>200&#44; presi&#243;n positiva al final de la espiraci&#243;n &#40;<span class="elsevierStyleItalic">positive pressure end-expiratory</span> &#91;PEEP&#93;&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; presencia del reflejo de tos&#44; relaci&#243;n frecuencia respiratoria&#47;volumen tidal &#40;FR&#47;V<span class="elsevierStyleInf">T</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>105&#44; sin vasopresores y agentes sedantes&#41; junto a la aplicaci&#243;n del ERE redujo la duraci&#243;n y las complicaciones asociadas a la VM&#44; disminuyendo los costos en salud&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En pediatr&#237;a&#44; la eficacia de los protocolos de destete a&#250;n es controvertida<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a>&#46; Schultz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> expusieron que el empleo de un protocolo redujo el tiempo destinado al destete respecto a la intervenci&#243;n guiada por el m&#233;dico intensivista&#46; Sin embargo&#44; tanto la duraci&#243;n de la VM como el tiempo de extubaci&#243;n no mostraron diferencias significativas entre ambos grupos&#46; Un estudio multic&#233;ntrico y prospectivo realizado por el grupo de investigaci&#243;n PALISI mostr&#243; que el empleo de un protocolo de destete en pacientes pedi&#225;tricos sometidos a VM&#44; quienes hab&#237;an experimentado un fracaso de destete previo&#44; no redujo de forma significativa el tiempo de destete&#44; as&#237; como tampoco la tasa de FE&#44; en comparaci&#243;n con la intervenci&#243;n est&#225;ndar&#46; Adem&#225;s&#44; los autores advirtieron que el sobreempleo de f&#225;rmacos sedantes retrasaba el tiempo de destete&#46; En este estudio sugieren que la evaluaci&#243;n de criterios cl&#237;nicos espec&#237;ficos&#44; sumada a la interrupci&#243;n diaria de la sedaci&#243;n&#44; podr&#237;an ser medidas efectivas para reducir la duraci&#243;n de la VM en pacientes pedi&#225;tricos<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En este sentido&#44; la administraci&#243;n excesiva de f&#225;rmacos sedantes durante la VM representa una problem&#225;tica importante&#44; prolongando la estancia en el respirador&#46; En adultos&#44; Kress et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> observaron que la interrupci&#243;n diaria de la sedaci&#243;n no solo redujo la duraci&#243;n de la VM y la estancia en la UCI&#44; sino que adem&#225;s no aument&#243; la tasa de eventos adversos y posibilit&#243; una mejor evaluaci&#243;n neurol&#243;gica&#46; En pediatr&#237;a&#44; Jin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> reportaron que la implementaci&#243;n de un protocolo de sedaci&#243;n&#44; el cual incluy&#243; la escala COMFORT&#44; redujo la duraci&#243;n de la VM&#44; la estancia en la UCI&#44; la dosis total de sedantes y la incidencia de s&#237;ndrome de abstinencia&#46; Recientemente&#44; Foronda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> implementaron la estrategia de la evaluaci&#243;n diaria sumada a la aplicaci&#243;n de un ERE en 294 ni&#241;os sometidos a VM por m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#44; logrando reducir la duraci&#243;n de la VM sin aumentar la tasa de FE&#46; Seg&#250;n los autores&#44; las diferencias con los resultados obtenidos por Randolph et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> se asociaron a la selecci&#243;n de pacientes&#44; ya que en este &#250;ltimo trabajo solo se incluyeron pacientes que hab&#237;an experimentado un fracaso de destete previo&#46; Por otra parte&#44; cabe se&#241;alar que en el estudio de Foronda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#44; a pesar de que los par&#225;metros programados en el respirador previo a la aplicaci&#243;n del ERE eran relativamente elevados&#44; no representaron un factor de riesgo de FE&#44; por lo que los autores especulan que las diferencias obtenidas entre ambos grupos se podr&#237;an atribuir a la aplicaci&#243;n de una evaluaci&#243;n diaria con criterios conservadores y a la reticencia a realizar un ERE en pacientes con asistencia respiratoria elevada&#44; como ocurri&#243; en el grupo control&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En este sentido&#44; creemos que la evaluaci&#243;n diaria a trav&#233;s de par&#225;metros cl&#237;nicos y funcionales integrados podr&#237;a abreviar la identificaci&#243;n de pacientes aptos para realizar un ERE<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46; A pesar de la disparidad en los criterios empleados por diversos autores&#44; en nuestra unidad utilizamos los criterios descritos en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">T&#233;cnicas de destete</span><p id="par0055" class="elsevierStylePara elsevierViewall">El m&#233;todo de destete m&#225;s empleado en pediatr&#237;a es la reducci&#243;n gradual de los par&#225;metros del respirador durante una modalidad de ventilaci&#243;n intermitente mandatorio sincronizado &#40;<span class="elsevierStyleItalic">synchronized intermittent mandatory ventilation</span> &#91;SIMV&#93;&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; A trav&#233;s de esta pr&#225;ctica&#44; el retiro de la VM se realiza cuando se alcanzan bajos niveles de frecuencia respiratoria&#46; Adem&#225;s&#44; este modo suele programarse con una presi&#243;n de soporte&#44; la cual garantiza un volumen tidal espec&#237;fico de acuerdo con las necesidades del paciente y eventualmente tendr&#237;a la ventaja de aminorar el trabajo respiratorio adicional impuesto por el tubo endotraqueal y el circuito del respirador mec&#225;nico<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;29</span></a>&#46; Sin embargo&#44; en adultos se ha evidenciado que este m&#233;todo prolonga la estancia en VM comparado con el empleo del ERE diario y presi&#243;n de soporte<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a>&#46; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> reportaron que la duraci&#243;n del destete depende de la t&#233;cnica utilizada&#44; donde la realizaci&#243;n diaria de un ERE reduce el tiempo de destete en comparaci&#243;n con el modo de SIMV y presi&#243;n de soporte&#46; Concordantemente&#44; 2 estudios mostraron que no todos los ni&#241;os requieren esta reducci&#243;n gradual para lograr un destete exitoso<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;29</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos de ensayo de respiraci&#243;n espont&#225;nea</span><p id="par0060" class="elsevierStylePara elsevierViewall">El ERE es una prueba que se realiza mientras el paciente est&#225; intubado y eval&#250;a su tolerancia cardiorrespiratoria para sostener una respiraci&#243;n espont&#225;nea con soporte respiratorio m&#237;nimo o nulo&#44; permitiendo identificar a los pacientes en condiciones de ser extubados&#46; Durante esta prueba se miden variables asociadas a la fatiga muscular respiratoria y al logro de un intercambio gaseoso efectivo<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;29&#44;31</span></a>&#46; Diversos reportes en pacientes adultos han mostrado que entre el 60 y el 80&#37; de los pacientes en VM pueden ser extubados sin inconvenientes despu&#233;s de tolerar exitosamente un ERE<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;30&#8211;33</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los m&#233;todos de ERE m&#225;s empleados son&#58; la presi&#243;n positiva continua en la v&#237;a a&#233;rea &#40;<span class="elsevierStyleItalic">continuous positive airway pressure</span> &#91;CPAP&#93;&#41;&#44; el tubo T y la presi&#243;n de soporte&#46; En pediatr&#237;a&#44; la elecci&#243;n del m&#233;todo depender&#225; fundamentalmente de la experiencia del equipo tratante&#44; ya que no se ha evidenciado que un m&#233;todo sea superior a otro<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;34</span></a>&#46; Sin embargo&#44; un estudio reciente sugiere que el empleo de altos niveles de presi&#243;n de soporte programados seg&#250;n el di&#225;metro del tubo endotraqueal podr&#237;a sobrestimar el &#233;xito del ERE en pacientes pedi&#225;tricos&#44; contribuyendo a elevar la tasa de FE<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Jones et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> compararon la t&#233;cnica de CPAP y tubo T durante 60<span class="elsevierStyleHsp" style=""></span>min en 106 pacientes adultos&#44; no encontrando diferencias en la tasa de FE&#46; Concordantemente&#44; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> no encontraron diferencias entre tubo T y presi&#243;n de soporte de 7<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O durante 120<span class="elsevierStyleHsp" style=""></span>min&#46; Estos resultados fueron adem&#225;s corroborados recientemente por Molina-Saldarriaga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> en pacientes con enfermedad pulmonar obstructiva cr&#243;nica&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Farias et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> replicaron estos estudios en 257 pacientes pedi&#225;tricos sometidos a VM por al menos 48<span class="elsevierStyleHsp" style=""></span>h&#44; sin encontrar diferencias entre tubo T y presi&#243;n de soporte de 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; tanto en la tolerancia al ERE como en la tasa de FE&#46; Posteriormente&#44; los mismos autores evaluaron a trav&#233;s de un m&#233;todo similar a 418 pacientes pedi&#225;tricos&#44; observando que la frecuencia respiratoria &#40;FR&#41;&#44; el volumen tidal &#40;V<span class="elsevierStyleInf">T</span>&#41;&#44; la relaci&#243;n entre FR y V<span class="elsevierStyleInf">T</span> indexada al peso &#40;FR&#47;V<span class="elsevierStyleInf">T</span>&#41; y presi&#243;n inspiratoria m&#225;xima &#40;PI<span class="elsevierStyleInf">max</span>&#41; medidos durante el ERE eran pobres predictores de FE<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La duraci&#243;n del ERE tambi&#233;n es un tema controvertido&#46; La mayor&#237;a de los trabajos ha establecido una duraci&#243;n del ERE de 120<span class="elsevierStyleHsp" style=""></span>min<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;29&#44;30&#44;32</span></a>&#46; Sin embargo&#44; un estudio prospectivo&#44; aleatorio y multic&#233;ntrico de 526 pacientes adultos mostr&#243; que un ERE de 30<span class="elsevierStyleHsp" style=""></span>min permite identificar de manera equivalente a un ERE de 120<span class="elsevierStyleHsp" style=""></span>min a los pacientes en condiciones de extubarse&#44; sin diferencias en la tasa de FE<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Por