¿Es el momento de incorporar el paquete de medidas Kidney Disease Improving Global Outcomes (KDIGO) a los Programas de Recuperación Intensificada para cirugía colorrectal?

Ripollés-Melchor, J.; Zorrilla-Vaca, A.; Lorente, J.V.; Weiss, R.
doi:10.1016/j.redar.2021.10.011
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Los programas de Recuperaci&#243;n Intensificada &#40;ERAS&#41; aparecieron como un enfoque integral para la atenci&#243;n del paciente quir&#250;rgico&#44; con el fin de estandarizar las intervenciones multimodales e implementar elementos de atenci&#243;n perioperatoria multidisciplinarios basados en la evidencia<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; La idea original de los programas ERAS se bas&#243; en los beneficios generados por la combinaci&#243;n sin&#233;rgica de m&#250;ltiples medidas e intervenciones<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a>&#46; Cada intervenci&#243;n contribuye de forma individual a obtener una ventaja global&#44; aunque consideradas como intervenciones aisladas&#44; s&#243;lo unas pocas parecen tener un beneficio significativo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>&#46; Dado que los protocolos ERAS abarcan un conjunto de intervenciones&#44; la cuesti&#243;n fundamental es saber cu&#225;les deben incluirse&#46; Estas decisiones suponen un gran reto en la era de la medicina perioperatoria individualizada<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#44; sobre todo porque dependen de diferentes criterios en un grupo heterog&#233;neo de pacientes&#46; Sobre todo&#44; el beneficio de un protocolo ERAS debe responder a una cuesti&#243;n espec&#237;fica en el grupo de pacientes concreto&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los ERAS han dado lugar a mejoras significativas en los resultados postoperatorios entre varias especialidades quir&#250;rgicas&#44; aunque todav&#237;a hay muchos elementos con poca evidencia &#40;por ejemplo&#44; biomarcadores&#44; <span class="elsevierStyleItalic">machine learning</span>&#44; terapias analg&#233;sicas alternativas&#41;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> y algunos objetivos siguen sin abordarse<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#46; La lesi&#243;n renal aguda &#40;LRA&#41; es un objetivo controvertido&#44; que se ha abordado a trav&#233;s de diferentes intervenciones&#44; incluidos los protocolos de fluidoterapia dirigida por objetivos &#40;GDFT&#41; y&#44; sin embargo&#44; estudios recientes destacan un aumento preocupante de las tasas de LRA tras la implantaci&#243;n de los programas de recuperaci&#243;n intensificada&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los programas ERAS pretenden responder a la siguiente pregunta&#58; &#191;La aplicaci&#243;n de un conjunto de medidas perioperatorias disminuye la duraci&#243;n de la estancia hospitalaria y la morbilidad postoperatoria en los pacientes que se someten a una intervenci&#243;n quir&#250;rgica dentro de estos programas frente a un enfoque tradicional&#63; En lo que respecta a los pacientes sometidos a cirug&#237;a colorrectal&#44; la respuesta general es afirmativa<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#44; aunque la respuesta correcta puede ser m&#225;s dif&#237;cil&#46; En primer lugar&#44; muchas de las intervenciones incluidas en una menci&#243;n son demasiado generales para abordar de forma exhaustiva los problemas postoperatorios espec&#237;ficos<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#46; Recientemente&#44; Hollis y Kennedy se&#241;alaron que los programas de ERAS podr&#237;an aumentar ciertas complicaciones postoperatorias<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a>&#44; incluida la LRA postoperatoria<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#46; Dependiendo de la definici&#243;n utilizada&#44; la incidencia de la LRA var&#237;a enormemente&#46; Con la introducci&#243;n del sistema de clasificaci&#243;n unificado <span class="elsevierStyleItalic">Kidney Disease&#58; Improving Global Outcomes</span> &#40;KDIGO&#41;&#44; los estudios observacionales han demostrado que incluso peque&#241;os aumentos de la creatinina o disminuciones de la diuresis pueden repercutir significativamente en la morbilidad y la duraci&#243;n de la estancia<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a>&#44; mientras que la clasificaci&#243;n <span class="elsevierStyleItalic">Risk&#44; Injury&#44; Failure&#44; Loss&#44; and End-Stage Renal Disease</span> &#40;RIFLE&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> tiende a subestimar la incidencia de la LRA&#46; Varios estudios han arrojado resultados controvertidos en cuanto a la relaci&#243;n entre la ERAS y la LRA&#46; Por ejemplo&#44; Horres et al&#46; no encontraron una asociaci&#243;n entre los programas de LRA y ERAS utilizando la clasificaci&#243;n RIFLE<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a>&#44; pero