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Model 3150&#44; con O<span class="elsevierStyleInf">2</span> a flujo continuo con el dispositivo que cre&#237;amos m&#225;s adecuado en funci&#243;n del flujo que estim&#225;bamos iba a necesitar&#44; la movilidad y las preferencias del paciente&#46; Las PM6M se realizaron siguiendo las recomendaciones SEPAR<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#46; Si en la primera prueba no se alcanzaba una SpO<span class="elsevierStyleInf">2</span> media<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#37; se repet&#237;a el test con un descanso m&#237;nimo de 30<span class="elsevierStyleHsp" style=""></span>min aumentando 1<span class="elsevierStyleHsp" style=""></span>l&#47;min hasta lograr el objetivo&#46; Comparamos el flujo fijado tras realizar el ajuste con la PM6M con el que se prescribir&#237;a si al O<span class="elsevierStyleInf">2</span> establecido en reposo se le a&#241;ad&#237;a un litro&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se utiliz&#243; el paquete SPSS versi&#243;n 20&#46;0&#46; Se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas de los pacientes y se us&#243; la prueba de la t de Student para la comparaci&#243;n de medias&#46; Consideramos significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 165 pacientes&#44; 113 &#40;68&#44;5&#37;&#41; eran varones&#44; con una edad media de 70&#44;9 &#40;DE 9&#44;31&#41; a&#241;os&#46; El flujo medio de O<span class="elsevierStyleInf">2</span> prescrito en el dispositivo port&#225;til fue de 3&#44;64 &#40;DE&#44; 0&#44;95&#41; l&#47;min&#46; En 77 pacientes &#40;46&#44;7&#37;&#41; se prescribi&#243; un concentrador a flujo continuo y en 88 &#40;53&#44;3&#37;&#41; una mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido&#46; Tras la titulaci&#243;n con la PM6M&#44; el O<span class="elsevierStyleInf">2</span> prescrito solamente fue el mismo que si al O<span class="elsevierStyleInf">2</span> en reposo se le hubiera a&#241;adido un litro en 49 pacientes &#40;29&#44;7&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Aumentamos el flujo de O<span class="elsevierStyleInf">2</span> a 88 enfermos &#40;53&#44;3&#37;&#41; y se disminuy&#243; a 28 &#40;17&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las enfermedades causantes de la insuficiencia respiratoria cr&#243;nica y la relaci&#243;n existente entre ambos m&#233;todos a la hora de prescribir el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til&#46; La prescripci&#243;n realizada coincidi&#243; en el 36&#37; de los EPOC&#44; pero solo en el 17&#44;5&#37; de las enfermedades intersticiales y en el 11&#37; de los pacientes con hipertensi&#243;n pulmonar&#44; donde la desaturaci&#243;n con el esfuerzo es mayor&#46; Veinti&#250;n pacientes rechazaron la mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido pese a que precisaban m&#225;s de 3<span class="elsevierStyleHsp" style=""></span>l&#47;min&#46; En 10 enfermos no se logr&#243; corregir la desaturaci&#243;n experimentada durante la PM6M&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Los resultados evidencian la superioridad de la PM6M sobre la alternativa de a&#241;adir un litro de O<span class="elsevierStyleInf">2</span> al de reposo para corregir la desaturaci&#243;n durante las actividades de la vida diaria&#44; ya que con esta forma de titulaci&#243;n el 53&#44;3&#37; de los pacientes &#40;72&#44;5 y 66&#44;7&#37; si tienen una enfermedad pulmonar intersticial difusa o hipertensi&#243;n pulmonar&#44; respectivamente&#41; seguir&#237;an desaturando durante el esfuerzo&#46; Los pacientes con insuficiencia respiratoria cr&#243;nica en situaci&#243;n estable es frecuente que presenten hipoxemia durante periodos prolongados de tiempo que se relacionan con una reducci&#243;n de la tolerancia al ejercicio y que favorecen la aparici&#243;n de complicaciones como&#58; hipertensi&#243;n pulmonar&#44; insuficiencia cardiaca derecha o policitemia<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; La gasometr&#237;a arterial en reposo no es &#250;til para ajustar el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; las pruebas de esfuerzo nos permiten evaluar la eficacia de las intervenciones terap&#233;uticas<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;11</span></a>&#46; La m&#225;s usada es la PM6M<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#44; en sus distintas modalidades<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;12</span></a>&#44; aunque tambi&#233;n se ha titulado con cicloerg&#243;metro<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Otro aspecto a tener en cuenta es el perfil de movilidad de cada paciente&#44; sus preferencias y la movilidad permitida por cada fuente de O<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; As&#237;&#44; 21 pacientes &#40;12&#44;7&#37;&#41; no aceptaron el cambio de dispositivo a mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido ante la necesidad de aportar m&#225;s de 3<span class="elsevierStyleHsp" style=""></span>l&#47;min de O<span class="elsevierStyleInf">2</span>&#44; ya que les restaba autonom&#237;a&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el momento actual no existen dispositivos port&#225;tiles que suplan las necesidades de los pacientes m&#225;s graves&#44; ya que la mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido solo nos permite aportar hasta 5<span class="elsevierStyleHsp" style=""></span>l&#47;min&#46; De hecho&#44; en 10 pacientes de nuestro estudio&#44; pese a tener mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido a 5<span class="elsevierStyleHsp" style=""></span>l&#47;min&#44; no se pudo corregir la desaturaci&#243;n experimentada durante la PM6M&#44; ya que manten&#237;an una SpO<span