otra parte&#44; Chavez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> utilizaron una modalidad novedosa de ERE&#44; adaptando una bolsa de anestesia de flujo continuo &#40;3<span class="elsevierStyleHsp" style=""></span>l&#47;min para lactantes y 10<span class="elsevierStyleHsp" style=""></span>l&#47;min para ni&#241;os mayores&#41; ajustada para otorgar 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O de CPAP durante 15<span class="elsevierStyleHsp" style=""></span>min&#44; observando que de 70 pacientes pedi&#225;tricos&#44; el 7&#44;8&#37; experimentaron FE&#46; Sin embargo&#44; cabe mencionar que los pacientes sometidos a ERE ya se encontraban en condiciones de ser extubados seg&#250;n el criterio del m&#233;dico intensivista a cargo&#44; por lo que la aplicaci&#243;n del ERE podr&#237;a haber sido innecesaria&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#205;ndices predictores de fracaso de extubaci&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">En adultos se han estudiado m&#225;s de 50 predictores de destete&#44; sin embargo solo 5 han mostrado una modesta capacidad de predecir el retiro de la VM &#40;PI<span class="elsevierStyleInf">max</span>&#44; volumen minuto &#91;V<span class="elsevierStyleInf">m</span>&#93;&#44; FR&#44; V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; En este sentido&#44; la medici&#243;n de &#237;ndices que integran m&#225;s de una variable&#44; como el FR&#47;V<span class="elsevierStyleInf">T</span> y el &#237;ndice CROP &#40;del ingl&#233;s <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index</span>&#41; han mostrado ser m&#225;s precisos respecto a mediciones como la PI<span class="elsevierStyleInf">max</span> y el V<span class="elsevierStyleInf">m</span>&#44; con una capacidad predictiva moderada en adultos<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a>&#46; Sin embargo&#44; estudios en pediatr&#237;a han reportado que tanto el FR&#47;V<span class="elsevierStyleInf">T</span> como el &#237;ndice CROP presentan un bajo poder predictivo<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;40&#44;41</span></a>&#44; y solo un trabajo ha mostrado que el &#237;ndice CROP podr&#237;a ser &#250;til para predecir el resultado de la extubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a>&#46; Esta discrepancia podr&#237;a atribuirse tanto al amplio rango de edad y peso de los pacientes pedi&#225;tricos&#44; como a la disparidad en el empleo de estos predictores en pediatr&#237;a respecto a la poblaci&#243;n adulta<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;39</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Thiagarajan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> mostraron que una FR<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>respiraciones&#47;min &#40;rpm&#41;&#44; un V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#44; FR&#47;V<span class="elsevierStyleInf">T</span> indexado al peso<span class="elsevierStyleHsp" style=""></span>&#8804;8<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kg e &#237;ndice CROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;15<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm fueron valores de corte para predecir el &#233;xito de la extubaci&#243;n&#46; Por otra parte&#44; Baumeister et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> emplearon el FR&#47;V<span class="elsevierStyleInf">T</span> y el &#237;ndice CROP para predecir el &#233;xito de la extubaci&#243;n&#44; mostrando diferentes valores de corte respecto a los reportados por Thiagarajan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> &#40;FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kg y el &#237;ndice CROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;1<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&#41;&#46; Contrariamente&#44; Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> reportaron que las mediciones tanto del V<span class="elsevierStyleInf">T</span> como del V<span class="elsevierStyleInf">m</span> previo a la extubaci&#243;n fueron m&#225;s sensibles y espec&#237;ficas respecto a mediciones multivariables para determinar el pron&#243;stico de la extubaci&#243;n en pacientes pedi&#225;tricos&#46; Venkataraman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> expusieron que el an&#225;lisis de variables como el V<span class="elsevierStyleInf">T</span>&#44; la presi&#243;n inspiratoria pico&#44; la elasticidad din&#225;mica&#44; el cociente entre el V<span class="elsevierStyleInf">T</span> y el tiempo inspiratorio previo a la extubaci&#243;n lograron predecir FE en 312 pacientes pedi&#225;tricos ventilados por m&#225;s de 24<span class="elsevierStyleHsp" style=""></span>h&#46; En concordancia con Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a>&#44; los autores observaron que tanto el FR&#47;V<span class="elsevierStyleInf">T</span> como el &#237;ndice CROP no eran &#237;ndices &#250;tiles para predecir el resultado de la extubaci&#243;n&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se ha evidenciado que la habilidad para sostener una respiraci&#243;n espont&#225;nea durante el destete depende del control respiratorio central&#44; de la capacidad de los m&#250;sculos inspiratorios y de la carga impuesta sobre ellos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#8211;49</span></a>&#46; Manczur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> observaron que la presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s &#40;P<span class="elsevierStyleInf">0&#44;1</span>&#41; fue m&#225;s baja en los pacientes pedi&#225;tricos que experimentaron FE&#46; Este resultado fue atribuido a un pobre control respiratorio central&#44; a la disminuci&#243;n de la fuerza muscular inspiratoria y a la hiperinflaci&#243;n&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As&#237; mismo&#44; trabajos en adultos han mostrado que el &#237;ndice tensi&#243;n-tiempo &#40;TTI&#41; y el balance carga&#47;fuerza&#44; que son mediciones relacionadas con la resistencia a la fatiga de los m&#250;sculos respiratorios&#44; permiten optimizar la precisi&#243;n en el pron&#243;stico del destete<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48</span></a>&#46; Sin embargo&#44; estudios en pediatr&#237;a han revelado resultados contradictorios respecto a la utilidad de estos &#237;ndices<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">46&#44;49&#44;50</span></a>&#46; Harikumar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> reportaron que la medici&#243;n de TTI logr&#243; una sensibilidad y una especificidad del 100&#37; para predecir FE&#44; con un punto de corte de 0&#44;18&#46; En contraposici&#243;n&#44; Noizet et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> se&#241;alaron que el TTI&#44; entre otros &#237;ndices multivariables&#44; fue incapaz de predecir el FE&#44; aludiendo que la principal causa de ineficacia de estos &#237;ndices se relaciona con el momento de la medici&#243;n&#44; la cual se realiza cuando el paciente ya se encuentra con criterios para lograr un destete exitoso&#46; Recientemente&#44; Johnston et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> reportaron que las mediciones de V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&#44; PI<span class="elsevierStyleInf">max</span> y el balance carga&#47;fuerza permitieron predecir FE en pacientes con diagn&#243;stico de bronquiolitis aguda severa&#46; Los valores del balance carga&#47;fuerza fueron significativamente inferiores en el grupo extubado exitosamente respecto al grupo que present&#243; FE&#44; aunque la capacidad predictiva de este &#237;ndice fue baja&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En este contexto&#44; los &#237;ndices univariables aparecen como una mejor alternativa respecto de los &#237;ndices integrados para predecir el FE&#46; Sin embargo&#44; a&#250;n quedan por establecer valores de corte que engloben a la totalidad de la poblaci&#243;n pedi&#225;trica&#44; as&#237; como tambi&#233;n determinar el momento id&#243;neo para realizar estas mediciones&#46; Los &#237;ndices predictores seg&#250;n el resultado de la extubaci&#243;n y sus valores de corte en pacientes pedi&#225;tricos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fracaso de extubaci&#243;n en pediatr&#237;a</span><p id="par0110" class="elsevierStylePara elsevierViewall">En adultos&#44; el FE ha sido asociado con aumento en la duraci&#243;n de la VM&#44; en la estancia en UCI&#44; en los costos en salud y en la tasa de mortalidad&#44; por lo que su prevenci&#243;n es de vital relevancia&#46; No obstante&#44; hasta la fecha no existen mediciones que permitan prevenir el FE con exactitud&#44; lo que nos lleva a estar alerta a los factores de riesgo asociados al FE con el fin de optimizar la decisi&#243;n de extubar a un paciente sometido a VM<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre las causas m&#225;s frecuentes de FE se encuentra la obstrucci&#243;n de la v&#237;a a&#233;rea superior posterior a la extubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;50&#8211;52</span></a>&#46; Predecir esta condici&#243;n es complejo&#44; ya que un ERE solo indaga la tolerancia cardiorrespiratoria para respirar espont&#225;neamente&#46; Wratney et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> reportaron que la medici&#243;n de un test de fuga previo al retiro del tubo endotraqueal no deber&#237;a emplearse como criterio &#250;nico para decidir la extubaci&#243;n del paciente pedi&#225;trico&#44; ya que la ausencia de fuga al aplicar una presi&#243;n de v&#237;a a&#233;rea igual o superior a 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;test de fuga negativo&#41; fue com&#250;n en esta poblaci&#243;n y no se observ&#243; asociaci&#243;n con la presencia de estridor lar&#237;ngeo y&#47;o necesidad de reintubaci&#243;n&#46; No obstante&#44; frente a la posibilidad de FE por obstrucci&#243;n de v&#237;a a&#233;rea superior&#44; la administraci&#243;n profil&#225;ctica de esteroides ha demostrado reducir la incidencia de estridor posterior a la extubaci&#243;n en la poblaci&#243;n neonatal y pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">53</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Estudios en pediatr&#237;a han mostrado resultados dis&#237;miles respecto a la tasa de FE y sus factores de riesgo asociados<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;24&#44;54&#8211;57</span></a>&#46; Esto ha sido atribuido en parte al dise&#241;o de los trabajos &#40;retrospectivo vs&#46; prospectivo&#41;&#44; a los criterios de inclusi&#243;n y a la cantidad de centros