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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-invasive mechanical ventilation &#40;NIMV&#41; is an accepted supportive strategy widely used in patients with acute respiratory failure from both hypercapnic and hypoxemic origin&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#8211;4</span></a> NIMV can also prevent re-intubation in some cases and might provide comfort at the end of life&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5&#44;6</span></a> Nevertheless&#44; NIMV can fail because many factors including inappropriate selection of individual cases and patient&#8211;ventilator asynchrony&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> Conversely to invasive mechanical ventilation&#44; NIMV is characterized by an open and non-hermetic circuit that is intrinsically leaky&#46; These air leaks pose a challenge for respiratory support because they create a mismatch between the flow provided by the ventilator and the flow effectively delivered to the patient&#44; leading sometimes to considerable asynchrony&#44; discomfort&#44; and ultimately&#44; to fail of NIMV support&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Critically ill patients often require enteral tubes to provide nutritional support or administering medications&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">8&#8211;11</span></a> These tubes can increase the risk of air leaks when NIMV is provided through oro-nasal interfaces&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12&#44;13</span></a> Although air leaks can be clinically challenging&#44; their magnitude might sometimes be reduced by adjusting the patient interface but it can increase the patient&#39;s discomfort and cause skin lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> Similarly&#44; specific algorithms for leak compensation have been incorporated into the latest generation of ventilators to reduce these adverse effects with non consistent clinical results&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> Thus&#44; we develop a new tube adaptor for NIMV &#40;TA-NIMV&#41; designed to minimize air leaks by improving the adjust of the oro-nasal interfaces in patients in whom an enteral tube has been placed&#46; In this first report&#44; we evaluate the impact of such TA-NIMV on the reduction of air leaks and the subjective comfort perceived by the patient during NIMV support&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">A non-randomised&#44; clinical intervention &#40;quasi-experimental design&#41; was conducted in a 90-bed mixed intensive care unit during a sixteen-month period&#46; Patients with one or more naso-enteric or oro-enteric tube&#40;s&#41; in place and requiring NIMV support through an oro-nasal mask interface were included in the study&#46; Then&#44; they received in a random order a run of at least 60<span class="elsevierStyleHsp" style=""></span>min of NIVM using the tube adaptor &#40;TA-NIMV&#41; or the conventional therapy &#40;CT-NIMV&#41;&#46; The percentage of air leaks and patients comfort was registered after a stabilization period of at least 15<span class="elsevierStyleHsp" style=""></span>min in each run&#46; A &#8220;washout period&#8221; of at least 4<span class="elsevierStyleHsp" style=""></span>h between each VMNI run was ensured to avoid potential interferences between TA-NIMV and CT-NIMV strategies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Participants</span><p id="par0020" class="elsevierStylePara elsevierViewall">All adult patients &#40;&#8805;18 years old&#41; admitted to the ICU by any cause&#44; requiring NIMV support thorough an oro-nasal interface and simultaneously requiring a naso-enteric tube in place for nutrition&#44; enteral decompression&#44; or drug administration&#46; NIMV was performed following the institutional protocol and international guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">16&#44;17</span></a> Patients were excluded if they had any contraindication for NIMV use&#46; The absolute contraindications were respiratory arrest&#44; uncontrolled vomiting&#44; or massive upper gastrointestinal bleeding&#44; upper airway obstruction&#44; facial trauma&#44; pregnancy and refusal to participate &#40;not willing to sign the consent form&#41;&#46; The relative contraindications were hypotensive shock&#44; uncontrolled cardiac ischaemia or arrhythmia&#44; agitation&#44; being uncooperative&#44; inability to protect the airway due to swallowing impairment&#44; excessive secretions &#40;not possible to manage by clearance techniques&#41;&#44; multiple organ failure&#44; recent upper airway or upper gastrointestinal surgery and progressive severe respiratory failure&#46; In addition&#44; patients with pulmonary bullae&#44; bronchopleural fistula&#44; or persistent pneumothorax were excluded from the study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Interventions</span><p id="par0025" class="elsevierStylePara elsevierViewall">Each eligible participant received NIMV support alternatively using the TA-NIMV and another therapy without the tube adaptor &#40;CT-NIMV&#41;&#46; Therefore&#44; the patients were their own controls&#46; Blinding and masking were not feasible because the tube adaptor was visible during the NIMV therapies and the evaluations for air leak and patient comfort were deemed performed at bedside&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Assignment method</span><p id="par0030" class="elsevierStylePara