estudios posteriores han indicado una asociaci&#243;n significativa&#44; especialmente cuando se utiliza la clasificaci&#243;n KDIGO<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Tras agrupar estos estudios en un reciente metaan&#225;lisis realizado por Zorrilla-Vaca et al&#46;&#44; los autores demostraron que los programas ERAS tienden a presentar tasas significativamente m&#225;s altas de LRA postoperatoria&#44; lo que hace temer un posible aumento de la mortalidad a largo plazo<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#46; Esto nos lleva a la pregunta de &#191;por qu&#233; una intervenci&#243;n destinada a mejorar los resultados &#40;ERAS&#41; empeora la funci&#243;n renal&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">No hay una respuesta corta ni f&#225;cil a esta pregunta&#46; En primer lugar&#44; la dogmatizaci&#243;n de los protocolos de ERAS ha dado lugar a la aplicaci&#243;n sistem&#225;tica de diversas intervenciones sin un enfoque claro de estratificaci&#243;n basada en el riesgo&#44; algunas de ellas sobrevaloradas&#44; y otras probadas fuera de los escenarios de investigaci&#243;n&#44; porque los programas ERAS no mejoran necesariamente los resultados en entornos del &#171;mundo real&#187; debido a la falta de cumplimiento suficiente de los protocolos<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Tanto la hipo- como la hipervolemia se asocian a mayores tasas de complicaciones postoperatorias<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">16&#44;17</span></a>&#44; por lo que las recomendaciones ERAS pueden conllevar el riesgo de desviar una estrategia de l&#237;quidos perioperatoria hacia uno de estos dos extremos opuestos cuando no se administran con cautela<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#46; Las recomendaciones iniciales se construyeron sobre la base de una matriz que consideraba los factores de riesgo quir&#250;rgicos y del paciente&#46; El llamado &#171;equilibrio cero&#187; se recomienda para los pacientes con bajo riesgo de complicaciones postoperatorias&#44; mientras que la optimizaci&#243;n del volumen de fluido &#40;VS&#41; para los pacientes y&#47;o procedimientos de alto riesgo<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se han comparado diferentes estrategias de fluidos en t&#233;rminos de resultados renales postoperatorios&#46; Brandstrup et al&#46; demostraron en un estudio de escasa potencia que la terapia de balance cero era comparable a la GDFT en funci&#243;n de los par&#225;metros hemodin&#225;micos<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a>&#46; En cambio&#44; un estudio reciente demostr&#243; que la LRA era significativamente mayor en el grupo de terapia de fluidos con balance cero en comparaci&#243;n con el grupo con GDFT &#40;21&#44;4&#37; frente a 13&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;040&#41; tras cirug&#237;a de c&#225;ncer colorrectal en un entorno ERAS<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a>&#46; El estudio RELIEF demostr&#243; que un enfoque restrictivo aumenta la incidencia de LRA postoperatoria en comparaci&#243;n con una estrategia liberal de fluidos<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#44; por lo que algunos autores recomiendan un balance global positivo de 1-2 litros<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#46; Esta recomendaci&#243;n puede apoyar la generalizaci&#243;n err&#243;nea de estrategias liberales en lugar de una fluidoterapia individualizada&#46; Probablemente el mensaje para el cl&#237;nico deber&#237;a ser hacia el fomento de la realizaci&#243;n de una GDFT&#44; ya que un r&#233;gimen de fluidoterapia restrictivo&#44; que no deber&#237;a implicar un balance de l&#237;quidos negativo&#44; no es la soluci&#243;n para nuestros pacientes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Conviene aclarar que las recomendaciones sobre la administraci&#243;n perioperatoria de fluidos no deben tomarse como <span class="elsevierStyleItalic">&#171;one size fits all&#187;</span><a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;24</span></a> y una mala interpretaci&#243;n de las mismas puede llevar a errores en la pr&#225;ctica diaria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Aunque se ha demostrado que la GDFT disminuye las complicaciones en los pacientes de alto riesgo<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#44; existen resultados controvertidos dentro de la ERAS debido a muchas razones &#40;por ejemplo&#44; euvolemia preoperatoria&#44; reducci&#243;n de la respuesta inflamatoria&#41;&#46; No obstante&#44; todos tienen en com&#250;n que los pacientes con hipotensi&#243;n y&#47;o bajo gasto card&#237;aco tienen un mayor riesgo de LRA postoperatoria<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">26&#44;27</span></a>&#46; Hay evidencia s&#243;lida que demuestra que los pacientes con niveles adecuados de presi&#243;n arterial y