Original Articles
Physiologic Effects of Noninvasive Ventilation in Patients With Chronic Obstructive Pulmonary Diseas
Jorge Y. Nemea,
, Amalia M. Gutiérrezb, M. Cristina Santosb, Marta Berónc, Cristina Ekrothb, José P. Arcosb, Héctor Píriza, F Javier Hurtadoa
Corresponding author
jneme@montevideo.com.uy
Correspondence: Dr. J.Y. Neme. Departamento de Fisiopatología. Hospital de Clínicas. Avda. Italia, s/n, 15.º piso. Montevideo. Uruguay
Correspondence: Dr. J.Y. Neme. Departamento de Fisiopatología. Hospital de Clínicas. Avda. Italia, s/n, 15.º piso. Montevideo. Uruguay
a Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
b Laboratorio de Exploración Funcional Respiratoria, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
c Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Neme, Amalia M. Gutiérrez, M. Cristina Santos, Marta Berón, Cristina Ekroth, José P. Arcos, Héctor Píriz, F Javier Hurtado" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Jorge Y." "apellidos" => "Neme" "email" => array:1 [ 0 => "jneme@montevideo.com.uy" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Amalia M." "apellidos" => "Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "M. 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"apellidos" => "Arcos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 6 => array:3 [ "nombre" => "Héctor" "apellidos" => "Píriz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 7 => array:3 [ "nombre" => "F Javier" "apellidos" => "Hurtado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Laboratorio de Exploración Funcional Respiratoria, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J.Y. Neme. Departamento de Fisiopatología. Hospital de Clínicas. Avda. Italia, s/n, 15.º piso. Montevideo. Uruguay" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-06-10" "fechaAceptado" => "2006-09-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154796" "palabras" => array:7 [ 0 => "Noninvasive ventilation" 1 => "Pressure support ventilation" 2 => "Chronic respiratory failure" 3 => "Work of breathing" 4 => "Pulmonary disease, chronic obstructive" 5 => "COPD" 6 => "Continuous positive airway pressure" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154795" "palabras" => array:6 [ 0 => "Ventilación no invasiva" 1 => "Presión de soporte" 2 => "Insuficiencia respiratoria crónica" 3 => "Trabajo respiratorio" 4 => "EPOC" 5 => "Presión positiva continua de la vía aérea" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Noninvasive mechanical ventilation has been of use in the treatment of some forms of chronic and acute respiratory failure. However, the benefits of its use in patients in the stable phase of severe chronic obstructive pulmonary disease (COPD) remain unclear. A combination of continuous positive airway pressure (CPAP) and pressure support ventilation (PSV) may improve respiratory mechanics and alveolar ventilation, and reduce inspiratory muscle effort. In this study, we analyzed the physiologic effects of differing levels of CPAP and CPAP plus PSV in patients with stable severe COPD.</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Work of breathing, breathing pattern, oxygen saturation measured by pulse oximetry, PaO<span class="elsevierStyleInf">2</span>, and PaCO<span class="elsevierStyleInf">2</span> were analyzed in a group of 18 patients under the following conditions: a) baseline; b) CPAP, 3 cm H<span class="elsevierStyleInf">2</span>0; c) CPAP, 6 cm H<span class="elsevierStyleInf">2</span>0; d) CPAP 3 cm H<span class="elsevierStyleInf">2</span>0 plus PSV 8 cm H<span class="elsevierStyleInf">2</span>0; and e) CPAP 3 cm H<span class="elsevierStyleInf">2</span>0 plus PSV 12 cm H<span class="elsevierStyleInf">2</span>0.