elsevierViewall">NIMV therapy was performed according to individual needs&#46; NIMV was usually given for periods of at least 60<span class="elsevierStyleHsp" style=""></span>min according to the attending recommendation&#46; NIMV was alternatively started by using the tube adaptor &#40;TA-NIMV&#41; or the conventional NIMV support &#40;CT-NIMV&#41;&#44; followed by the other strategy during the next NIMV run&#44; after a washout period of at least 4<span class="elsevierStyleHsp" style=""></span>h&#46; This method was sequentially performed until the desired sample size was reached&#46; The ventilator parameters were maintained throughout the two interventions&#46; These paired interventions were performed once in each patient&#46; General ICU management was continued for each patient following institutional protocols&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The NIMV oro-nasal masks &#40;RESMED&#174;&#41; were classified by size in accordance with each patient&#39;s facial morphology&#46; The ventilator used was either SERVO-i&#174; or SERVO-s&#174;&#46; Ventilator leakage was defined as the amount of ICV lost and was recorded in terms of percentage&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Adaptor design</span><p id="par0040" class="elsevierStylePara elsevierViewall">The size of the enteric tube was fundamental to developing the tube adaptor for this study&#46; There were two types of enteric tubes used in our adult ICU patients&#46; The gastric drainage probe &#40;Levin&#44; Salem&#44; Miller Abbott&#41;&#44; which was used to administer medications and control gastric contents&#44; had varying sizes that ranged from 14F &#40;4&#46;0<span class="elsevierStyleHsp" style=""></span>mm&#41; to 20F &#40;7&#46;3<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; with an outer diameter of approximately 9<span class="elsevierStyleHsp" style=""></span>mm on its distal end&#46; The tube for enteral feeding was usually of the 12F &#40;4&#46;0<span class="elsevierStyleHsp" style=""></span>mm&#41; caliber and had a universal two-way connector that measured approximately 17-mm wide on its distal end&#59; it was used for nutritional support and administration of medications or fluids&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The tube adaptor device was made of a rigid polymer plastic for one or two enteric tubes sizes&#46; The adapter that interfaces between ventilator circuit and mask opens laterally&#44; allowing tubes passing through the center of the mask to be placed in appropriately sized holes&#44; when closed&#44; it is inserted in the mask and attached to ventilator in patients whit one &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; or two &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; enteric tubes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study variables and outcomes</span><p id="par0050" class="elsevierStylePara elsevierViewall">The demographics &#40;e&#46;g&#46; age and sex&#41; and clinical information &#40;i&#46;e&#46; reasons for NIMV&#41; were obtained from the FVL electronic medical charts&#46; Clinical examinations provided information on the use of dental prosthesis and the presence of abundant beard&#46; Naso-enteric tubes &#40;Nutritional Jejune&#41; are classified according to calibre and usage&#44; but the usual standard is 12F&#59; in our patients&#44; the sizes of the gastric tubes were 14F&#44; 16F&#44; 18F and 20F&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The respiratory parameters were obtained from the ventilator&#44; and the hemodynamic parameters were obtained from the central monitor&#46; The average of six recordings were calculated for the following parameters&#58; heart rate&#44; blood pressure&#44; oxygen saturation &#40;SO<span class="elsevierStyleInf">2</span>&#41;&#44; fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41;&#44; inspiratory tidal volume &#40;ITV&#41;&#44; expiratory tidal volume &#40;ETV&#41;&#44; respiratory rate and percentage of air leak&#46; Ventilator mode and positive-end expiratory pressure &#40;PEEP&#41; were also recorded&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The main outcomes were the average percentage of air leak and patient comfort during each intervention&#46; To assess comfort&#44; a visual analogue scale of comfort &#40;VASC&#41; was developed&#46; A preliminary version of the VASC was tested on patients with no neurologic involvement&#44; and its use was then explored using techniques according to the types of cognitive procedures&#44; such as thinking aloud&#44; verbal tests and ethnography&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A focal group of physicians&#44; all of whom were experienced in management and use of scales&#44; developed the final version of the scale&#44; which included the use of colours &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The VASC was classified as &#8722;2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>very uncomfortable&#44; &#8722;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>uncomfortable&#44; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>indifferent&#44; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>comfortable and 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>very comfortable&#46; It was applied only to patients with Glasgow coma scale &#40;GCS&#41; of 15 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41; at the time of bedside data collection during each intervention&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The