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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Foreign body &#40;FB&#41; aspiration is a common problem in children and adults&#44; necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> Consequences of an aspirated FB include the possibility of complete or partial airway obstruction&#44; post-obstructive pneumonia&#44; respiratory distress&#44; pneumothorax or hemorrhage&#46; Risk factors for FB aspiration include intellectual disability&#44; neuromuscular diseases&#44; maxillofacial trauma&#44; unconsciousness&#44; intoxication&#44; dementia&#44; and use of sedative drugs and dental medications&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At present&#44; FB removal in adults relies mainly on bronchoscopic techniques&#44; including rigid and flexible bronchoscopy&#46; A rigid bronchoscope provides greater access to the subglottic airways&#44; ensuring correct oxygenation and easy passage of the telescope and grasping forceps during the extraction of a large FB&#46; Furthermore&#44; a rigid bronchoscope allows efficient airway suctioning if a massive bleed occurs&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;4</span></a> Flexible bronchoscopy offers several advantages compared with rigid bronchoscopy&#58; first&#44; it is more cost effective and easily applicable in an outpatient setting&#46; Second&#44; it avoids the need for anesthesia and deep sedation&#46; Finally&#44; it has been shown to be associated with lower mortality compared with rigid bronchoscopy &#40;1&#37; vs 12&#37;&#41;&#44; a difference which may be attributable to the avoidance of general anesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is difficult to extract large FBs from the airway using a flexible bronchoscope&#44; especially FBs such as dental prostheses&#46; The irregular surface and hard composition of dental prostheses make them particularly difficult to grasp and extract using normally effective instruments &#40;e&#46;g&#46; biopsy forceps&#44; Fogarty balloon catheters&#44; alligator forceps&#44; or wire baskets&#41;&#46; For this reason&#44; practitioners commonly use a multidisciplinary approach or a combination of instruments&#46; In this case report&#44; we describe the successful removal of a very large dental prosthesis that nearly totally occluded the right main bronchus of a 72-year-old woman following a myocardial infarction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 72-year-old female patient was admitted to the hospital due to an anterior wall ST elevation myocardial infarction&#46; She underwent a primary percutaneous coronary intervention with the insertion of a stent to her left anterior descending coronary artery&#46; She was intubated due to severe pulmonary edema and then safely weaned from mechanical ventilation seven days later&#46; Ten hours after extubation&#44; the patient suddenly developed dyspnea&#44; tachypnea and severe hypoxemia&#46; On physical examination&#44; there were no signs of pulmonary edema&#44; though decreased breathing sounds were noted on her right hemithorax&#46; She underwent an immediate re-intubation&#44; and an emergent chest X-ray revealed a large&#44; fixed 7-unit restoration dental prosthesis nearly totally occluding the right main bronchus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Since the prosthesis was much wider than the 7&#46;5-mm diameter of the endotracheal tube&#44; we needed an innovative strategy for its extraction to avoid tracheotomy&#46; A flexible bronchoscope was inserted through the endotracheal tube&#44; after which the prosthesis could be seen in the right main bronchus&#46; After a few attempts&#44; the slippery prosthesis was finally grasped by large alligator forceps and the process of slowly withdrawing the scope began&#46; When the prosthesis reached the distal end of the endotracheal tube&#44; the complex of the tube&#44; the bronchoscope and the grasped prosthesis were withdrawn until the prosthesis was brought to the level of the oropharynx&#46; The prosthesis was extracted using Magill forceps together with the tube and bronchoscope&#46; Immediately following the extraction&#44; a new endotracheal tube was inserted&#46; The patient tolerated this procedure well&#59; she was weaned from mechanical ventilation the following day and discharged from the hospital 10 days later&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foreign body &#40;FB&#41; aspiration is a common problem necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Aspiration of a very large FB can constitute a technical problem&#44; since its extraction may require an invasive procedure&#44; such as rigid bronchoscopy&#44; tracheotomy or thoracotomy&#44; especially in an intubated patient&#46; The use of a flexible bronchoscope decreases the risks associated with those procedures<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a> and has a high success rate &#40;89&#46;6&#37;&#41; in the extraction of FBs&#59; thus&#44; it should normally be considered