gasto card&#237;aco tienen una menor incidencia de LRA<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">28&#44;29</span></a>&#46; Los estudios sin diferencias entre los grupos control e intervenci&#243;n tampoco presentaron diferencias en la incidencia de LRA postoperatoria<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; Se cree que un bajo cumplimiento de los protocolos de ERAS est&#225; directamente relacionado con una menor adherencia de los algoritmos hemodin&#225;micos&#44; lo que conlleva una mayor variabilidad en la administraci&#243;n de fluidos intraoperatorios y un mayor riesgo de resultados adversos a nivel renal<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">30&#44;31</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la fisiopatolog&#237;a que conduce a la LRA postoperatoria&#44; parece l&#243;gico aplicar protocolos hemodin&#225;micos adaptados al paciente<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a>&#46; El estudio INPRESS subraya este aspecto y demuestra con &#233;xito que la individualizaci&#243;n es una soluci&#243;n razonable&#46; Los autores concluyeron que la incidencia de LRA postoperatoria se reduce significativamente &#40;riesgo relativo 0&#44;70&#59; IC del 95&#37;&#58; 0&#44;53 a 0&#44;92&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; cuando se utiliza una estrategia de tratamiento individualizada &#40;es decir&#44; mantener una presi&#243;n arterial sist&#243;lica perioperatoria dentro de un intervalo del 10&#37; del valor basal&#44; junto con una optimizaci&#243;n del flujo y del volumen sist&#243;lico&#41;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; Adem&#225;s&#44; la disminuci&#243;n de la duraci&#243;n de la hipotensi&#243;n perioperatoria tambi&#233;n reduce la incidencia de IRA postoperatoria<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a>&#46; Hatib et al&#46; desarrollaron un algoritmo que utiliza el aprendizaje autom&#225;tico para predecir la duraci&#243;n de la hipotensi&#243;n&#44; conocido como &#205;ndice de Predicci&#243;n de Hipotensi&#243;n &#40;HPI&#41;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a>&#46; El estudio HYPE demostr&#243; recientemente que la utilizaci&#243;n de HPI&#44; junto con un algoritmo de optimizaci&#243;n hemodin&#225;mica&#44; reduce la gravedad y la duraci&#243;n de la hipotensi&#243;n intraoperatoria<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&#46; Este enfoque proactivo parece prevenir los per&#237;odos de hipotensi&#243;n que pueden conducir a la hipoperfusi&#243;n y a la LRA&#44; aunque se necesita m&#225;s evidencia para aclarar su impacto cl&#237;nico&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Dado que la mayor&#237;a de los protocolos del ERAS no contemplan las recomendaciones espec&#237;ficas para los pacientes de alto riesgo&#44; se suele subestimar la importancia de la LRA postoperatoria<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#44; por lo que a&#250;n no est&#225; claro qu&#233; serie de medidas pueden ayudar a prevenir esta complicaci&#243;n&#46; En el contexto del ERAS&#44; hay dos opciones posibles&#58; &#40;1&#41; considerar a todos los pacientes como pacientes de alto riesgo de LRA&#44; y generalizar la aplicaci&#243;n de los paquetes para reducir la IRA&#44; o &#40;2&#41; aplicar los paquetes adecuados individualmente a los pacientes de alto riesgo de IRA&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El estudio BigPAK pretend&#237;a comprobar el beneficio del paquete de medidas KDIGO &#40;es decir&#44; interrupci&#243;n de todos los agentes neurot&#243;xicos cuando sea posible&#44; optimizaci&#243;n de la volemia y hemodin&#225;mica&#44; consideraci&#243;n de la monitorizaci&#243;n hemodin&#225;mica funcional&#44; monitorizaci&#243;n estrecha de la creatinina s&#233;rica y la diuresis&#44; evitar la hiperglucemia y considerar alternativas a los agentes de radiocontraste&#41;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> en un subgrupo de pacientes con alto riesgo de LRA identificados por niveles elevados de dos nuevos biomarcadores de estr&#233;s &#40;&#91;TIMP-2&#93;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#91;IGFBP7&#93;&#41; en el per&#237;odo postoperatorio temprano&#46; En el grupo de pacientes con estr&#233;s renal&#44; la incidencia de LRA se redujo significativamente &#91;27&#44;1&#37; de intervenci&#243;n frente al 48&#37; de control&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#93;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&#46; Bas&#225;ndose en estos resultados&#44; se puede dar un paso m&#225;s y preguntarse por qu&#233; debemos esperar al per&#237;odo postoperatorio&#44; si los pacientes con alto riesgo de LRA podr&#237;an identificarse f&#225;cilmente antes de la cirug&#237;a y las directrices KDIGO podr&#237;an aplicarse desde el principio&#46; Es l&#243;gico que se apliquen las medidas KDIGO a todos los pacientes con riesgo de