involucrados<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En un estudio retrospectivo&#44; Baisch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> observaron una tasa de FE del 4&#44;1&#37; en 3&#46;193 pacientes pedi&#225;tricos retirados de VM&#46; Las causas de FE fueron multifactoriales&#44; predominando la obstrucci&#243;n de la v&#237;a a&#233;rea superior&#46; Los factores de riesgo asociados a FE fueron la corta edad&#44; la permanencia en VM&#44; la estancia en la UCI y hospitalaria&#44; sin asociaci&#243;n con el riesgo de mortalidad hospitalaria&#46; Por su parte&#44; Edmunds et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">55</span></a> mostraron una tasa de FE del 7&#44;9&#37; en 280 pacientes intubados por al menos 48<span class="elsevierStyleHsp" style=""></span>h&#46; La obstrucci&#243;n de v&#237;a a&#233;rea superior nuevamente fue la causa m&#225;s com&#250;n de FE&#44; estableciendo adem&#225;s una asociaci&#243;n entre la duraci&#243;n de la VM y FE&#46; Fontela et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> reportaron una tasa de FE del 10&#44;5&#37;&#44; observando que la principal causa de FE fue el fallo respiratorio&#46; En este estudio&#44; los factores de riesgo asociados a FE fueron la corta edad&#44; la estancia en VM<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>d&#237;as&#44; el &#237;ndice de oxigenaci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>5&#44; el uso de in&#243;tropos y la administraci&#243;n de f&#225;rmacos sedantes intravenosos &#62;<span class="elsevierStyleHsp" style=""></span>10 d&#237;as&#46; Kurachek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44; en un estudio prospectivo y multic&#233;ntrico que incluy&#243; a 16<span class="elsevierStyleHsp" style=""></span>UCI&#44; reportaron una tasa de FE del 6&#44;2&#37; &#40;rango&#44; 1&#44;5-8&#44;8&#37;&#41; y una estancia promedio en VM de 4&#44;8<span class="elsevierStyleHsp" style=""></span>d&#237;as en 1&#46;459 pacientes pedi&#225;tricos intubados por al menos 24<span class="elsevierStyleHsp" style=""></span>h&#44; estableciendo que los factores de riesgo de FE fueron una edad menor de 24<span class="elsevierStyleHsp" style=""></span>meses&#44; s&#237;ndrome gen&#233;tico&#44; alteraci&#243;n respiratoria y neurol&#243;gica cr&#243;nica&#44; adem&#225;s de la necesidad de reemplazar el tubo endotraqueal al ingreso&#46; La incidencia de obstrucci&#243;n de v&#237;a a&#233;rea superior posterior a la extubaci&#243;n fue del 37&#37;&#44; y los autores no observaron asociaci&#243;n entre la duraci&#243;n de la VM y la tasa de FE&#46; Sin embargo&#44; al realizar un an&#225;lisis m&#225;s riguroso de la tasa de FE&#44; esta aument&#243; al incluir solo a pacientes que permanecieron m&#225;s de 48<span class="elsevierStyleHsp" style=""></span>h en VM &#40;del 4&#44;2 al 8&#37;&#41;&#46; Nuestra experiencia coincide con los estudios mencionados previamente&#44; ya que observamos una tasa de FE del 5&#44;3&#37; asociada directamente con la estancia en VM y la duraci&#243;n de la administraci&#243;n continua de opi&#225;ceos y benzodiacepinas<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Rol de la ventilaci&#243;n no invasiva en el destete</span><p id="par0125" class="elsevierStylePara elsevierViewall">En adultos&#44; se han descrito 3 indicaciones comunes de ventilaci&#243;n no invasiva &#40;VNI&#41; durante el destete&#58; a&#41;<span class="elsevierStyleHsp" style=""></span>modalidad alternativa de destete en pacientes con fracaso del ERE&#59; b&#41;<span class="elsevierStyleHsp" style=""></span>profilaxis posterior a la extubaci&#243;n en pacientes con alto riesgo de reintubaci&#243;n pero sin fallo respiratorio&#44; y c&#41;<span class="elsevierStyleHsp" style=""></span>soporte en pacientes extubados con fallo respiratorio dentro de las primeras 48<span class="elsevierStyleHsp" style=""></span>h posterior a la extubaci&#243;n&#46; La primera estrategia tiene como objetivo facilitar el destete&#44; y las 2 &#250;ltimas intentan evitar la reintubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;58</span></a>&#46; Sin embargo&#44; los estudios relacionados con la tem&#225;tica han mostrado resultados contradictorios respecto a la utilidad de la VNI durante el destete<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">58&#8211;62</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En un metaan&#225;lisis&#44; Burns et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> evaluaron el empleo de la VNI como modalidad alternativa para facilitar el destete temprano&#44; observando que esta estrategia se asoci&#243; a una significativa reducci&#243;n de la mortalidad&#44; incidencia de neumon&#237;a y duraci&#243;n de la VM&#46; Adem&#225;s&#44; en el an&#225;lisis de subgrupos&#44; los autores se&#241;alaron que los beneficios de la VNI en la mortalidad fueron mayores en pacientes con enfermedad pulmonar obstructiva cr&#243;nica&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Por su parte&#44; Ferrer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">60</span></a> mostraron que la VNI utilizada como terapia de rescate inmediatamente posterior a la extubaci&#243;n redujo el riesgo de fallo respiratorio agudo en pacientes con insuficiencia respiratoria cr&#243;nica hiperc&#225;pnica durante el ERE&#44; logrando incluso disminuir la mortalidad a los 90<span class="elsevierStyleHsp" style=""></span>d&#237;as&#46; Contrariamente&#44; 2 estudios no reportaron diferencias en la tasa de reintubaci&#243;n al comparar el uso de VNI respecto a la terapia est&#225;ndar en pacientes con fallo respiratorio posterior a la extubaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">61&#44;62</span></a>&#46; Adem&#225;s&#44; Esteban et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> describieron una mayor mortalidad en el grupo de pacientes que recibieron VNI&#44; probablemente asociada al retraso de la reintubaci&#243;n&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En pediatr&#237;a&#44; la experiencia sobre el uso de VNI durante el destete es limitada&#44; debido a que la informaci&#243;n disponible proviene de estudios no controlados y series de casos con pocos pacientes<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a>&#46; Mayordomo-Colunga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> reportaron que la VNI fue m&#225;s efectiva evitando la reintubaci&#243;n cuando se emple&#243; precozmente en pacientes con alto riesgo de FE respecto a su uso como terapia de rescate en pacientes con fallo respiratorio establecido&#46; Adem&#225;s&#44; los autores observaron que la reducci&#243;n de FR y FiO<span class="elsevierStyleInf">2</span> al cabo de 6<span class="elsevierStyleHsp" style=""></span>h se asoci&#243; al &#233;xito de la VNI&#46; As&#237; mismo&#44; James et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a> coincidieron en que ambas mediciones&#44; sumadas al pH y a la patolog&#237;a subyacente&#44; son criterios a tomar en cuenta cuando se desea predecir la efectividad de la VNI en pacientes pedi&#225;tricos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En otra interesante faceta de la VNI&#44; Fauroux et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> reportaron recientemente efectos beneficiosos durante el proceso de decanulaci&#243;n en un grupo selecto de pacientes pedi&#225;tricos con obstrucci&#243;n grave de la v&#237;a a&#233;rea superior&#44; as&#237; como en el tratamiento del fallo respiratorio posterior a la decanulaci&#243;n&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">De todas maneras&#44; la integraci&#243;n de la VNI en el destete requiere de criterios preestablecidos de inicio y de fracaso que a&#250;n no est&#225;n completamente definidos y validados en pediatr&#237;a&#46; En el futuro&#44; el uso transitorio de VNI en un proceso de retirada de la VM podr&#237;a considerarse exitoso si facilita el destete y&#47;o evita la reintubaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusiones</span><p id="par0155" class="elsevierStylePara elsevierViewall">Bas&#225;ndonos en la informaci&#243;n previamente expuesta&#44; creemos que la evaluaci&#243;n diaria de criterios cl&#237;nicos y funcionales espec&#237;ficos junto a la aplicaci&#243;n de un ERE es una metodolog&#237;a que permite identificar precozmente a los pacientes en condiciones de ser destetados del respirador mec&#225;nico&#46; La suspensi&#243;n diaria de la sedaci&#243;n permite acortar la duraci&#243;n de la VM&#44; y la evaluaci&#243;n a trav&#233;s de la escala COMFORT evita la sedaci&#243;n excesiva en los pacientes pedi&#225;tricos&#46; La medici&#243;n de predictores univariables previo al retiro del respirador parece ser m&#225;s efectiva para determinar el pron&#243;stico de la extubaci&#243;n&#46; No todos los pacientes pedi&#225;tricos requieren una estrategia de destete protocolizada&#46; Esta medida puede ser m&#225;s efectiva en pacientes pedi&#225;tricos que presentan factores de riesgo&#44; como por ejemplo corta edad&#44; mayor duraci&#243;n de la VM&#44; s&#237;ndromes gen&#233;ticos&#44; alteraciones respiratorias y neurol&#243;gicas cr&#243;nicas&#44; pacientes habitualmente excluidos en los estudios pedi&#225;tricos de destete&#46; A pesar de la elevada incidencia de FE por obstrucci&#243;n de la v&#237;a a&#233;rea superior&#44; la ausencia de fuga audible alrededor del tubo endotraqueal aplicando una presi&#243;n de v&#237;a a&#233;rea superior a 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O no deber&#237;a retrasar la decisi&#243;n de extubar&#44; ya que la administraci&#243;n profil&#225;ctica de esteroides ha demostrado resultados positivos&#44; atenuando esta condici&#243;n&#46; No existen suficientes estudios para recomendar de forma rutinaria el uso de VNI posterior a la extubaci&#243;n&#44; aunque se han establecido algunas indicaciones prometedoras en grupos seleccionados de pacientes pedi&#225;tricos&#46; En pacientes con fallo respiratorio establecido que requieran VNI se deber&#237;a objetivar la respuesta cl&#237;nica&#44; considerando la posibilidad de aumento de la mortalidad debido al retraso de la reintubaci&#243;n&#46; Nuestra propuesta de algoritmo de retirada de la VM en pacientes pedi&#225;tricos se detalla en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Finalmente&#44; creemos en la necesidad de realizar nuevos estudios que comparen m&#233;todos y protocolos de destete en pacientes m&#225;s complejos&#44; ya que probablemente ser&#225;n ellos los m&#225;s beneficiados de una elecci&#243;n adecuada de estrategia de retirada&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0160" class="elsevierStylePara elsevierViewall">No se ha contado con financiaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener potenciales conflictos de intereses&#46;</p></span></span>"