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">CPAP at pressures of 3 and 6 cm H<span class="elsevierStyleInf">2</span>0 was associated with an increase in tidal volume (V<span class="elsevierStyleInf">T</span>) from a mean (SD) baseline value of 0.52 (0.04) L to 0.62 (0.04) and 0.61 (0.03) L, respectively. Minute ventilation increased from 8.6 (0.5) L/min to 10.8 (0.6) and 10.9 (0.5) L/min, respectively. Mean inspiratory flow (V<span class="elsevierStyleInf">T</span>/Ti) increased from 0.35 (0.02) L/s to 0.44 (0.02) and 0.41 (0.02) L/s, respectively, and dynamic intrinsic positive end-expiratory pressure (PEEPi,dyn) was reduced from 1.63 (0.7) cm H<span class="elsevierStyleInf">2</span>0 to 1.1 (0.06) and 0.37 (0.4) cm H<span class="elsevierStyleInf">2</span>0, respectively. CPAP did not reduce the work of breathing. Association of CPAP at 3 cm H<span class="elsevierStyleInf">2</span>0 with PSV of 8 or 12 cm H<span class="elsevierStyleInf">2</span>0 increased V<span class="elsevierStyleInf">T</span> to 0.72 (0.07) and 0.87 (0.08) L, respectively, while minute ventilation increased to 12.9 (0.8) and 14.9 (1.1) L/s, respectively. Mean inspiratory flow also increased to 0.50 (0.03) and 0.57 (0.03) L/s, respectively. Work of breathing was reduced from 0.90 (0.01) J/L to 0.48 (0.06) and 0.30 (0.06) J/L, respectively, while PEEPi,dyn increased to 1.30 (0.02) and 2.42 (0.08) cm H<span class="elsevierStyleInf">2</span>0, respectively. With combined CPAP of 3 cm H<span class="elsevierStyleInf">2</span>0 and PSV of 12 cm H<span class="elsevierStyleInf">2</span>0, PaCO<span class="elsevierStyleInf">2</span> was reduced from a baseline value of 41.2 (1.5) mm Hg to 38.7 (1.9) mm Hg. All of the changes were statistically significant (P<.05).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">CPAP of 3 cm H<span class="elsevierStyleInf">2</span>0 in combination with PSV improved breathing pattern, increased alveolar ventilation, and reduced work of breathing. These results offer a rational basis for the use of noninvasive mechanical ventilation in the treatment of patients with stable severe COPD.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La ventilación mecánica no invasiva ha sido útil en el tratamiento de algunas formas de insuficiencia respiratoria aguda y crónica. Sin embargo, sus posibles beneficios para pacientes con enfermedad pulmonar obstructiva crónica (EPOC) grave en fase estable continúan siendo objeto de controversia. La combinación de presión positiva continua de la vía aérea (CPAP) y presión de soporte (PS) puede mejorar la mecánica respiratoria, el trabajo muscular y la ventilación alveolar. Estudiamos los efectos fisiológicos de diferentes cifras de CPAP y CPAP + PS en pacientes con EPOC grave en fase estable.</p> <span class="elsevierStyleSectionTitle">Pacientes y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">En 18 pacientes se determinaron el trabajo respiratorio, el patrón respiratorio, la oximetría de pulso y los gases sanguíneos en las siguientes condiciones: a) basal; b) CPAP: 3 cmH<span class="elsevierStyleInf">2</span>O; c) CPAP: 6 cmH<span class="elsevierStyleInf">2</span>O; d) CPAP + PS: 3 y 8 cmH<span class="elsevierStyleInf">2</span>O, respectivamente, y e) CPAP + PS: 3 y 12 cmH<span class="elsevierStyleInf">2</span>O, respectivamente.