variables were collected by ICU therapists onto a standardised paper format&#44; designed for the purpose of this study&#44; then were entered into an electronic database&#46; The data on respiratory and hemodynamic parameters were collected 15<span class="elsevierStyleHsp" style=""></span>min after each intervention&#44; whereas the data on comfort were obtained at the end of each intervention&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Sample size</span><p id="par0075" class="elsevierStylePara elsevierViewall">The outcome of interest for sample size calculation was the air leak percentage&#46; To our knowledge&#44; there had been no studies evaluating the effectiveness of devices for two enteric tubes in patients requiring NIMV with oro-nasal interface&#46; A literature review of studies that evaluated the devices&#8217; effectiveness for one enteric tube in patients requiring NIMV with an oro-nasal interface revealed that the air leak percentage ranged between 25&#37; and 60&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">19&#44;20</span></a> We expected an average of 30&#37; air leaks during CT-NIMV&#46; We assumed that an air leak percentage up to 21&#37; would be clinically significant and tolerable for an acceptable NIMV therapy&#46; Therefore&#44; with a power of 80&#37; and a significance of 5&#37;&#44; the estimated sample size for one-sample comparison of proportions was 191 patients&#46; With this sample size&#44; a 9&#37; absolute reduction in air leak was supposed to be observed during TA-NIMV&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analyses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Qualitative variables were presented as absolute and relative frequencies&#46; They were presented as mean with standard deviation &#40;SD&#41; or as median with 25th and 75th interquartile range &#40;IQR&#41;&#46; Comparisons of quantitative variables between the two interventions were performed using paired Student&#39;s <span class="elsevierStyleItalic">t</span>-test or Wilcoxon matched pairs test&#44; as appropriate&#46; Patient comfort on the VASC was compared between interventions using the marginal homogeneity test &#40;Stuart&#8211;Maxwell&#41;&#46; The main outcomes were compared between TA-NIMV and CT-NIMV using paired <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; Subgroup analyses were performed based on the number and sizes of enteral tubes&#46; <span class="elsevierStyleItalic">p</span> values &#60;0&#46;05 were considered statistically significant&#46; All analyses were performed using Stata &#40;version 12&#46;1&#41; software&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">There were 196 patients studied between October 2012 and January 2014&#46; The mean age was 61&#46;2 years &#40;SD&#44; 18&#46;4 years&#41; and 102 &#40;52&#46;0&#37;&#41; were women&#46; The reasons for NIMV were hypoxemia in 113 patients &#40;57&#46;7&#37;&#41;&#44; post-operative respiratory distress in 24 &#40;12&#46;2&#37;&#41;&#44; pulmonary oedema in 20 &#40;10&#46;2&#37;&#41;&#44; hypercapnia in 16 &#40;8&#46;2&#37;&#41; and others in 12 &#40;6&#46;1&#37;&#41;&#46; Ninety-nine patients &#40;50&#46;5&#37;&#41; had a naso-enteric tube and 68 &#40;34&#46;7&#37;&#41; a naso-enteric tube&#46; The size of the naso-enteric tube was 12F in 99 patients &#40;50&#46;5&#37;&#41;&#44; 14F in 12 &#40;6&#46;1&#37;&#41;&#44; 16F in 29 &#40;14&#46;8&#37;&#41;&#44; 18F in 15 &#40;7&#46;7&#37;&#41; and 20F in 12 &#40;6&#46;1&#37;&#41;&#46; There were 29 patients &#40;14&#46;8&#37;&#41; who required simultaneous use of more than one naso-enteric tube&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean washout period between the two interventions was 5&#46;48<span class="elsevierStyleHsp" style=""></span>h &#40;SD&#44; 2&#46;94<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; The ventilator mode was control pressure in 142 patients &#40;72&#46;4&#37;&#41;&#44; support pressure in 42 &#40;21&#46;4&#37;&#41; and continuous positive airway pressure in 12 &#40;6&#46;1&#37;&#41;&#46; The mean FiO<span class="elsevierStyleInf">2</span> was 44&#46;6&#37; &#40;SD&#44; 12&#46;3&#37;&#41;&#44; and the median PEEP was 7 &#40;IQR&#44; 5&#8211;8&#41;&#46; Dental prostheses were used in 59 patients &#40;30&#46;1&#37;&#41;&#44; and abundant beard was noticed in five patients &#40;2&#46;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Comparisons of the respiratory and hemodynamic parameters between interventions are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The mean duration was similar &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#41; between the TA-NIMV &#91;1&#46;96<span class="elsevierStyleHsp" style=""></span>h &#40;SD&#44; 2&#46;33<span class="elsevierStyleHsp" style=""></span>h&#41;&#93; and the CT-NIMV &#91;1&#46;8<span class="elsevierStyleHsp" style=""></span>h &#40;SD&#44; 2&#46;13<span class="elsevierStyleHsp" style=""></span>h&#41;&#93;&#46; Compared with the CT-NIMV group&#44; the TA-NIMV group had significantly higher mean ITV &#91;496&#46;4 &#40;SD&#44; 98&#46;7&#41; vs&#46; 452&#46;3 &#40;SD&#44; 102&#46;0&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#93;&#59; mean ETV &#91;502&#46;6 &#40;SD 101&#46;0&#41; vs&#46; 457&#46;7 &#40;SD&#44; 98&#46;8&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#93; and mean SO<span class="elsevierStyleInf">2</span> &#91;97&#46;6&#37; &#40;SD&#44; 1&#46;9&#37;&#41; vs&#46; 96&#46;0&#37; &#40;SD&#44; 