Share
array:23 [ "pii" => "S2341192923000938" "issn" => "23411929" "doi" => "10.1016/j.redare.2022.08.009" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "1473" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:368-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935623000877" "issn" => "00349356" "doi" => "10.1016/j.redar.2022.08.001" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "1473" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Rev Esp Anestesiol Reanim. 2023;70:368-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Desigualdad ventilatoria en quirófano. Diferencias de género en las pautas de ventilación mecánica intraoperatorias" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "368" "paginaFinal" => "369" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ventilatory inequality in the operating room. Gender differences in intraoperative mechanical ventilation guidelines" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Matías Aguilera, E. Alday Muñoz, J.L. Muñoz de Nova, A. Planas Roca" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Matías Aguilera" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Alday Muñoz" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Muñoz de Nova" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Planas Roca" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192923000938" "doi" => "10.1016/j.redare.2022.08.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000938?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623000877?idApp=UINPBA00004N" "url" => "/00349356/0000007000000006/v2_202309140845/S0034935623000877/v2_202309140845/es/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S234119292300094X" "issn" => "23411929" "doi" => "10.1016/j.redare.2023.06.001" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "1472" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:367-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Security and efficiency of health care models based on anesthetist nursing: Time to move on" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "367" "paginaFinal" => "368" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad y eficacia de los modelos asistenciales basados en enfermería de anestesia: <span class="elsevierStyleItalic">time to move on</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Dieguez, A. Goma, E. Rivas, G. Martinez-Palli" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Dieguez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Goma" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rivas" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Martinez-Palli" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623000865" "doi" => "10.1016/j.redar.2022.07.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623000865?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292300094X?idApp=UINPBA00004N" "url" => "/23411929/0000007000000006/v3_202310300659/S234119292300094X/v3_202310300659/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Ventilatory inequality in the operating room. Gender differences in intraoperative mechanical ventilation guidelines" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "368" "paginaFinal" => "369" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Matías Aguilera, E. Alday Muñoz, J.L. Muñoz de Nova, A. Planas Roca" "autores" => array:4 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Matías Aguilera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "E." "apellidos" => "Alday Muñoz" "email" => array:1 [ 0 => "kikealday@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J.L." "apellidos" => "Muñoz de Nova" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Planas Roca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cirugía General y del Aparato Digestivo, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desigualdad ventilatoria en quirófano. Diferencias de género en las pautas de ventilación mecánica intraoperatorias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the context of a recent dissertation, we performed a cross-sectional observational study that analysed the extent to which anaesthesiologists from a tertiary University Hospital adhere to the consensus-based recommendations on intraoperative mechanical ventilation (MV) published in 2019 by Young et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to these guidelines, patients should initially be ventilated using a tidal volume (Vt) of 6–8 ml kg predicted body weight, PEEP ≥ 5 cm H2O and FiO<span class="elsevierStyleInf">2</span> ≤ 0.6, and alveolar recruitment manoeuvres (ARM) should be performed in case of hypoxaemia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">After obtaining the informed consent of the treating anaesthesiologist, we collected data during anaesthesia maintenance in the operating room. We recorded the ventilator settings and collected patient data from their clinical history and anaesthesia chart. We used the <span class="elsevierStyleItalic">ARDSNet</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> protocol to calculate weight: men: 50 + 0.91 × (height in cm - 152.4); women: 45.5 + 0.91 × (height in cm - 152.4).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committees of the Hospital Universitario La Princesa.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The estimated sample size was 65 patients (95% confidence level, 10% precision, and 50% estimated adherence, which maximized the sample size).</p><p id="par0025" class="elsevierStylePara elsevierViewall">We recruited a total of 73 patients (42 men and 31 women), and found a 50% rate of adherence to recommendations (95% CI 39–61). In 40% of patients, lack of adherence was due to the programmed Vt exceeding 8 ml/kg of predicted weight. Significantly, 71% of women in the sample were ventilated with Vt > 8 ml/kg compared to 16% of men, showing that women were 3 times more likely to be ventilated using a higher-than-recommended Vt. Regarding the other parameters analysed, Vt > 8 ml/kg was also more likely to be used in obese (body mass index > 30) patients, although this difference was not statistically significant, and recommendations were more likely to be followed when an anaesthesiology resident was present in the operating room (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Our results show the existence of gender inequality in the application of lung protective recommendations in intraoperative MV.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Swart et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> also found differences between the Vt used in men and women admitted to intensive care units. In their prospective observational study, they analysed MV Vt settings in in critically ill patients from 2001 to 2015, and found that the Vt used gradually decreased over time, although the use of Vt < 8 ml/kg increased from 12% to 78% in men and from 5% to only 50% in women.