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La CPAP de 3 y 6 cmH<span class="elsevierStyleInf">2</span>O se asoció con aumento del volumen corriente (Vc), que de un valor basal medio (± desviación estándar) de 0,52 ± 0,04 pasó a 0,62 ± 0,04 y 0,61 ± 0,03 l, respectivamente. La ventilación minuto aumentó de 8,6 ± 0,5 a 10,8 ± 0,6 y 10,9 ± 0,5 l/min, respectivamente. El flujo medio inspiratorio (Vc/Ti) pasó de 0,35 ± 0,02 a 0,44 ± 0,02 y 0,41 ± 0,02 ml/min, y la presión positiva al final de la inspiración intrínseca (PEEPi dinámica) disminuyó de 1,63 ± 0,7 a 1,1 ± 0,06 y 0,37 ± 0,4 cmH<span class="elsevierStyleInf">2</span>O, respectivamente. La CPAP no disminuyó el trabajo respiratorio. La asociación de CPAP de 3 cmH<span class="elsevierStyleInf">2</span>O con PS de 8 y 12 cmH<span class="elsevierStyleInf">2</span>O aumentó el Vc a 0,72 ± 0,07 y 0,87 ± 0,08 l, mientras la ventilación minuto aumentó a 12,9 ± 0,8 y 14,9 ± 1,1 l/min, respectivamente. El Vc/Ti también aumentó a 0,50 ± 0,03 y 0,57 ± 0,03 l/s, respectivamente. El trabajo respiratorio disminuyó desde 0,90 ± 0,01 a 0,48 ± 0,06 y 0,30 ± 0,06 J/l, mientras que la PEEPi dinámica aumentó a 1,30 ± 0,02 y 2,42 ± 0,08 cmH<span class="elsevierStyleInf">2</span>O, respectivamente. Con CPAP de 3 cmH<span class="elsevierStyleInf">2</span>O y PS de 12 cmH<span class="elsevierStyleInf">2</span>O la presión arterial de anhídrido carbónico disminuyó de un valor basal de 41,2 ± 1,5 a 38,7 ± 1,9 Torr. Todos estos cambios fueron estadísticamente significativos (p < 0,05).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El uso de CPAP de 3 cmH<span class="elsevierStyleInf">2</span>O con PS mejoró el patrón ventilatorio, aumentó la ventilación alveolar y disminuyó el trabajo respiratorio. Estos resultados ofrecen fundamentos para un uso racional de la ventilación mecánica no invasiva para el tratamiento de los pacientes con EPOC grave en fase estable.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L Brochard" 1 => "J Mancebo" 2 => "M Wysocki" 3 => "F Lofaso" 4 => "G Conti" 5 => "A Rauss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199509283331301" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1995" "volumen" => "333" "paginaInicial" => "817" "paginaFinal" => "822" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7651472" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive face mask ventilation in patients with acute respiratory failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "GU Meduri" 1 => "CC Conoscenti" 2 => "P Menashe" 3 => "S Nair" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1989" "volumen" => "95" "paginaInicial" => "865" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2924616" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Italian multicenter study on noninvasive ventilation in chronic obstructive pulmonary disease patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E Clini" 1 => "C Sturani" 2 => "A Rossi" 3 => "S Viaggi" 4 => "A Corrado" 5 => "C Donner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2002" "volumen" => "20" "paginaInicial" => "529" "paginaFinal" => "538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12358325" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S Mehta" 1 => "NS Hill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.163.2.9906116" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "163" "paginaInicial" => "540" "paginaFinal" => "577" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11179136" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of noninvasive ventilation on lung hyperinflation in stable hypercapnic COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "O Díaz" 1 => "P Bégin" 2 => "B Torrealba" 3 => "E Jover" 4 => "C Lisboa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2002" "volumen" => "20" "paginaInicial" => "1490" "paginaFinal" => "1498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12503709" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical indications for non-invasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 56 | 17 | 73 |