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        2 => array:2 [
          "identificador" => "xres315143"
          "titulo" => "Abstract"
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        3 => array:2 [
          "identificador" => "xpalclavsec297893"
          "titulo" => "Keywords"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
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        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Protocolos de destete"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "T&#233;cnicas de destete"
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        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "M&#233;todos de ensayo de respiraci&#243;n espont&#225;nea"
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        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "&#205;ndices predictores de fracaso de extubaci&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Fracaso de extubaci&#243;n en pediatr&#237;a"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Rol de la ventilaci&#243;n no invasiva en el destete"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclusiones"
        ]
        12 => array:2 [
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          "titulo" => "Financiaci&#243;n"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflicto de intereses"
        ]
        14 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2012-11-18"
    "fechaAceptado" => "2013-02-04"
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          "palabras" => array:4 [
            0 => "Ventilaci&#243;n mec&#225;nica"
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            2 => "Extubaci&#243;n"
            3 => "Pediatr&#237;a"
          ]
        ]
      ]
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La retirada de la ventilaci&#243;n mec&#225;nica es una de las tem&#225;ticas con mayor volumen y solidez en medicina basada en la evidencia en adultos gravemente enfermos&#46; La protocolizaci&#243;n del destete y la interrupci&#243;n diaria de la sedaci&#243;n han sido instauradas&#44; reduciendo la duraci&#243;n de la ventilaci&#243;n mec&#225;nica y la morbilidad asociada en esta poblaci&#243;n&#46; En pediatr&#237;a la informaci&#243;n reportada es menos consistente&#44; propiciando que el destete y la extubaci&#243;n no cuenten a&#250;n con criterios de inicio objetivos y reproducibles&#46; Diversos &#237;ndices han sido desarrollados para predecir el resultado del destete&#59; sin embargo&#44; estos no han logrado reemplazar el juicio cl&#237;nico&#44; aunque algunas mediciones complementarias pudieran facilitar esta decisi&#243;n&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults&#46; In these patients&#44; weaning protocols and daily interruption of sedation have been implemented&#44; reducing the duration of mechanical ventilation and associated morbidity&#46; In paediatrics&#44; the information reported is less consistent&#44; so that as yet there are no reliable criteria for weaning and extubation in this patient group&#46; Several indices have been developed to predict the outcome of weaning&#46; However&#44; these have failed to replace clinical judgement&#44; although some additional measurements could facilitate this decision&#46;</p>"
      ]
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo que representa el proceso de retirada de la ventilaci&#243;n mec&#225;nica en pediatr&#237;a&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Resoluci&#243;n o mejor&#237;a de la causa de fallo respiratorio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estabilidad hemodin&#225;mica&#58; ausencia o disminuci&#243;n progresiva de f&#225;rmacos vasoactivos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nivel de conciencia adecuado &#40;COMFORT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Esfuerzo respiratorio espont&#225;neo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspensi&#243;n de la sedaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suspensi&#243;n de los relajantes musculares al menos 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ausencia de signos cl&#237;nicos de sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reflejo de tos presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Correcci&#243;n de desequilibrios metab&#243;licos y electrol&#237;ticos importantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Intercambio gaseoso adecuado con PEEP<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O y FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Criterios cl&#237;nicos para iniciar el destete en pacientes pedi&#225;tricos sometidos a ventilaci&#243;n mec&#225;nica</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">CROP&#58; <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index&#59;</span> FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno&#59; PI<span class="elsevierStyleInf">max</span>&#58; presi&#243;n inspiratoria m&#225;xima&#59; P<span class="elsevierStyleInf">0&#44;1</span>&#58; presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; rpm&#58; respiraciones por minuto&#59; V<span class="elsevierStyleInf">m</span>&#58; volumen minuto&#59; V<span class="elsevierStyleInf">T</span>&#58; volumen tidal&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Autor principal &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Predicci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#205;ndices&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baumeister &#40;1997&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#201;xito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#60;11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgCROP<span class="elsevierStyleHsp" style=""></span>&#8805;0&#44;1<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;1998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;4<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiagarajan &#40;1999&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#201;xito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR<span class="elsevierStyleHsp" style=""></span>&#8804;45<span class="elsevierStyleHsp" style=""></span>rpmV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>5&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kgFR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;8<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgCROP<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;15<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;rpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#60;6<span class="elsevierStyleHsp" style=""></span>ml&#47;kgV<span class="elsevierStyleInf">m</span><span class="elsevierStyleHsp" style=""></span>&#60;180<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venkataraman &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>rpmV<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8804;4<span class="elsevierStyleHsp" style=""></span>ml&#47;kgFR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;11<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgPI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OPaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harikumar &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>32&#44;6<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OP<span class="elsevierStyleInf">0&#44;1</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#44;45<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnston &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fracaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6&#44;7<span class="elsevierStyleHsp" style=""></span>rpm&#47;ml&#47;kgPI<span class="elsevierStyleInf">max</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>OV<span class="elsevierStyleInf">m</span><span class="elsevierStyleHsp" style=""></span>&#60;0&#44;8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#205;ndices predictores seg&#250;n el resultado de la extubaci&#243;n y sus valores de corte en pacientes pedi&#225;tricos</p>"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CPAP&#58; presi&#243;n continua en la v&#237;a a&#233;rea&#59; CRF&#47;kg&#58; capacidad residual funcional indexada al peso del paciente&#59; CROP&#58; <span class="elsevierStyleItalic">compliance&#44; resistance&#44; oxigenation&#44; pressure index&#59;</span> E<span class="elsevierStyleInf">din</span>&#58; elasticidad din&#225;mica&#59; ERE&#58; ensayo de respiraci&#243;n espont&#225;nea&#59; FE&#58; fracaso de extubaci&#243;n&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; FR&#58; frecuencia respiratoria&#59; FrVe&#58; fracci&#243;n de la ventilaci&#243;n minuto total entregada por el respirador&#59; IO&#58; &#237;ndice de oxigenaci&#243;n&#59; IPT&#58; &#237;ndice presi&#243;n tiempo&#59; ND&#58; no hay datos&#59; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#58; cociente presi&#243;n arterial de ox&#237;geno&#47;fracci&#243;n inspirada de ox&#237;geno&#59; PI<span class="elsevierStyleInf">max</span>&#58; presi&#243;n inspiratoria m&#225;xima&#59; PI&#47;PI<span class="elsevierStyleInf">max</span>&#58; cociente entre la presi&#243;n inspiratoria de la v&#237;a a&#233;rea y la presi&#243;n inspiratoria m&#225;xima&#59; PIP&#58; presi&#243;n inspiratoria pico&#59; PMVA&#58; presi&#243;n media de la v&#237;a a&#233;rea&#59; P<span class="elsevierStyleInf">0&#44;1</span>&#58; presi&#243;n negativa medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; P<span class="elsevierStyleInf">0&#44;1max</span>&#58; presi&#243;n negativa m&#225;xima medida posterior a la oclusi&#243;n de la v&#237;a a&#233;rea en 0&#44;1<span class="elsevierStyleHsp" style=""></span>s&#59; PS&#58; presi&#243;n de soporte&#59; TET&#58; tubo endotraqueal&#59; TTI<span class="elsevierStyleInf">1</span>&#58; &#237;ndice tensi&#243;n tiempo obtenido desde P<span class="elsevierStyleInf">0&#44;1</span>&#59; TTI<span class="elsevierStyleInf">2</span>&#58; &#237;ndice tensi&#243;n tiempo obtenido desde la PMVA&#59; T<span class="elsevierStyleInf">I</span>&#47;T<span class="elsevierStyleInf">TOT</span>&#58; cociente tiempo inspiratorio&#47;tiempo total del ciclo respiratorio&#59; TT<span class="elsevierStyleInf">mus</span>&#58; &#237;ndice tensi&#243;n tiempo muscular&#59; VM&#58; ventilaci&#243;n mec&#225;nica&#59; V<span class="elsevierStyleInf">m</span>&#58; volumen minuto&#59; V<span class="elsevierStyleInf">T</span>&#58; volumen tidal&#59; V<span