LRA&#44; en lugar de esperar a que aparezca el da&#241;o renal o la lesi&#243;n renal&#44; ya que ambos se asocian a peores resultados<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a las v&#237;as de ERAS&#44; los biomarcadores de estr&#233;s podr&#237;an utilizarse de varias formas<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#44; ya sea para la identificaci&#243;n temprana de pacientes con alto riesgo de LRA o para guiar terapias de fluidos&#47;f&#225;rmacos inmediatamente despu&#233;s de la cirug&#237;a&#46; La evidencia favorece los paquetes KDIGO como elemento de seguridad en casos de niveles altos de biomarcadores&#46; Los pacientes con niveles bajos de biomarcadores en el postoperatorio inmediato podr&#237;an ser candidatos en los que las medidas perioperatorias complejas de los programas ERAS podr&#237;an implementarse de forma segura &#40;es decir&#44; administraci&#243;n de f&#225;rmacos no esteroideos&#44; fluidoterapia de &#171;equilibrio cero&#187;&#41; para facilitar el alta temprana<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los programas de recuperaci&#243;n intensificada se consideran la mejor pr&#225;ctica perioperatoria y deben aplicarse de forma integral para lograr mejores resultados en los pacientes&#59; sin embargo&#44; bas&#225;ndonos en las pruebas resumidas anteriormente y en las alarmantes tasas de LRA notificadas en los programas de ERAS&#44; animamos a aplicar los paquetes KDIGO junto con la GDFT en los pacientes con alto riesgo de LRA en entornos de ERAS&#46;</p></span>"
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                      "titulo" => "Enhanced recovery after surgery society guidelines for perioperative care in elective colonic surgery&#58; Enhanced Recovery After Surgery &#40;ERAS&#174;&#41; Society recommendations"
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                            3 => "N&#46; Demartines"
                            4 => "D&#46; Roulin"
                            5 => "N&#46; Francis"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23099039"
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                      "titulo" => "Guidelines for perioperative care in elective colorectal surgery&#58; Enhanced Recovery After Surgery &#40;ERAS&#174;&#41; Society Recommendations&#58; 2018"
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                            5 => "N&#46; Francis"
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                        "tituloSerie" => "World J Surg&#46;"
                        "fecha" => "2019"
                        "volumen" => "43"
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                        "paginaFinal" => "695"
                        "link" => array:1 [
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                      "titulo" => "Committed to be fit&#46; The value of preoperative care in the perioperative medicine era"
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                            0 => "J&#46; Ripolles-Melchor"
                            1 => "F&#46; Carli"
                            2 => "M&#46; Coca-Martinez"
                            3 => "M&#46; Barbero-Mielgo"
                            4 => "J&#46;M&#46; Ramirez-Rodriguez"
                            5 => "J&#46;A&#46; Garcia-Erce"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
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                      "doi" => "10.23736/S0375-9393.18.12286-3"
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                        "tituloSerie" => "Minerva Anestesiol&#46;"
                        "fecha" => "2018"
                        "volumen" => "84"
                        "paginaInicial" => "615"
                        "paginaFinal" => "625"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29444561"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "The enhanced recovery after surgery &#40;ERAS&#41; pathway for patients undergoing major elective open colorectal surgery&#58; a meta-analysis of randomized controlled trials"
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                            2 => "C&#46;H&#46;C&#46; Dejong"
                            3 => "K&#46;C&#46;H&#46; Fearon"
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                            5 => "D&#46;N&#46; Lobo"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2010.01.004"
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                        "tituloSerie" => "Clin Nutr&#46;"
                        "fecha" => "2010"
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                      "titulo" => "Enhanced recovery protocols for colorectal surgery and postoperative renal function&#58; a retrospective review"
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                    0 => array:2 [
                      "titulo" => "KDIGO clinical practice guidelines for acute kidney injury"