| 2024 September | 38 | 14 | 52 |
| 2024 August | 56 | 39 | 95 |
| 2024 July | 36 | 19 | 55 |
| 2024 June | 61 | 22 | 83 |
| 2024 May | 28 | 24 | 52 |
| 2024 April | 18 | 28 | 46 |
| 2024 March | 24 | 16 | 40 |
| 2024 February | 16 | 17 | 33 |
| 2023 March | 5 | 2 | 7 |
| 2023 February | 16 | 23 | 39 |
| 2023 January | 14 | 26 | 40 |
| 2022 December | 26 | 23 | 49 |
| 2022 November | 28 | 25 | 53 |
| 2022 October | 26 | 45 | 71 |
| 2022 September | 28 | 18 | 46 |
| 2022 August | 26 | 39 | 65 |
| 2022 July | 23 | 43 | 66 |
| 2022 June | 16 | 30 | 46 |
| 2022 May | 21 | 34 | 55 |
| 2022 April | 16 | 23 | 39 |
| 2022 March | 18 | 41 | 59 |
| 2022 February | 16 | 26 | 42 |
| 2022 January | 15 | 27 | 42 |
| 2021 December | 14 | 32 | 46 |
| 2021 November | 14 | 40 | 54 |
| 2021 October | 19 | 50 | 69 |
| 2021 September | 20 | 64 | 84 |
| 2021 August | 10 | 28 | 38 |
| 2021 July | 13 | 22 | 35 |
| 2021 June | 26 | 39 | 65 |
| 2021 May | 24 | 31 | 55 |
| 2021 April | 25 | 44 | 69 |
| 2021 March | 13 | 16 | 29 |
| 2021 February | 12 | 12 | 24 |
| 2021 January | 16 | 16 | 32 |
| 2020 December | 7 | 15 | 22 |
| 2020 November | 8 | 11 | 19 |
| 2020 October | 12 | 2 | 14 |
| 2020 September | 10 | 5 | 15 |
| 2020 August | 21 | 15 | 36 |
| 2020 July | 15 | 10 | 25 |
| 2020 June | 21 | 6 | 27 |
| 2020 May | 27 | 16 | 43 |
| 2020 April | 19 | 15 | 34 |
| 2020 March | 10 | 13 | 23 |
| 2020 February | 29 | 19 | 48 |
| 2020 January | 23 | 19 | 42 |
| 2019 December | 16 | 15 | 31 |
| 2019 November | 12 | 15 | 27 |
| 2019 October | 8 | 10 | 18 |
| 2019 September | 14 | 22 | 36 |
| 2019 August | 14 | 13 | 27 |
| 2019 July | 8 | 20 | 28 |
| 2019 June | 5 | 9 | 14 |
| 2019 May | 9 | 23 | 32 |
| 2019 April | 17 | 29 | 46 |
| 2019 March | 6 | 22 | 28 |
| 2019 February | 7 | 10 | 17 |
| 2019 January | 1 | 9 | 10 |
| 2018 December | 3 | 12 | 15 |
| 2018 November | 34 | 14 | 48 |
| 2018 October | 18 | 9 | 27 |
| 2018 September | 13 | 12 | 25 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 3 | 9 | 12 |
| 2018 March | 4 | 3 | 7 |
| 2018 February | 5 | 4 | 9 |
| 2018 January | 5 | 9 | 14 |
| 2017 December | 3 | 5 | 8 |
| 2017 November | 2 | 14 | 16 |
| 2017 October | 4 | 6 | 10 |
| 2017 September | 3 | 7 | 10 |
| 2017 August | 4 | 13 | 17 |
| 2017 July | 1 | 7 | 8 |
| 2017 June | 9 | 13 | 22 |
| 2017 May | 5 | 16 | 21 |
| 2017 April | 1 | 7 | 8 |
| 2017 March | 4 | 16 | 20 |
| 2017 February | 1 | 8 | 9 |
| 2017 January | 1 | 2 | 3 |
| 2016 December | 7 | 7 | 14 |
| 2016 November | 14 | 8 | 22 |
| 2016 October | 14 | 11 | 25 |
| 2016 September | 12 | 8 | 20 |
| 2016 August | 15 | 6 | 21 |
| 2016 July | 6 | 0 | 6 |
| 2016 March | 2 | 0 | 2 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 52 | 13 | 65 |
| 2015 September | 38 | 12 | 50 |
| 2015 August | 35 | 7 | 42 |
| 2015 July | 38 | 9 | 47 |
| 2015 June | 40 | 10 | 50 |
| 2015 May | 47 | 13 | 60 |
| 2015 April | 36 | 12 | 48 |
| 2015 March | 44 | 10 | 54 |
| 2015 February | 34 | 5 | 39 |
| 2015 January | 29 | 5 | 34 |
| 2014 December | 28 | 5 | 33 |
| 2014 November | 32 | 4 | 36 |
| 2014 October | 52 | 10 | 62 |
| 2014 September | 48 | 6 | 54 |
| 2014 August | 62 | 11 | 73 |
| 2014 July | 50 | 9 | 59 |
| 2014 June | 49 | 8 | 57 |
| 2014 May | 64 | 18 | 82 |
| 2014 April | 51 | 9 | 60 |
| 2014 March | 62 | 13 | 75 |
| 2014 February | 43 | 12 | 55 |
| 2014 January | 38 | 13 | 51 |
| 2013 December | 47 | 13 | 60 |
| 2013 November | 35 | 3 | 38 |
| 2013 October | 56 | 15 | 71 |
| 2013 September | 44 | 10 | 54 |
| 2013 August | 45 | 10 | 55 |
| 2013 July | 57 | 17 | 74 |
| 2013 June | 37 | 8 | 45 |
| 2013 May | 33 | 8 | 41 |
| 2013 April | 14 | 3 | 17 |
| 2013 March | 6 | 3 | 9 |
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