2&#46;7&#37;&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#93;&#46; The mean respiratory rate and heart rate were significantly lower in the TA-NIMV group than in the CT-NIMV group &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Evaluating comfort after the intervention was possible in 99 patients with a GCS of 15&#46; After TA-NIMV 59 patients &#40;59&#46;6&#37;&#41; reported being comfortable&#44; and 25 patients &#40;25&#46;3&#37;&#41; reported being very comfortable&#46; After CT-NIMV&#44; 14 patients &#40;14&#46;1&#37;&#41; reported being comfortable&#44; while only three patients &#40;3&#46;0&#37;&#41; reported being very comfortable&#46; The use of TA-NIMV was significantly more comfortable than CT-NIMV when PCV or PSV modes were used &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">In all patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>196&#41;&#44; the mean air leak percentage was 9&#46;2&#37; &#40;SD&#44; 7&#46;7&#37;&#41; during TA-NIMV and 32&#46;5&#37; &#40;SD&#44; 12&#46;5&#37;&#41; during CT-NIMV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Subgroup analyses by the numbers and sizes of naso-enteric tubes showed that the air leak percentages were significantly lower with TA-NIMV than with CT-NIMV &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In this study&#44; we presented the feasibility and actual effectiveness of a device designed by our hospital ICU staff&#46; Our results suggested that using the new tube adaptor for NIMV administered&#44; via an oro-nasal mask in patients with one or two naso-enteral tubes&#44; improved patient comfort and significantly decreased the air leakage volume&#46; The statistically significant lower sir leak percentages with TA-NIMV than with CT-NIMV were consistent among all subgroup analyses&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">NIMV had been shown to significantly decrease mortality&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">21</span></a> but the factors that determine its success are based on adequate tolerance and the patient&#39;s comfort&#46; Previously conducted studies have proved that the magnitude of air leaks is correlated with the number of ineffective breaths and severity of delayed cycling&#44; both of which play important roles in generating patient&#8211;ventilator asynchrony and discomfort&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> We designed our device aiming to decrease air leaks to improve patient comfort&#46; Moreover&#44; we observed that patients who were placed on TA-NIMV had higher comfort levels than those who were not placed on TA-NIMV&#46; Our device possibly had beneficial effects even though we did not measure patient&#8211;ventilator asynchrony metrics&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Significant air leaks can induce a pressure drop or generate flows that are perceived as patient inspiratory effort&#46; These inevitably results in auto-triggering&#44; which is a highly undesirable phenomenon that can be resolved only by reducing triggering sensitivity&#46; This reduction in triggering sensitivity reportedly leads to late cycling or failure to trigger in 12&#37;&#8211;23&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">When a tube adaptor was added to the NIMV&#44; approximately 85&#37; of patients with GCS of 15&#47;15 confirmed that they felt comfortable or very comfortable&#46; By utilising a special mask that engaged the naso-enteric tubes based on a scale of 1 to 5&#44; our results were consistent with those obtained by Gregoretti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> who reported significant improvement with respect to patient comfort levels&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We described the effects of a new device that decreased air leak in cases treated with NIMV via an oro-nasal mask with concomitant use of one or two naso-enteric tubes&#46; These findings were consistent regardless of the number and size of the naso-enteric tubes&#46; Few articles have reported using tube adaptors in NIMV&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> Moreover&#44; much less is known about the comparative effectiveness between a mask prototype with a port for the naso-enteric tube and a conventional mask&#46; A case report demonstrated that using a special endoscopy mask with a 16F probe for the enteral tubes reduced the risks of failure and improved NIMV quality in two patients&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> At the moment&#44; there had been no reports on using NIMV oro-nasal mask in patients who needed more than one enteric tube&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our results showed using the tube adaptor maintained the air leak percentage below 10&#37;&#44; except in the subgroup of patients with 20F enteric tubes&#59; in that group&#44; the air leak percentage reached slightly above 10&#37;&#46; Nevertheless&#44; the differences between TA-NIMV and CT-NIMV were statistically significant&#44; and the air leak percentage was much higher with CT-NIMV&#46; Reducing the air leak percentage with our new device may improve the outcomes of critically ill patients who usually require multiple interventions&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Current ventilators can be programmed to deliver between 40<span class="elsevierStyleHsp" style=""></span>L&#47;min and 65<span class="elsevierStyleHsp" style=""></span>L&#47;min to compensate for air leaks&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> However&#44; excessive