class="elsevierStyleInf">T</span>&#47;Ti&#58; flujo inspiratorio promedio&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ref&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autor principal &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad promedio &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Protocolo destete</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duraci&#243;n VM &#40;d&#237;as&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fracaso de extubaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Motivo principal FE &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Evaluaci&#243;n diaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ERE - Tipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#205;ndices predictores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tasa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khan &#40;1996&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;41&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baumeister &#40;1997&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#47;V<span class="elsevierStyleInf">T</span>&#44; CROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Far&#237;as &#40;1998&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T&#44; 120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n del nivel de conciencia &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiagarajan &#40;1999&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#44; V<span class="elsevierStyleInf">T</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; CROP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;42&#44;9&#41;&#44; hipoventilaci&#243;n &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Venkataraman &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FiO<span class="elsevierStyleInf">2</span> pre extubaci&#243;n&#44; PMVA&#44; IO&#44; FrVe&#44; PIP&#44; E<span class="elsevierStyleInf">din</span>&#44; V<span class="elsevierStyleInf">T</span>&#47;Ti&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento del trabajo respiratorio &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Manczur &#40;2000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P<span class="elsevierStyleInf">0&#46;1</span>&#44; P<span class="elsevierStyleInf">0&#46;1</span>&#47;P<span class="elsevierStyleInf">0&#46;1</span><span class="elsevierStyleInf">max</span>&#44; P<span class="elsevierStyleInf">0&#46;1</span>&#47;PI<span class="elsevierStyleInf">max</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Schultz &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farias &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T o PS 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multifactorial &#40;82&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edmunds &#40;2001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">548&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estridor &#40;22&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Randolph &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">182&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Si&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS&#44; 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio agudo bajo &#40;54&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farias &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T o PS 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O 120<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; FR&#44; PI<span class="elsevierStyleInf">max</span>&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kurachek &#40;2003&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstrucci&#243;n de v&#237;a a&#233;rea superior &#40;37&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Restrepo &#40;2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">187&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Noizet &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tubo T&#44; 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FR&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; P<span class="elsevierStyleInf">0&#44;1</span> &#215; FR&#47;V<span class="elsevierStyleInf">T</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; IPT&#44; TTI<span class="elsevierStyleInf">1</span>&#44; TTI<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baisch &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multifactorial &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fontela &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chavez &#40;2006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;5<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bolsa anestesia de flujo continuo&#44; 15<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;27<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cruces &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estridor &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Harikumar &#40;2009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CPAP 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T<span class="elsevierStyleInf">I</span>&#47;T<span class="elsevierStyleInf">TOT</span>&#44; P<span class="elsevierStyleInf">0&#44;1</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; PI&#47;PI<span class="elsevierStyleInf">max</span>&#44; CRF&#47;kg&#44; TT<span class="elsevierStyleInf">mus</span>&#44; PIP&#44; FiO<span class="elsevierStyleInf">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo respiratorio &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnston &#40;2010&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V<span class="elsevierStyleInf">T</span>&#44; V<span class="elsevierStyleInf">m</span>&#44; PI<span class="elsevierStyleInf">max</span>&#44; balance carga&#47;fuerza&#44; FR&#47;V<span class="elsevierStyleInf">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Foronda &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obstrucci&#243;n v&#237;a a&#233;rea superior &#40;57&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ferguson &#40;2011&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">538&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PS seg&#250;n di&#225;metro del TET&#44; 120<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fallo respiratorio bajo &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "What is the daily practice of mechanical ventilation in pediatric intensive care units&#46; A multicenter study"
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                            0 => "J&#46;A&#46; Farias"
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                            2 => "A&#46; Esteban"
                            3 => "J&#46;C&#46; Flores"
                            4 => "A&#46; Retta"
                            5 => "A&#46; Baltodano"
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                    0 => array:2 [
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                        "paginaInicial" => "918"
                        "paginaFinal" => "925"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15029473"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilator-induced lung injury&#58; From barotrauma to biotrauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;S&#46; Slutsky"
                          ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2005"
                        "volumen" => "50"
                        "paginaInicial" => "646"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15912625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation associated pneumonia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Diaz"
                            1 => "L&#46; Lorente"
                            2 => "J&#46; Valles"
                            3 => "J&#46; Rello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2010.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "318"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20466456"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Breathing as exercise&#58; The cardiovascular response to weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;R&#46; Pinsky"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2000"
                        "volumen" => "26"
                        "paginaInicial" => "1164"
                        "paginaFinal" => "1166"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11089735"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0025"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning and extubation readiness in pediatric patients"
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                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Newth"
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                            2 => "D&#46;F&#46; Willson"
                            3 => "K&#46;L&#46; Meert"
                            4 => "R&#46; Harrison"
                            5 => "J&#46;M&#46; Dean"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e318193724d"
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057432"
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                          ]
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              "identificador" => "bib0030"
              "etiqueta" => "6"
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                  "contribucion" => array:1 [
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                      "titulo" => "Weaning from mechanical ventilation"
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                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Boles"
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                            2 => "A&#46; Connors"
                            3 => "M&#46; Herridge"
                            4 => "B&#46; Marsh"
                            5 => "C&#46; Melot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00010206"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "1033"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17470624"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extubation failure in pediatric intensive care&#58; A multiple-center study of risk factors and outcomes"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;C&#46; Kurachek"
                            1 => "C&#46;J&#46; Newth"
                            2 => "M&#46;W&#46; Quasney"
                            3 => "T&#46; Rice"
                            4 => "R&#46;C&#46; Sachdeva"
                            5 => "N&#46;R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000094228.90557.85"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2003"