class="elsevierStyleInf">2</span> media<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En el futuro&#44; una alternativa a los procedimientos de titulaci&#243;n actuales ser&#237;a individualizar el aporte de ox&#237;geno domiciliario a cada enfermo integrando sensores en los dispositivos port&#225;tiles de O<span class="elsevierStyleInf">2</span> que medir&#237;an la SpO<span class="elsevierStyleInf">2</span> en tiempo real y ajustar&#237;an autom&#225;ticamente el flujo de O<span class="elsevierStyleInf">2</span> de acuerdo con las necesidades del enfermo en todo momento<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En resumen&#44; en la actualidad parece necesario titular el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til a trav&#233;s de una prueba de esfuerzo si queremos corregir adecuadamente la desaturaci&#243;n durante el esfuerzo&#46; Aun as&#237;&#44; existen limitaciones y no es el &#250;nico factor a tener en cuenta a la hora de prescribir el O<span class="elsevierStyleInf">2</span> port&#225;til&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&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">165&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88 &#40;53&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">EPOC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42 &#40;49&#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">13 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">40 &#40;24&#44;2&#41;&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">7 &#40;17&#44;5&#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">29 &#40;72&#44;5&#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">4 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hipertensi&#243;n pulmonar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Cardiopat&#237;a&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\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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">C&#225;ncer&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">4 &#40;2&#44;4&#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">3 &#40;75&#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">1 &#40;25&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Bronquiectasias&nbsp;\t\t\t\t\t\t\n
                  \t\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">3 &#40;1&#44;8&#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">2 &#40;66&#44;6&#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">1 &#40;33&#44;3&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Broncopat&#237;a no filiada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;3&#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">2 &#40;40&#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">3 &#40;60&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cifoescoliosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">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">1 &#40;100&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poscirug&#237;a tor&#225;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">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">1 &#40;100&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Embolia pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\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">1 &#40;0&#44;6&#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">1 &#40;100&#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">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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de apnea-hipopnea del sue&#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-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;6&#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">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">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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome hipoventilaci&#243;n obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\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">1 &#40;0&#44;6&#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">0&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">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
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                  \t\t\t\t">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enfermedades de base de los pacientes y comparaci&#243;n del flujo de ox&#237;geno prescrito&#44; tras realizar la titulaci&#243;n de ox&#237;geno port&#225;til por ambos m&#233;todos</p>"
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                      "titulo" => "Gu&#237;a espa&#241;ola de la enfermedad pulmonar obstructiva cr&#243;nica &#40;GesEPOC&#41; 2017&#46; Tratamiento farmacol&#243;gico en fase estable"
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                          "etal" => true
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                            3 => "J&#46; Molina"
                            4 => "P&#46; Almagro"
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                          "autores" => array:6 [
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                    0 => array:2 [
                      "doi" => "10.1183/09031936.01.00202301"
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                        "paginaInicial" => "909"
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                          "autores" => array:6 [
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Carta Científica
Necesidad de titular el oxígeno portátil mediante pruebas de marcha de 6 minutos
Need for Portable Oxygen Titration During 6-Minute Walk Tests
Tamara Lourido-Cebreiroa,
Corresponding author
tamara.lourido.cebreiro@sergas.es

Autor para correspondencia.