air leaks cannot be well compensated&#44; and the use of NIMV becomes ineffective when air leaks exceed 20&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">25&#44;26</span></a> In particular&#44; this is an important finding for institutions in low- to middle-income countries&#44; which rarely have such technology&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Limitations</span><p id="par0145" class="elsevierStylePara elsevierViewall">This study had some limitations and the results should be interpreted in the context of the patients included&#46; We did not actively evaluate some adverse effects related to oro&#47;naso mask interface such a skin irritation or abrasions&#46; Nevertheless&#44; all patients received skin protection barriers according to the local protocol&#46; Further bias could have been introduced because the outcome evaluators were not blinded to the interventions&#46; However&#44; the comparisons were performed in the same patients as their own controls&#46; Therefore&#44; the addition of a tube adaptor seems to reduce air leaks and improve patient comfort compared to those during conventional NIMV&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conclusion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The use of a tube adaptor to adjust NIMV mask interfaces in patients in whom oro- or naso-enteral tubes are in place&#44; significantly reduces air leaks and improves subjective comfort perceived by the patient during NIMV support&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authorship</span><p id="par0155" class="elsevierStylePara elsevierViewall">Oscar I&#46; Quintero&#58; Conception and design of the study&#44; writing the core content of the study&#44; analysis and interpretation of data&#44; drafting the article or revising it critically for important intellectual content&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Alvaro I&#46; Sanchez&#58; Writing the core content of the study&#44; coordinated delivery of interventions&#44; analysis and interpretation of data&#44; preparation and critical review of the manuscript&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Paola A&#46; Chavarro&#58; Writing the core content of the study&#44; coordinated delivery of interventions&#44; analysis and interpretation of data&#44; preparation and critical review of the manuscript&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Isabel C&#46; Casas&#58; Writing the core content of the study&#44; analysis and interpretation of data&#44; preparation and critical review of the manuscript&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Gustavo A&#46; Ospina Tasc&#243;n&#58; Writing the core content of the study&#44; coordinated delivery of interventions&#44; analysis and interpretation of data&#44; preparation and critical review of the manuscript&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">All authors declare their approval for the current version of the manuscript&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">This work was funded by Fundaci&#243;n Valle del Lili &#40;Centro de Investigaciones Cl&#237;nicas&#41;&#44; Grand 00576&#47;12&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare one conflict of interest&#46; Fundaci&#243;n Valle del Lili has the device patent of the tube adapter for non-invasive mechanical ventilation&#46; The patent number 1165 is registered at the Colombian Patent and Trademark Office &#40;Superintendencia de Industria y Comercio de la Republica de Colombia&#41;&#46; International publication is WO2014188242A1 of World Intellectual Property Organization&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The presence of oral or naso-enteral probes during non-invasive mechanical ventilation &#40;NIMV&#41; increases the risk of leakage and patient discomfort&#46; The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV &#40;TA-NIMV&#41; in relation to leakage and comfort level&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital&#44; in which patients were their own controls&#46; We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes&#46; The interventions were as follows&#58; every participant received two therapies&#44; one with the TA-NIMV and one conventional therapy of NIMV &#40;CT-NIMV&#41;&#46; Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15&#46; The outcomes of interest was the average percentage of air leak and patient comfort during each intervention&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">196 patients were included in the study during a 16-month period&#46; The mean air leak percentage was 9&#46;2&#37; &#91;standard deviation &#40;SD&#41;&#44; 7&#46;7&#93; during TA-NIMV and 32&#46;5&#37; &#40;SD&#44; 12&#46;5&#41; during CT-NIMV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; 84&#46;9&#37; reported being comfortable or very comfortable during TA-VMNI&#46; 66&#46;7&#37; Uncomfortable or Very uncomfortable during CT-NIMV &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Higher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La presencia de sondas orales o nasoenterales durante la ventilaci&#243;n mec&#225;nica no invasiva &#40;VMNI&#41; incrementa el riesgo de fugas y la incomodidad del paciente&#46; El objetivo de este estudio fue evaluar la efectividad de un novedoso adaptador de sondas para VMNI &#40;AS-VMNI&#41; en relaci&#243;n con las fugas y nivel de comodidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un dise&#241;o cuasiexperimental no aleatorizado