as the initial approach&#46; There are certain situations&#44; however&#44; in which a rigid bronchoscope should be considered&#44; for example&#44; with FBs that are impacted in extensive granulation tissue or excessive tissue scarring&#44; asphyxiating FBs&#44; FBs that cannot be gripped with flexible forceps as a consequence of their large size&#44; sharpness and smooth margins&#44; as well as failed attempts with a flexible one&#46; In these cases&#44; rigid bronchoscopy remains the procedure of choice&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; in our case due to the patient&#39;s condition&#44; and even though the FB was very large&#44; we decided to begin immediately with a flexible bronchoscope&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Bronchoscopic procedures are not commonly performed in unstable patients&#44; especially immediately following myocardial infarction&#44; as it can result in fatal consequences&#46; Pre-procedural planning is required and should include the whole care team&#58; the bronchoscopist&#44; assistants&#44; nurses and anesthesiologist&#46; Planning should involve discussion of the FB&#39;s characteristics&#44; location&#44; and the patient&#39;s comorbidities&#46; Proper ventilation must be arranged for during the procedure&#44; and a back-up plan developed to account for the potential that the foreign body may become lodged within the retro pharynx and completely occlude the airway&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> This scenario is more common when the FB is very large&#46; In this case&#44; the FB was indeed very large&#59; however&#44; the patient was also unstable&#44; and so the normal pre-planning process was impossible and immediate action was required&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We describe the technique we used to successfully remove a large dental prosthesis in a mechanically ventilated patient&#44; by extracting the FB with the endotracheal tube followed by an immediate re-intubation&#46; Case reports on extractions of very large FBs are scarce&#46; Sampan-Singh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> described extraction of a 3-unit dental prosthesis via direct laryngoscopy and tracheotomy&#46; Tu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> described an approach using wire loop snares together with a flexible bronchoscope for the removal of a 4-unit dental prosthesis&#46; Our patient aspirated a 7-unit dental prosthesis&#44; which we believe represents the largest reported FB extraction by flexible bronchoscopy&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This case represents an emergent exceptional approach of extracting large foreign bodies from the tracheobronchial tree in an unstable patient&#44; with relatively minimal temporary compromise of the airway&#44; using only a flexible bronchoscope&#46; The advantages of flexible over rigid bronchoscopes have been described&#59; they provide applicable&#44; cost-effective&#44; safer and faster method of extraction of FBs&#44; and thus should be considered first in experienced hands&#44; even in cases in which rigid bronchoscopy is apparently indicated&#46; Although reports on FB extraction are common&#44; our case&#44; which describes the removal of a very large prosthesis from the bronchial tree in a high-risk patient&#44; is unique&#46;</p></span>"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foreign body inhalation in the adult population&#58; experience of 25&#44;998 bronchoscopies and systematic review of the literature"
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                      ]
                    ]
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                        "paginaInicial" => "1438"
                        "paginaFinal" => "1448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25969517"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Missing aspirated impacted denture requiring tracheotomy for removal"
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                        "paginaInicial" => "359"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29383318"
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                    ]
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                    0 => array:2 [
                      "titulo" => "A feasible approach for extraction of dental prostheses from the airway by flexible bronchoscopy in concert with wire loop snares"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            3 => "Y&#46;H&#46; Liu"
                            4 => "C&#46;H&#46; Chen"
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                        "link" => array:1 [
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Scientific Letter
Retrieval of a Very Large Foreign Body From the Bronchial Tree in an Intubated Patient
Recuperación de un cuerpo extraño de gran tamaño del árbol bronquial de un paciente intubado
Amir Bar-Shaia,
Corresponding author
amirb@bmc.gov.il

Corresponding author.