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                        "tituloSerie" => "Nephron Clin Pract&#46;"
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                        "paginaInicial" => "c179"
                        "paginaFinal" => "c184"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22890468"
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                      "titulo" => "Enhanced recovery after surgery&#58; Moving toward best practice"
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                        "fecha" => "2021"
                        "volumen" => "7"
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                    0 => array:2 [
                      "titulo" => "Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery &#40;ERAS&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                      ]
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                      "titulo" => "Perioperative fluid therapy for major surgery"
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                        0 => array:2 [
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                            3 => "T&#46; Godet"
                            4 => "E&#46; Lorne"
                            5 => "P&#46; Cuvillon"
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                    ]
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                        "paginaInicial" => "1346"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Variability in practice and factors predictive of total crystalloid administration during abdominal surgery&#58; retrospective two-centre analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Lilot"
                            1 => "J&#46;M&#46; Ehrenfeld"
                            2 => "C&#46; Lee"
                            3 => "B&#46; Harrington"
                            4 => "M&#46; Cannesson"
                            5 => "J&#46; Rinehart"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Br J Anaesth&#46;"
                        "fecha" => "2015"
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                        "paginaInicial" => "767"
                        "paginaFinal" => "776"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25586725"
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                          ]
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                    0 => array:2 [
                      "titulo" => "Intraoperative crystalloid utilization variability and association with postoperative outcomes&#58; A post hoc analysis of two multicenter prospective cohort studies"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "C&#46; Aldecoa"
                            2 => "E&#46; Alday-Mu&#241;oz"
                            3 => "S&#46; Del R&#237;o"
                            4 => "A&#46; Batalla"
                            5 => "E&#46; Del-Cojo-Peces"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.redar.2020.10.011"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanim&#46;"
                        "fecha" => "2021"
                        "volumen" => "68"
                        "paginaInicial" => "373"
                        "paginaFinal" => "383"
                      ]
                    ]
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                      "titulo" => "Relationship between intraoperative hypotension defined by either reduction from baseline or absolute thresholds&#44; and acute kidney and myocardial injury after noncardiac surgery&#58; a retrospective cohort analysis"
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                        0 => array:2 [
                          "etal" => true
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                            0 => "V&#46; Salmasi"
                            1 => "K&#46; Maheshwari"
                            2 => "D&#46; Yang"
                            3 => "E&#46;J&#46; Mascha"
                            4 => "A&#46; Singh"
                            5 => "D&#46;I&#46; Sessler"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "Anesthesiology&#46;"
                        "fecha" => "2017"
                        "volumen" => "126"
                        "paginaInicial" => "47"
                        "paginaFinal" => "65"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27792044"
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                          "issn" => "00333506"
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                    0 => array:2 [
                      "titulo" => "Machine-learning algorithm to predict hypotension based on high-fidelity arterial pressure waveform analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Hatib"
                            1 => "Z&#46; Jian"