en la unidad de cuidados intensivos del adulto de un hospital de alta complejidad&#44; en el cual los pacientes fueron sus propios controles&#46; Se incluyeron pacientes adultos que requer&#237;an VMNI con m&#225;scara oronasal y que ten&#237;an simult&#225;neamente sondas orales o nasoenterales&#46; Cada participante recibi&#243; 2 tratamientos&#58; uno con el AS-VMNI y otro&#44; convencional&#44; con VMNI &#40;CT-NIMV&#41;&#46; La comodidad pudo evaluarse en 99 pacientes con un 15 en la escala de coma de Glasgow&#46; Las variables de resultado fueron el porcentaje de fugas y la comodidad del paciente durante cada una de las intervenciones&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ciento noventa y seis pacientes fueron incluidos en el estudio durante un per&#237;odo de 16 meses&#46; El porcentaje medio de fuga de aire fue del 9&#44;2&#37; &#40;desviaci&#243;n est&#225;ndar&#44; 7&#44;7&#41; durante el AS-VMNI y del 32&#44;5&#37; &#40;desviaci&#243;n est&#225;ndar&#44; 12&#44;5&#41; durante el TC-VMNI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El 84&#44;9&#37; de los pacientes refirieron sentirse c&#243;modos o muy c&#243;modos durante AS-VMNI&#46; El 66&#44;7&#37; refirieron estar inc&#243;modos o muy inc&#243;modos durante TC-NIMV &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El uso del AS-VMNI permiti&#243; mayores niveles de comodidad y menores porcentajes de fugas de aire que con el TC-VMNI&#46;</p></span>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparisons comfort between interventions&#46; &#40;a&#41; Percentage of comfort perception during TA-NIMV and CT-NIMV in all patients evaluated &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>99&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; &#40;b&#41; Percentage of comfort among patients on pressure support mode&#44; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; &#40;c&#41; Percentage of comfort among patients on pressure control mode&#44; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46; &#40;d&#41; Percentage of comfort among patients on continuous positive airway pressure ventilation mode&#44; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;261&#46; Differences between groups were tested using the marginal homogeneity test &#40;Stuart&#8211;Maxwell&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; IQR&#44; interquartile range&#59; NIMV&#44; non-invasive mechanical ventilation&#59; CP&#44; control pressure&#59; SP&#44; support pressure&#59; CPAP&#44; continuous positive airway pressure&#59; FiO<span class="elsevierStyleInf">2</span>&#44; fraction of inspired oxygen&#59; PEEP&#44; positive-end expiratory pressure&#46;</p>"
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">29 &#40;14&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>18&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;7&#46;7&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>20&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;6&#46;1&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Two tubes&#44; n &#40;&#37;&#41;</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">29 &#40;14&#46;8&#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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CP&#44; n &#40;&#37;&#41;</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
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                  \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
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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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">CPAP&#44; n &#40;&#37;&#41;</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">12 &#40;6&#46;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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">FiO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#40;&#37;&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6 &#40;12&#46;3&#41;&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;40&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">PEEP &#40;cmH</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">O&#41;</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;4 &#40;1&#46;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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#8211;8&#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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Others features</span></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dental prosthesis&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;30&#46;1&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Abundant beard&#44; n &#40;&#37;&#41;</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">5 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-entry\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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
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                  \t\t\t\t">1&#46;9 &#40;2&#46;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="char" valign="\n
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                  \t\t\t\t">1&#46;8 &#40;2&#46;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
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                  \t\t\t\t">0&#46;23&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