, Aviad Laviana, Yigal Abramowitzb, Yehuda Schwarzc
a Division of Pulmonary Medicine, Barzilai Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
b Department of Cardiology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
c Institute of Pulmonary Diseases, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Foreign body &#40;FB&#41; aspiration is a common problem in children and adults&#44; necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2</span></a> Consequences of an aspirated FB include the possibility of complete or partial airway obstruction&#44; post-obstructive pneumonia&#44; respiratory distress&#44; pneumothorax or hemorrhage&#46; Risk factors for FB aspiration include intellectual disability&#44; neuromuscular diseases&#44; maxillofacial trauma&#44; unconsciousness&#44; intoxication&#44; dementia&#44; and use of sedative drugs and dental medications&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">At present&#44; FB removal in adults relies mainly on bronchoscopic techniques&#44; including rigid and flexible bronchoscopy&#46; A rigid bronchoscope provides greater access to the subglottic airways&#44; ensuring correct oxygenation and easy passage of the telescope and grasping forceps during the extraction of a large FB&#46; Furthermore&#44; a rigid bronchoscope allows efficient airway suctioning if a massive bleed occurs&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2&#44;4</span></a> Flexible bronchoscopy offers several advantages compared with rigid bronchoscopy&#58; first&#44; it is more cost effective and easily applicable in an outpatient setting&#46; Second&#44; it avoids the need for anesthesia and deep sedation&#46; Finally&#44; it has been shown to be associated with lower mortality compared with rigid bronchoscopy &#40;1&#37; vs 12&#37;&#41;&#44; a difference which may be attributable to the avoidance of general anesthesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is difficult to extract large FBs from the airway using a flexible bronchoscope&#44; especially FBs such as dental prostheses&#46; The irregular surface and hard composition of dental prostheses make them particularly difficult to grasp and extract using normally effective instruments &#40;e&#46;g&#46; biopsy forceps&#44; Fogarty balloon catheters&#44; alligator forceps&#44; or wire baskets&#41;&#46; For this reason&#44; practitioners commonly use a multidisciplinary approach or a combination of instruments&#46; In this case report&#44; we describe the successful removal of a very large dental prosthesis that nearly totally occluded the right main bronchus of a 72-year-old woman following a myocardial infarction&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A 72-year-old female patient was admitted to the hospital due to an anterior wall ST elevation myocardial infarction&#46; She underwent a primary percutaneous coronary intervention with the insertion of a stent to her left anterior descending coronary artery&#46; She was intubated due to severe pulmonary edema and then safely weaned from mechanical ventilation seven days later&#46; Ten hours after extubation&#44; the patient suddenly developed dyspnea&#44; tachypnea and severe hypoxemia&#46; On physical examination&#44; there were no signs of pulmonary edema&#44; though decreased breathing sounds were noted on her right hemithorax&#46; She underwent an immediate re-intubation&#44; and an emergent chest X-ray revealed a large&#44; fixed 7-unit restoration dental prosthesis nearly totally occluding the right main bronchus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Since the prosthesis was much wider than the 7&#46;5-mm diameter of the endotracheal tube&#44; we needed an innovative strategy for its extraction to avoid tracheotomy&#46; A flexible bronchoscope was inserted through the endotracheal tube&#44; after which the prosthesis could be seen in the right main bronchus&#46; After a few attempts&#44; the slippery prosthesis was finally grasped by large alligator forceps and the process of slowly withdrawing the scope began&#46; When the prosthesis reached the distal end of the endotracheal tube&#44; the complex of the tube&#44; the bronchoscope and the grasped prosthesis were withdrawn until the prosthesis was brought to the level of the oropharynx&#46; The prosthesis was extracted using Magill forceps together with the tube and bronchoscope&#46; Immediately following the extraction&#44; a new endotracheal tube was inserted&#46; The patient tolerated this procedure well&#59; she was weaned from mechanical ventilation the following day and discharged from the hospital 10 days later&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Foreign body &#40;FB&#41; aspiration is a common problem necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes fatal consequences&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Aspiration of a very large FB can constitute a technical problem&#44; since its extraction may require an invasive procedure&#44; such as rigid bronchoscopy&#44; tracheotomy or thoracotomy&#44; especially in an intubated patient&#46; The use of a flexible bronchoscope decreases the risks associated with those procedures<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5&#44;6</span></a> and has a high success rate &#40;89&#46;6&#37;&#41; in the extraction of FBs&#59; thus&#44; it should normally be considered as the initial approach&#46; There are certain situations&#44; however&#44; in which a rigid bronchoscope should be considered&#44; for example&#44; with FBs that are impacted in extensive granulation tissue or excessive tissue scarring&#44; asphyxiating FBs&#44; FBs that cannot be gripped with flexible forceps as a consequence of their large size&#44; sharpness and smooth margins&#44; as well as failed attempts with a flexible one&#46; In these cases&#44; rigid bronchoscopy remains the procedure of choice&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; in our case due to the patient&#39;s condition&#44; and even though the FB was very large&#44; we decided to begin immediately with a flexible bronchoscope&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Bronchoscopic procedures are not commonly performed in unstable patients&#44; especially immediately following myocardial infarction&#44; as it can result in fatal consequences&#46; Pre-procedural planning is required and should include the whole care team&#58; the bronchoscopist&#44; assistants&#44; nurses and anesthesiologist&#46; Planning should involve discussion of the FB&#39;s characteristics&#44; location&#44; and the patient&#39;s comorbidities&#46; Proper ventilation must be arranged for during the procedure&#44; and a back-up plan developed to account for the potential that the foreign body may become lodged within the retro pharynx and completely occlude the airway&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> This scenario is more common when the FB is very large&#46; In this case&#44; the FB was indeed very large&#59; however&#44; the patient was also unstable&#44; and so the normal pre-planning process was impossible and immediate action was