                            2 => "S&#46; Buddi"
                            3 => "C&#46; Lee"
                            4 => "J&#46; Settels"
                            5 => "K&#46; Sibert"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29894315"
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                      "titulo" => "Effect of a machine learning-derived early warning system for intraoperative hypotension vs standard care on depth and duration of intraoperative hypotension during elective noncardiac surgery&#58; The HYPE randomized clinical trial"
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                        0 => array:2 [
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                            3 => "N&#46; Lemmers"
                            4 => "M&#46;P&#46; Mulder"
                            5 => "P&#46; Berge"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "fecha" => "2020 17"
                        "volumen" => "323"
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                        "paginaFinal" => "1060"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32065827"
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                      "titulo" => "Caution&#58; Increased acute kidney injury in enhanced recovery after surgery &#40;ERAS&#41; protocols"
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                          "etal" => false
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                            1 => "A&#46;G&#46; Lopez-Aguiar"
                            2 => "M&#46; Zaidi"
                            3 => "S&#46; Speegle"
                            4 => "G&#46; Balch"
                            5 => "V&#46;O&#46; Shaffer"
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                      ]
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                        "fecha" => "2019"
                        "volumen" => "85"
                        "paginaInicial" => "156"
                        "paginaFinal" => "161"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30819291"
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                    ]
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              "etiqueta" => "36"
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                    0 => array:2 [
                      "titulo" => "Kidney disease&#58; Improving global outcomes &#40;KDIGO&#41; acute kidney injury work group KDIGO clinical practice guideline for acute kidney injury"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                    ]
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                        "tituloSerie" => "Ann Intern Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "158"
                        "paginaInicial" => "825"
                        "paginaFinal" => "830"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23732715"
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                    ]
                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "Biomarker-guided intervention to prevent acute kidney injury after major surgery&#58; the prospective randomized BigpAK study"
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                            4 => "B&#46; Jung"
                            5 => "F&#46; Zeman"
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                        "tituloSerie" => "Ann Surg&#46;"
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                        "volumen" => "267"
                        "paginaInicial" => "1013"
                        "paginaFinal" => "1020"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28857811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "Tissue inhibitor metalloproteinase-2 &#40;TIMP-2&#41; &#8226; IGF-binding protein-7 &#40;IGFBP7&#41; levels are associated with adverse outcomes in patients in the intensive care unit with acute kidney injury"
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                            4 => "A&#46; Passannante"
                            5 => "A&#46; Breglia"
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                        ]
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                      "titulo" => "Potential use of biomarkers in acute kidney injury&#58; Report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference"
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                            4 => "Z&#46; Endre"
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                        ]
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                      "titulo" => "Using urinary biomarkers to reduce acute kidney injury following cardiac surgery"
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                            4 => "B&#46;H&#46; Nathanson"
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