                        "volumen" => "31"
                        "paginaInicial" => "2657"
                        "paginaFinal" => "2664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14605539"
                            "web" => "Medline"
                          ]
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                ]
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            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning from mechanical ventilation in pediatric intensive care patients"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;A&#46; Farias"
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                            2 => "A&#46; Esteban"
                            3 => "A&#46;N&#46; Golubicki"
                            4 => "F&#46;A&#46; Olazarri"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "1998"
                        "volumen" => "24"
                        "paginaInicial" => "1070"
                        "paginaFinal" => "1075"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9840242"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0045"
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              "referencia" => array:1 [
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                    0 => array:2 [
                      "titulo" => "We need to predict extubation failure"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Farias"
                            1 => "E&#46; Monteverde"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "paginaInicial" => "322"
                        "paginaFinal" => "324"
                      ]
                    ]
                  ]
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              "identificador" => "bib0050"
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                            0 => "S&#46;K&#46; Epstein"
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                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e3283220e07"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "36"
                        "paginaFinal" => "43"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19179869"
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                    ]
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              "identificador" => "bib0055"
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              "referencia" => array:1 [
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                          "autores" => array:3 [
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                            2 => "J&#46;B&#46; Wong"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1997"
                        "volumen" => "112"
                        "paginaInicial" => "186"
                        "paginaFinal" => "192"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9228375"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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                ]
              ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "J&#46;M&#46; Gatell"
                            2 => "E&#46; Aznar"
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                            4 => "J&#46; Puig de la Bellacasa"
                            5 => "J&#46; Gonz&#225;lez"
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "152"
                        "paginaInicial" => "137"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7599812"
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              "identificador" => "bib0065"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation&#46; The Spanish Lung Failure Collaborative Group"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "F&#46; Gordo"
                            3 => "R&#46; Fern&#225;ndez"
                            4 => "J&#46;F&#46; Solsona"
                            5 => "I&#46; Vallverd&#250;"
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "156"
                        "paginaInicial" => "459"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9279224"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning from mechanical ventilation"
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                            0 => "I&#46; Al&#237;a"
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                        "tituloSerie" => "Crit Care"
                        "fecha" => "2000"
                        "volumen" => "4"
                        "paginaInicial" => "72"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11094496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "15"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized&#44; controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Kollef"
                            1 => "S&#46;D&#46; Shapiro"
                            2 => "P&#46; Silver"
                            3 => "R&#46;E&#46; St John"
                            4 => "D&#46; Prentice"
                            5 => "S&#46; Sauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "25"
                        "paginaInicial" => "567"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9142019"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses&#58; Effect on weaning time and incidence of ventilator-associated pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;P&#46; Marelich"
                            1 => "S&#46; Murin"
                            2 => "F&#46; Battistella"
                            3 => "J&#46; Inciardi"
                            4 => "T&#46; Vierra"
                            5 => "M&#46; Roby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2000"
                        "volumen" => "118"
                        "paginaInicial" => "459"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10936141"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0085"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilator weaning protocols driven by nonphysician health-care professionals&#58; Evidence-based clinical practice guidelines"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;W&#46; Ely"
                            1 => "M&#46;O&#46; Meade"
                            2 => "E&#46;F&#46; Haponik"
                            3 => "M&#46;H&#46; Kollef"
                            4 => "D&#46;J&#46; Cook"
                            5 => "G&#46;H&#46; Guyatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2001"
                        "volumen" => "120"
                        "paginaInicial" => "S454"
                        "paginaFinal" => "S463"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practising evidence-based medicine&#58; The design and implementation of a multidisciplinary team-driven extubation protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;K&#46; Chan"
                            1 => "S&#46; Fischer"
                            2 => "T&#46;E&#46; Stewart"
                            3 => "D&#46;C&#46; Hallett"
                            4 => "P&#46; Hynes-Gay"
                            5 => "S&#46;E&#46; Lapinsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2001"
                        "volumen" => "5"
                        "paginaInicial" => "349"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11737924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of a nurses&#8217; protocol-directed weaning procedure on outcomes in patients undergoing mechanical ventilation for longer than 48<span class="elsevierStyleHsp" style=""></span>hours&#58; A prospective cohort study with a matched historical control group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Tonnelier"
                            1 => "G&#46; Prat"
                            2 => "G&#46; Le Gal"
                            3 => "C&#46; Gut-Gobert"
                            4 => "A&#46; Renault"
                            5 => "J&#46;M&#46; Boles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc3030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "R83"
                        "paginaFinal" => "R89"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15774054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol-directed vs physician-directed weaning from ventilator in intra-abdominal surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46; Chaiwat"
                            1 => "N&#46; Sarima"
                            2 => "K&#46; Niyompanitpattana"
                            3 => "C&#46; Komoltri"
                            4 => "Y&#46; Udomphorn"
                            5 => "S&#46; Kongsayreepong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Assoc Thai"
                        "fecha" => "2010"
                        "volumen" => "93"
                        "paginaInicial" => "930"
                        "paginaFinal" => "936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20718169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;W&#46; Ely"
                            1 => "A&#46;M&#46; Baker"
                            2 => "D&#46;P&#46; Dunagan"
                            3 => "H&#46;L&#46; Burke"
                            4 => "A&#46;C&#46; Smith"
                            5 => "P&#46;T&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199612193352502"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1996"
                        "volumen" => "335"
                        "paginaInicial" => "1864"
                        "paginaFinal" => "1869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8948561"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weaning children from mechanical ventilation&#58; A prospective randomized trial of protocol-directed versus physician-directed weaning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;R&#46; Schultz"
                            1 => "R&#46;J&#46; Lin"
                            2 => "H&#46;M&#46; Watzman"
                            3 => "S&#46;M&#46; Durning"
                            4 => "R&#46; Hales"
                            5 => "A&#46; Woodson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2001"
                        "volumen" => "46"
                        "paginaInicial" => "772"
                        "paginaFinal" => "782"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11463367"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protocol-driven ventilator management in children&#58; Comparison to nonprotocol care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;D&#46; Restrepo"
                            1 => "J&#46;D&#46; Fortenberry"