required&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We describe the technique we used to successfully remove a large dental prosthesis in a mechanically ventilated patient&#44; by extracting the FB with the endotracheal tube followed by an immediate re-intubation&#46; Case reports on extractions of very large FBs are scarce&#46; Sampan-Singh et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> described extraction of a 3-unit dental prosthesis via direct laryngoscopy and tracheotomy&#46; Tu et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> described an approach using wire loop snares together with a flexible bronchoscope for the removal of a 4-unit dental prosthesis&#46; Our patient aspirated a 7-unit dental prosthesis&#44; which we believe represents the largest reported FB extraction by flexible bronchoscopy&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This case represents an emergent exceptional approach of extracting large foreign bodies from the tracheobronchial tree in an unstable patient&#44; with relatively minimal temporary compromise of the airway&#44; using only a flexible bronchoscope&#46; The advantages of flexible over rigid bronchoscopes have been described&#59; they provide applicable&#44; cost-effective&#44; safer and faster method of extraction of FBs&#44; and thus should be considered first in experienced hands&#44; even in cases in which rigid bronchoscopy is apparently indicated&#46; Although reports on FB extraction are common&#44; our case&#44; which describes the removal of a very large prosthesis from the bronchial tree in a high-risk patient&#44; is unique&#46;</p></span>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:8 [
            0 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foreign body inhalation in children&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Passali"
                            1 => "M&#46; Lauriello"
                            2 => "L&#46; Bellussi"
                            3 => "G&#46;C&#46; Passali"
                            4 => "F&#46;M&#46; Passali"
                            5 => "D&#46; Gregori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Otorhinolaryngol Ital"
                        "fecha" => "2010"
                        "volumen" => "30"
                        "paginaInicial" => "27"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20559470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foreign body aspiration in adult airways&#58; therapeutic approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;C&#46; Hewlett"
                            1 => "O&#46;B&#46; Rickman"
                            2 => "R&#46;J&#46; Lentz"
                            3 => "U&#46;B&#46; Prakash"
                            4 => "F&#46; Maldonado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/jtd.2017.06.137"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2017"
                        "volumen" => "9"
                        "paginaInicial" => "3398"
                        "paginaFinal" => "3409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29221325"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tracheobronchial foreign body aspiration&#58; dental prosthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; K&#246;se"
                            1 => "D&#46; Kostak"
                            2 => "E&#46; Aramagan"
                            3 => "A&#46; Durak"
                            4 => "N&#46;S&#46; Se&#231;kin"
                            5 => "S&#46;S&#46; D&#246;nmez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Pulmonol"
                        "fecha" => "2014"
                        "volumen" => "2014"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indications and complications of rigid bronchoscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Batra"
                            1 => "L&#46; Yarmus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17476348.2018.1473037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Respir Med"
                        "fecha" => "2018"
                        "volumen" => "12"
                        "paginaInicial" => "509"
                        "paginaFinal" => "520"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29727208"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The flexible fiberoptic bronchoscope in foreign body removal&#46; Experience in 300 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "O&#46;S&#46; Cunanan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1978"
                        "volumen" => "73"
                        "paginaInicial" => "725"
                        "paginaFinal" => "726"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/639586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foreign body inhalation in the adult population&#58; experience of 25&#44;998 bronchoscopies and systematic review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;S&#46; Sehgal"
                            1 => "S&#46; Dhooria"
                            2 => "B&#46; Ram"
                            3 => "N&#46; Singh"
                            4 => "A&#46;N&#46; Aggarwal"
                            5 => "D&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4187/respcare.03976"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Care"
                        "fecha" => "2015"
                        "volumen" => "60"
                        "paginaInicial" => "1438"
                        "paginaFinal" => "1448"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25969517"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Missing aspirated impacted denture requiring tracheotomy for removal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Bist"
                            1 => "M&#46; Luthera"
                            2 => "P&#46; Arora"
                            3 => "L&#46; Kumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Iran J Otorhinolaryngol"
                        "fecha" => "2017"
                        "volumen" => "29"
                        "paginaInicial" => "359"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29383318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A feasible approach for extraction of dental prostheses from the airway by flexible bronchoscopy in concert with wire loop snares"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;Y&#46; Tu"
                            1 => "H&#46;J&#46; Chen"
                            2 => "W&#46; Chen"
                            3 => "Y&#46;H&#46; Liu"
                            4 => "C&#46;H&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MLG.0b013e3180581991"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2007"
                        "volumen" => "117"
                        "paginaInicial" => "1280"
                        "paginaFinal" => "1282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17603327"
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                ]
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ISSN: 15792129
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