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Low Vt ventilation (6−8 ml/kg of predicted weight) is the cornerstone of lung protective ventilation. According to Severgnini et al.,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> low Vt together with PEEP ≥ 5 or adjusted for ARM can reduce systemic and local inflammation, the rate of postoperative pulmonary complications, and hospital length of stay. Our results show that women are at higher risk of overventilation-related perioperative injury for several reasons:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0045" class="elsevierStylePara elsevierViewall">First, the default Vt setting on anaesthesia ventilators is 500 ml, which means ventilating female patients measuring least 171 cm in height with a Vt of 8 ml/kg of predicted weight, and overventilating any female patient under this height. According to the Spanish <span class="elsevierStyleItalic">National Statistics Institute</span> (<span class="elsevierStyleItalic">INE,</span> in its Spanish acronym),<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the average height of women in Europe is 163 cm, and 85% of women are under 171 cm tall.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0050" class="elsevierStylePara elsevierViewall">Secondly, the recommended <span class="elsevierStyleItalic">ARDSNet</span> protocol for calculating predicted weight is complex and infeasible in normal practice, unless it is built into the ventilator. Formulas based directly on height, subtracting 100 or 110 cm depending on sex, are useful in our opinion, since in most patients they correlate with the <span class="elsevierStyleItalic">ARSDNet</span> formula, except in women measuring under 150 cm and in men measuring over 190 cm.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0055" class="elsevierStylePara elsevierViewall">Finally, according to the <span class="elsevierStyleItalic">European Health Survey 2020 in Spain</span>,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> 16.5% of men and 15.5% of women have a BMI > 30. In these patients, the use of actual weight to calculate intraoperative Vt will increase the risk of overventilation in both men and women.</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">In view of the results obtained, we believe that adherence to recommendations for intraoperative MV can be improved by:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1</span><p id="par0065" class="elsevierStylePara elsevierViewall">Raising awareness of existing gender differences in order to promote the practice of calculating Vt based on predicted weight.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2</span><p id="par0070" class="elsevierStylePara elsevierViewall">Encouraging ventilator manufacturers to factor in gender and height in addition to age and weight in their automatic calculation of Vt settings. The interface can also report Vt based on predicted weight, including an alarm.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3</span><p id="par0075" class="elsevierStylePara elsevierViewall">Reduce default Vt to 400 ml on ventilators. Based on the foregoing calculations and the average height according to the INE, this would reduce the percentage of women at risk of being ventilated with Vt greater than 8 ml/kg from 85% to less than 15%.</p></li></ul></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vt 6–8 ml/kg \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vt > 8 ml/kg \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><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="elsevierStyleItalic">Sex n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.63−5.06 \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="elsevierStyleItalic">Obesity n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>BMI < 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>BMI > 30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86−3.13 \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="elsevierStyleItalic">Resident n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.01−2.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3319989.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Factors related to Vt > 8 ml/kg.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.C. Young" 1 => "E.M. Harris" 2 => "C. Vacchiano" 3 => "S. Bodnar" 4 => "B. Bukowy" 5 => "R.R.D. Elliot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bja.2019.08.017" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth." "fecha" => "2019" "volumen" => "123" "paginaInicial" => "898" "paginaFinal" => "913" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31587835" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.G. Brower" 1 => "M.A. Matthay" 2 => "A. Morris" 3 => "D. Schoenfeld" 4 => "B.T. Thompson" 5 => "A. Wheeler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200005043421801" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2000" "volumen" => "342" "paginaInicial" => "1301" "paginaFinal" => "1308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients. A mediation analysis using two observational cohorts" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Swart" 1 => "R.O. Deliberato" 2 => "A.E.W. Johnson" 3 => "T.J. Pollard" 4 => "L. Bulgarelli" 5 => "P. Pelosi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0253933" "Revista" => array:3 [ "tituloSerie" => "PLoS ONE." "fecha" => "2021" "volumen" => "16" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilación protectora en anestesia general. ¿Algo nuevo?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Severgnini" 1 => "A. Bacuzzi" 2 => "L. Guzzetti" 3 => "G. Selmo" 4 => "L. Peluso" 5 => "M. Chiaranda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim." "fecha" => "2018" "volumen" => "65" "paginaInicial" => "218" "paginaFinal" => "224" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Instituto Nacional de Estadística (INE), 1999. Adultos por edad, sexo y estatura <a target="_blank" href="https://www.ine.es/jaxi/Datos.htm?path=/t25/p442/histo/a1999/&file=02082.px">https://www.ine.es/jaxi/Datos.htm?path=/t25/p442/histo/a1999/&file=02082.px</a>." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad. Centro de publicaciones, 2020. Encuesta Europea de Salud en España (EESE). <a target="_blank" href="http://EESE2020_inf_evol_princip_result.pdf.(sanidad.gob.es)">EESE2020_inf_evol_princip_result.pdf.(sanidad.gob.es)</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000006/v3_202310300659/S2341192923000938/v3_202310300659/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000006/v3_202310300659/S2341192923000938/v3_202310300659/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000938?idApp=UINPBA00004N" ]