                            2 => "C&#46; Spainhour"
                            3 => "J&#46; Stockwell"
                            4 => "L&#46;T&#46; Goodfellow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066604267646"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "274"
                        "paginaFinal" => "284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15358946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of mechanical ventilator weaning protocols on respiratory outcomes in infants and children&#58; A randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Randolph"
                            1 => "D&#46; Wypij"
                            2 => "S&#46;T&#46; Venkataraman"
                            3 => "J&#46;H&#46; Hanson"
                            4 => "R&#46;G&#46; Gedeit"
                            5 => "K&#46;L&#46; Meert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2002"
                        "volumen" => "288"
                        "paginaInicial" => "2561"
                        "paginaFinal" => "2568"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12444863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;P&#46; Kress"
                            1 => "A&#46;S&#46; Pohlman"
                            2 => "M&#46;F&#46; O&#8217;Connor"
                            3 => "J&#46;B&#46; Hall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200005183422002"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "342"
                        "paginaInicial" => "1471"
                        "paginaFinal" => "1477"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10816184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;S&#46; Jin"
                            1 => "M&#46;S&#46; Yum"
                            2 => "S&#46;L&#46; Kim"
                            3 => "H&#46;Y&#46; Shin"
                            4 => "E&#46;H&#46; Lee"
                            5 => "E&#46;J&#46; Ha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3346/jkms.2007.22.4.693"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Med Sci"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "693"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17728512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation&#58; A randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;K&#46; Foronda"
                            1 => "E&#46;J&#46; Troster"
                            2 => "J&#46;A&#46; Farias"
                            3 => "C&#46;S&#46; Barbas"
                            4 => "A&#46;A&#46; Ferraro"
                            5 => "L&#46;S&#46; Faria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3182257520"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "39"
                        "paginaInicial" => "2526"
                        "paginaFinal" => "2533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21705894"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilaci&#243;n mec&#225;nica en pediatr&#237;a&#46; &#191;C&#243;mo y cu&#225;ndo extubar&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Mart&#237;nez de Azagra"
                            1 => "J&#46; Casado Flores"
                            2 => "R&#46; Jim&#233;nez Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2003"
                        "volumen" => "27"
                        "paginaInicial" => "673"
                        "paginaFinal" => "675"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Farias"
                            1 => "A&#46; Retta"
                            2 => "I&#46; Al&#237;a"
                            3 => "F&#46; Olazarri"
                            4 => "A&#46; Esteban"
                            5 => "A&#46; Golubicki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s001340101035"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2001"
                        "volumen" => "27"
                        "paginaInicial" => "1649"
                        "paginaFinal" => "1654"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11685307"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparision of four methods of weaning patients from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Esteban"
                            1 => "F&#46; Frutos"
                            2 => "M&#46;J&#46; Tobin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199502093320601"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1995"
                        "volumen" => "332"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7823995"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Brochard"
                            1 => "A&#46; Rauss"
                            2 => "S&#46; Benito"
                            3 => "G&#46; Conti"
                            4 => "J&#46; Mancebo"
                            5 => "N&#46; Rekik"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.150.4.7921460"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "150"
                        "paginaInicial" => "896"
                        "paginaFinal" => "903"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7921460"
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                      "titulo" => "Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation&#46; Spanish Lung Failure Collaborative Group"
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                          "etal" => true
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                            2 => "M&#46;J&#46; Tobin"
                            3 => "A&#46; Gil"
                            4 => "F&#46; Gordo"
                            5 => "I&#46; Vallverd&#250;"
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "159"
                        "paginaInicial" => "512"
                        "paginaFinal" => "518"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9927366"
                            "web" => "Medline"
                          ]
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            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Positive end-expiratory pressure vs T-piece&#46; Extubation after mechanical ventilation"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;P&#46; Jones"
                            1 => "P&#46; Byrne"
                            2 => "C&#46; Morgan"
                            3 => "I&#46; Fraser"
                            4 => "R&#46; Hyland"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1991"
                        "volumen" => "100"
                        "paginaInicial" => "1655"
                        "paginaFinal" => "1659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1959410"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0170"
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                    0 => array:2 [
                      "titulo" => "Differences in respiratory parameters during continuous positive airway pressure and pressure support ventilation in infants and children"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "R&#46; Hasegawa"
                            3 => "K&#46; Saitoh"
                            4 => "S&#46; Satoh"
                            5 => "S&#46; Matsukawa"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tohoku J Exp Med"
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                        "volumen" => "194"
                        "paginaInicial" => "45"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11556733"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "A spontaneous breathing trial with pressure support overestimates readiness for extubation in children"
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                            2 => "D&#46; Munhall"
                            3 => "J&#46;H&#46; Arnold"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "e330"
                        "paginaFinal" => "e335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21666529"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0180"
              "etiqueta" => "36"
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                    0 => array:2 [
                      "titulo" => "Spontaneous breathing trial in chronic obstructive pulmonary disease&#58; Continuous positive airway pressure &#40;CPAP&#41; versus T-piece"
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                          "etal" => false
                          "autores" => array:5 [
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                            3 => "A&#46; Esteban"
                            4 => "F&#46; Frutos-Vivar"
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                    0 => array:2 [
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                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "453"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20452705"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0185"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An evaluation of extubation failure predictors in mechanically ventilated infants and children"
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                            3 => "F&#46; Olazarri"
                            4 => "A&#46; Fern&#225;ndez"
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                    0 => array:2 [
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                        "tituloSerie" => "Intensive Care Med"
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                        "volumen" => "28"
                        "paginaInicial" => "752"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12107682"
                            "web" => "Medline"
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              ]
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              "identificador" => "bib0190"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous breathing trial predicts successful extubation in infants and children"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Chavez"
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                            2 => "A&#46; Zaritsky"
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                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
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                        "volumen" => "7"
                        "paginaInicial" => "324"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16738500"
                            "web" => "Medline"
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                ]
              ]