, Francisco J. González-Barcalaa,b, José Manuel Álvarez-Dobañoa,b, Tara Pereiro-Breaa, Romina Abelleira-Parisa, Luis Valdésa,b
a Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
b Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">La oxigenoterapia mejora la supervivencia&#44; la calidad de vida y la capacidad de ejercicio en pacientes diagnosticados de enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; con insuficiencia respiratoria grave en reposo<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Los dispositivos port&#225;tiles de ox&#237;geno &#40;O<span class="elsevierStyleInf">2</span>&#41; facilitan dicho cumplimiento y evitan las restricciones de la actividad f&#237;sica&#46; La normativa SEPAR de oxigenoterapia recomienda ajustar el flujo de O<span class="elsevierStyleInf">2</span> para la deambulaci&#243;n durante una prueba de esfuerzo hasta alcanzar una saturaci&#243;n arterial de oxihemoglobina &#40;SpO<span class="elsevierStyleInf">2</span>&#41; media<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#37;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; La prueba de marcha de seis minutos &#40;PM6M&#41; es la m&#225;s utilizada<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46; Sin embargo&#44; con frecuencia&#44; el ajuste de O<span class="elsevierStyleInf">2</span> para deambulaci&#243;n no se hace de forma adecuada&#44; ya que resulta laboriosa y&#44; en ocasiones&#44; puede estar contraindicada<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Algunos pa&#237;ses recomiendan utilizar el mismo flujo de O<span class="elsevierStyleInf">2</span> que el indicado en reposo o a&#241;adir un litro a este<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es comparar si el flujo prescrito tras realizar un ajuste de oxigenoterapia port&#225;til con PM6M es similar al que se indicar&#237;a si al O<span class="elsevierStyleInf">2</span> prescrito en reposo se le a&#241;ade un litro&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se incluyeron prospectivamente todos los pacientes con insuficiencia respiratoria cr&#243;nica vistos en la consulta de oxigenoterapia desde octubre de 2015 a septiembre de 2018 a los que se les prescribi&#243; un dispositivo port&#225;til de O<span class="elsevierStyleInf">2</span> a flujo continuo&#46; Se encontraban en fase estable&#44; cumpl&#237;an criterios para tratamiento con O<span class="elsevierStyleInf">2</span> domiciliario&#44; presentaban autonom&#237;a para realizar actividades fuera del domicilio y estaban en condiciones de realizar una PM6<span class="elsevierStyleHsp" style=""></span>M<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#46; No se incluyeron en el estudio pacientes a los que se les prescrib&#237;a un dispositivo con v&#225;lvula&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Inicialmente se realizaba un ajuste de O<span class="elsevierStyleInf">2</span> en reposo siguiendo las recomendaciones SEPAR<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Despu&#233;s se llevaba a cabo al menos una PM6M&#44; utilizando un pulsiox&#237;metro WristOx<span class="elsevierStyleInf">2</span>&#44; Model 3150&#44; con O<span class="elsevierStyleInf">2</span> a flujo continuo con el dispositivo que cre&#237;amos m&#225;s adecuado en funci&#243;n del flujo que estim&#225;bamos iba a necesitar&#44; la movilidad y las preferencias del paciente&#46; Las PM6M se realizaron siguiendo las recomendaciones SEPAR<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a>&#46; Si en la primera prueba no se alcanzaba una SpO<span class="elsevierStyleInf">2</span> media<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#37; se repet&#237;a el test con un descanso m&#237;nimo de 30<span class="elsevierStyleHsp" style=""></span>min aumentando 1<span class="elsevierStyleHsp" style=""></span>l&#47;min hasta lograr el objetivo&#46; Comparamos el flujo fijado tras realizar el ajuste con la PM6M con el que se prescribir&#237;a si al O<span class="elsevierStyleInf">2</span> establecido en reposo se le a&#241;ad&#237;a un litro&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para el an&#225;lisis estad&#237;stico se utiliz&#243; el paquete SPSS versi&#243;n 20&#46;0&#46; Se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas de los pacientes y se us&#243; la prueba de la t de Student para la comparaci&#243;n de medias&#46; Consideramos significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 165 pacientes&#44; 113 &#40;68&#44;5&#37;&#41; eran varones&#44; con una edad media de 70&#44;9 &#40;DE 9&#44;31&#41; a&#241;os&#46; El flujo medio de O<span class="elsevierStyleInf">2</span> prescrito en el dispositivo port&#225;til fue de 3&#44;64 &#40;DE&#44; 0&#44;95&#41; l&#47;min&#46; En 77 pacientes &#40;46&#44;7&#37;&#41; se prescribi&#243; un concentrador a flujo continuo y en 88 &#40;53&#44;3&#37;&#41; una mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido&#46; Tras la titulaci&#243;n con la PM6M&#44; el O<span class="elsevierStyleInf">2</span> prescrito solamente fue el mismo que si al O<span class="elsevierStyleInf">2</span> en reposo se le hubiera a&#241;adido un litro en 49 pacientes &#40;29&#44;7&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Aumentamos el flujo de O<span class="elsevierStyleInf">2</span> a 88 enfermos &#40;53&#44;3&#37;&#41; y se disminuy&#243; a 28 &#40;17&#37;&#41;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran las enfermedades causantes de la insuficiencia respiratoria cr&#243;nica y la relaci&#243;n existente entre ambos m&#233;todos a la hora de prescribir el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til&#46; La prescripci&#243;n realizada coincidi&#243; en el 36&#37; de los EPOC&#44; pero solo en el 17&#44;5&#37; de las enfermedades intersticiales y en el 11&#37; de los pacientes con hipertensi&#243;n pulmonar&#44; donde la desaturaci&#243;n con el esfuerzo es mayor&#46; Veinti&#250;n pacientes rechazaron la mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido pese a que precisaban m&#225;s de 3<span class="elsevierStyleHsp" style=""></span>l&#47;min&#46; En 10 enfermos no se logr&#243; corregir la desaturaci&#243;n experimentada durante la PM6M&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Los resultados evidencian la superioridad de la PM6M sobre la alternativa de a&#241;adir un litro de O<span class="elsevierStyleInf">2</span> al de reposo para corregir la desaturaci&#243;n durante las actividades de la vida diaria&#44; ya que con esta forma de titulaci&#243;n el 53&#44;3&#37; de los pacientes &#40;72&#44;5 y 66&#44;7&#37; si tienen una enfermedad pulmonar intersticial difusa o hipertensi&#243;n pulmonar&#44; respectivamente&#41; seguir&#237;an desaturando durante el esfuerzo&#46; Los pacientes con insuficiencia respiratoria cr&#243;nica en situaci&#243;n estable es frecuente que presenten hipoxemia durante periodos prolongados de tiempo que se relacionan con una reducci&#243;n de la tolerancia al ejercicio y que favorecen la aparici&#243;n de complicaciones como&#58; hipertensi&#243;n pulmonar&#44; insuficiencia cardiaca derecha o policitemia<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; La gasometr&#237;a arterial en reposo no es &#250;til para ajustar el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&#46; Por el contrario&#44; las pruebas de esfuerzo nos permiten evaluar la eficacia de las intervenciones terap&#233;uticas<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5&#44;11</span></a>&#46; La m&#225;s usada es la PM6M<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a>&#44; en sus distintas modalidades<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;12</span></a>&#44; aunque tambi&#233;n se ha titulado con cicloerg&#243;metro<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Otro aspecto a tener en cuenta es el perfil de movilidad de cada paciente&#44; sus preferencias y la movilidad permitida por cada fuente de O<span class="elsevierStyleInf">2</span><a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&#46; As&#237;&#44; 21 pacientes &#40;12&#44;7&#37;&#41; no aceptaron el cambio de dispositivo a mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido ante la necesidad de aportar m&#225;s de 3<span class="elsevierStyleHsp" style=""></span>l&#47;min de O<span class="elsevierStyleInf">2</span>&#44; ya que les restaba autonom&#237;a&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el momento actual no existen dispositivos port&#225;tiles que suplan las necesidades de los pacientes m&#225;s graves&#44; ya que la mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido solo nos permite aportar hasta 5<span class="elsevierStyleHsp" style=""></span>l&#47;min&#46; De hecho&#44; en 10 pacientes de nuestro estudio&#44; pese a tener mochila de O<span class="elsevierStyleInf">2</span> l&#237;quido a 5<span class="elsevierStyleHsp" style=""></span>l&#47;min&#44; no se pudo corregir la desaturaci&#243;n experimentada durante la PM6M&#44; ya que manten&#237;an una SpO<span class="elsevierStyleInf">2</span> media<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En el futuro&#44; una alternativa a los procedimientos de titulaci&#243;n actuales ser&#237;a individualizar el aporte de ox&#237;geno domiciliario a cada enfermo integrando sensores en los dispositivos port&#225;tiles de O<span class="elsevierStyleInf">2</span> que medir&#237;an la SpO<span class="elsevierStyleInf">2</span> en tiempo real y ajustar&#237;an autom&#225;ticamente el flujo de O<span class="elsevierStyleInf">2</span> de acuerdo con las necesidades del enfermo en todo momento<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En resumen&#44; en la actualidad parece necesario titular el flujo de O<span class="elsevierStyleInf">2</span> port&#225;til a trav&#233;s de una prueba de esfuerzo si queremos corregir adecuadamente la desaturaci&#243;n durante el esfuerzo&#46; Aun as&#237;&#44; existen limitaciones y no es el &#250;nico factor a tener en cuenta a la hora de prescribir el O<span class="elsevierStyleInf">2</span> port&#225;til&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#44;1&#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">6 &#40;66&#44;7&#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">2 &#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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;4&#44;8&#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">2 &#40;25&#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">3 &#40;37&#44;5&#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">3 &#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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cardiopat&#237;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">5 &#40;3&#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">1 &#40;20&#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">3 &#40;60&#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">1 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C&#225;ncer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;2&#44;4&#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">3 &#40;75&#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">1 &#40;25&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bronquiectasias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;1&#44;8&#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">2 &#40;66&#44;6&#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">1 &#40;33&#44;3&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Broncopat&#237;a no filiada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;3&#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">2 &#40;40&#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">3 &#40;60&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cifoescoliosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">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">1 &#40;100&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poscirug&#237;a tor&#225;cica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">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">1 &#40;100&#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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Embolia pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">1 &#40;100&#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">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">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de apnea-hipopnea del sue&#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-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;6&#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">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">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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome hipoventilaci&#243;n obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;6&#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">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">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">1 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enfermedades de base de los pacientes y comparaci&#243;n del flujo de ox&#237;geno prescrito&#44; tras realizar la titulaci&#243;n de ox&#237;geno port&#225;til por ambos m&#233;todos</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0080"
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                    0 => array:1 [
                      "titulo" => "Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema&#46; Report of the Medical Research Council Working Party"
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                      "doi" => "10.1016/S2213-2600(13)70179-6"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a espa&#241;ola de la enfermedad pulmonar obstructiva cr&#243;nica &#40;GesEPOC&#41; 2017&#46; Tratamiento farmacol&#243;gico en fase estable"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Miravitlles"
                            1 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            2 => "M&#46; Calle"
                            3 => "J&#46; Molina"
                            4 => "P&#46; Almagro"
                            5 => "J&#46;A&#46; Quintano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2017.03.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2017"
                        "volumen" => "53"
                        "paginaInicial" => "324"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28477954"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease&#58; A clinical trial"
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                        0 => array:2 [
                          "colaboracion" => "Nocturnal Oxygen Therapy Trial Group"
                          "etal" => false
                        ]
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                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-93-3-391"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med&#46;"
                        "fecha" => "1980"
                        "volumen" => "93"
                        "paginaInicial" => "391"
                        "paginaFinal" => "398"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6776858"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oxigenoterapia continua domiciliaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Ortega-Ruiz"
                            1 => "S&#46; D&#237;az-Lobato"
                            2 => "G&#46; Galdiz-Iturri"
                            3 => "F&#46; Garc&#237;a-Rio"
                            4 => "R&#46; G&#252;ell-Rous"
                            5 => "F&#46; Morante-Velez"
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                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2013.11.025"
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                        "tituloSerie" => "Arch Bronconeumol&#46;"
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ISSN: 03002896
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