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                  \t\t\t\t">1&#46;2 &#40;1&#46;0&#8211;2&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1 &#40;1&#46;0&#8211;2&#46;0&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ITV &#40;mL&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">496&#46;4 &#40;98&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">452&#46;3 &#40;102&#46;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">488&#46;5 &#40;416&#8211;560&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">438 &#40;380&#8211;522&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ETV &#40;mL&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">502&#46;6 &#40;101&#46;0&#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="char" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
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                  \t\t\t\t">22 &#40;18&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;21&#46;5&#8211;27&#46;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
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
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                  \t\t\t\t">89&#46;2 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&#46;2 &#40;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#41;&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">90 &#40;77&#8211;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;82&#8211;106&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9&#46;2 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;5&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">One &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">167&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;0 &#40;6&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;2 &#40;11&#46;4&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#8211;11&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;22&#8211;38&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Two &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">29&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2 &#40;12&#46;2&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;7 &#40;10&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#8211;9&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;37&#8211;54&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Size of naso-gastric tube &#40;French&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">12 &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">99&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;0 &#40;6&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;1 &#40;7&#46;9&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#8211;11&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;20&#8211;26&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">14 &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">12&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;1 &#40;1&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;6&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#8211;6&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;5 &#40;29&#46;5&#8211;36&#46;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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">16 &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">29&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2 &#40;7&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;3 &#40;8&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#8211;9&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;29&#8211;43&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">18 &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">15&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;8 &#40;7&#46;0&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6&#8211;14&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;39&#8211;46&#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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">20 &#40;n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">12&#41;</span></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"><span class="elsevierStyleHsp" style=""></span>Mean &#40;SD&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5 &#40;6&#46;9&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;5 &#40;7&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&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"><span class="elsevierStyleHsp" style=""></span>Median &#40;IQR&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#8211;11&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;5 &#40;44&#46;5&#8211;55&#46;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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Comparison of the percentages of air leak between the types of interventions&#44; stratified by the number and size of enteric tubes&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pathophysiological basis of acute respiratory failure on non-invasive mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Romero-Dapueto"
                            1 => "H&#46; Budini"
                            2 => "F&#46; Cerpa"
                            3 => "D&#46; Caceres"
                            4 => "V&#46; Hidalgo"
                            5 => "T&#46; Guti&#233;rrez"
                          ]
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                      "doi" => "10.2174/1874306401509010097"
                      "Revista" => array:6 [
                        "tituloSerie" => "Open Respir Med J"
                        "fecha" => "2015"
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