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              "identificador" => "bib0195"
              "etiqueta" => "39"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation"
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                          "autores" => array:2 [
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                        "tituloSerie" => "N Engl J Med"
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                        "volumen" => "324"
                        "paginaInicial" => "1445"
                        "paginaFinal" => "1450"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2023603"
                            "web" => "Medline"
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              "identificador" => "bib0200"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predictors of extubation success and failure in mechanically ventilated infants and children"
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                            2 => "S&#46;T&#46; Venkataraman"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1996"
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                        "paginaInicial" => "1568"
                        "paginaFinal" => "1579"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8797633"
                            "web" => "Medline"
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              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of predictors of extubation from mechanical ventilation in children"
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                            3 => "G&#46;F&#46; Rafferty"
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                      "Revista" => array:6 [
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                        "volumen" => "1"
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                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12813282"
                            "web" => "Medline"
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              "identificador" => "bib0210"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluation of predictors of weaning from mechanical ventilation in pediatric patients"
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                        "tituloSerie" => "Pediatr Pulmonol"
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                        "paginaInicial" => "344"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9407568"
                            "web" => "Medline"
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              "identificador" => "bib0215"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predictors of successful extubation in children"
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                        "tituloSerie" => "Am J Respir Crit Care Med"
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                        "paginaFinal" => "1566"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of predictors of extubation success and failure in mechanically ventilated infants and children"
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                          0 => array:2 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Tension-time index as a predictor of extubation outcome in ventilated children"
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                        "paginaInicial" => "982"
                        "paginaFinal" => "988"
                        "link" => array:1 [
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                        "paginaFinal" => "385"
                        "link" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
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                        "volumen" => "9"
                        "paginaInicial" => "R798"
                        "paginaFinal" => "R807"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16356229"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Risk factors for extubation failure in infants with severe acute bronchiolitis"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Johnston"
                            1 => "W&#46;B&#46; de Carvalho"
                            2 => "J&#46; Piva"
                            3 => "P&#46;C&#46; Garcia"
                            4 => "M&#46;C&#46; Fonseca"
                          ]
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                      ]
                    ]
                  ]
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                        "tituloSerie" => "Respir Care"
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                        "paginaInicial" => "328"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20196883"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extubation failure&#58; Magnitude of the problem&#44; impact on outcomes&#44; and prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "S&#46;K&#46; Epstein"
                          ]
                        ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2003"
                        "volumen" => "9"
                        "paginaInicial" => "59"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12548031"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                      "titulo" => "The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "A&#46;D&#46; Slonim"
                            3 => "J&#46; He"
                            4 => "D&#46;S&#46; Hamel"
                            5 => "I&#46;M&#46; Cheifetz"
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                        ]
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                    ]
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "490"
                        "paginaFinal" => "496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18679147"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Corticosteroids for the prevention of reintubation and postextubation stridor in pediatric patients&#58; A meta-analysis"
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                          "etal" => false
                          "autores" => array:2 [
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                            1 => "A&#46;G&#46; Randolph"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "3"
                        "paginaInicial" => "223"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12780960"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0163445310000976"
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                          "issn" => "01634453"
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                  ]
                ]
              ]
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              "identificador" => "bib0270"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Extubation failure in pediatric intensive care incidence and outcomes"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;D&#46; Baisch"
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                            2 => "S&#46;C&#46; Kurachek"
                            3 => "D&#46;N&#46; Cornfield"
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                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "6"
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                        "paginaFinal" => "318"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15857531"
                            "web" => "Medline"
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extubation failure in a large pediatric ICU population"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Edmunds"
                            1 => "I&#46; Weiss"
                            2 => "R&#46; Harrison"
                          ]
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                      ]
                    ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2001"
                        "volumen" => "119"
                        "paginaInicial" => "897"
                        "paginaFinal" => "900"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11243974"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for extubation failure in mechanically ventilated pediatric patients"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;S&#46; Fontela"
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                            2 => "P&#46;C&#46; Garcia"
                            3 => "P&#46;L&#46; Bered"
                            4 => "K&#46; Zilles"
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                    ]
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                    0 => array:2 [
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15730603"
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                    ]
                  ]
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                        "volumen" => "12"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18439326"
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                ]
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                      "titulo" => "A meta-analysis of noninvasive weaning to facilitate liberation from mechanical ventilation"
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                            2 => "M&#46;O&#46; Meade"
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                    ]
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                      "Revista" => array:6 [
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                        "paginaInicial" => "305"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
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                          "etal" => false
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                        "paginaFinal" => "3244"
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                          0 => array:2 [
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                  ]
                ]
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                        "paginaFinal" => "2460"
                        "link" => array:1 [
                          0 => array:2 [
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                        "volumen" => "1"
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Article information
ISSN: 03002896
Original language: Spanish
DOI:10.1016/j.arbres.2013.02.003
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