Protective ventilation in general anesthesia. Anything new? | Revista Española de Anestesiología y Reanimación (English Edition)

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(A) Hypertensive peak, with BP of 279/122mmHg during tumour manipulation and the start of clevidipine administration, increasing gradually to 8mg/h, and normalising BP after 5min. (B) Start of clevidipine down-dosing 5min after clamping. (C) Point at which clevidipine perfusion was suspended. (D) New hypertensive peak when placing the patient in the supine position at the end of the surgery. Clevidipine was immediately restarted at 2mg/h, which was maintained up to 30min after transfer of the patient to the PACU." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Luis-García, E. Arbonés-Aran, C. Teixell-Aleu, L. Lorente-Poch, L. Trillo-Urrutia" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Luis-García" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Arbonés-Aran" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Teixell-Aleu" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Lorente-Poch" ] 4 => array:2 [ "nombre" => "L." 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The manoeuvre is performed in pressure control mode with a fixed driving pressure of 15cmH2O, and with 5cmH2O increments in PEEP. The most commonly used parameters are: respiratory rate of 20bpm in adults and 30bpm in children; FiO2 remains unchanged except in the case of desaturation; the I:E ratio remains unchanged. Three breaths are delivered at each step, 5–10 breaths are delivered at the point of maximum pressure. Once opening pressure has been reached, the ventilator can be switched to volume control with a tidal volume of 6ml/kg, or pressure control can be maintained, with a driving pressure of 10cmH2O. PEEP is then gradually reduced to a level at which maximum dynamic compliance is achieved and/or the lowest driving pressure. A second opening manoeuvre is performed, and PEEP is set at the lowest level for optimal Cdyn and the lowest driving pressure." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. García-Fernández, A. Romero, A. Blanco, P. Gonzalez, A. 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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "218" "paginaFinal" => "224" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Severgnini, A. Bacuzzi, L. Guzzetti, G. Selmo, L. Peluso, M. Chiaranda" "autores" => array:6 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Severgnini" "email" => array:1 [ 0 => "paolo.severgnini@uninsubria.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Bacuzzi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Guzzetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Selmo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "L." "apellidos" => "Peluso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Chiaranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Biotechnology and Sciences of Life, University of Insubria, Anesthesia and Intensive Care, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Anesthesia, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Biotechnology and Sciences of Life, University of Insubria, Cardiac Anesthesia and Cardio-surgical Intensive Care, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ventilación protectora en anestesia general. ¿Algo nuevo?" ] ] "textoCompleto" => "IntroductionAnaesthesia management now plays a key role in guaranteeing a high standard of patient care, and an integrated multidisciplinary approach in the perioperative period is the pillar of “Enhanced Recovery After Surgery” (ERAS) protocols.<a class="elsevierStyleCrossRefs" href="#bib0425">1,2</a> ERAS protocols are characterised by a series of key procedures along a continuum of care, starting with the preoperative evaluation and ending with discharge, including the surgical, anaesthesiology, nursing and rehabilitation teams.In this context, the importance of anaesthesia management has increased, and an appropriate mechanical ventilation strategy<a class="elsevierStyleCrossRef" href="#bib0435">3</a> in the operating room reduces the incidence of postoperative pulmonary complications (PPCs).<a class="elsevierStyleCrossRef" href="#bib0440">4</a>Around 230 million surgeries are performed worldwide each year, with a morbidity rate of 3–16% (7,020,000–37,440,000 patients), and a mortality rate of 0.4–0.8% (936,000–1,872,000 patients).<a class="elsevierStyleCrossRef" href="#bib0445">5</a>Thoracic surgery, major abdominal surgery, neurosurgery and vascular surgery have the highest rate of post-operative morbidity/mortality.<a class="elsevierStyleCrossRef" href="#bib0450">6</a> About 5% of surgical patients develop PPCs, of whom 9–40% undergo major abdominal surgery.<a class="elsevierStyleCrossRefs" href="#bib0445">5,7</a> PPCs increase the risk of short-term mortality.<a class="elsevierStyleCrossRef" href="#bib0460">8</a> In particular, early re-intubation for respiratory failure before the third postoperative day increases the risk of intra-hospital death.<a class="elsevierStyleCrossRef" href="#bib0465">9</a>Below, we discuss protective ventilation strategies in general anaesthesia, focusing on the physiopathological basis of PPCs and the safest approach to ventilator management.Postoperative pulmonary complicationsPPCs, which occur within 5–7 days after surgery, include several physiopathological entities, such as respiratory failure, pneumonia, prolonged mechanical ventilation or unexpected re-intubation, hypoxia, atelectasis, bronchospasm, pleural effusion and respiratory depression.<a class="elsevierStyleCrossRefs" href="#bib0470">10–13</a> Due to their impact on surgical outcomes, it is important to identify the risk factors for PPCs and to take all possible preventive measures. In 2006, the American College of Physicians published a systematic review of the literature relating to PPC risk factors,<a class="elsevierStyleCrossRef" href="#bib0490">14</a> and since then other studies have contributed more updated findings.<a class="elsevierStyleCrossRef" href="#bib0440">4</a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the risk factors for the development of PPCs.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>About 50% of the risk factors in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> are attributable to the patient's conditions, while the remaining 50% are related to surgical and anaesthesia procedures.<a class="elsevierStyleCrossRef" href="#bib0480">12</a> The ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score evaluates 7 independent risk factors, and a score of more than 26 indicates a high or intermediate risk for developing PPCs. Recently, ARISCAT has been validated by the PERISCOPE study (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlication in Europe study),<a class="elsevierStyleCrossRef" href="#bib0460">8</a> which assessed the ability of the score to discriminate 3 different levels of PPCs (low, intermediate, high). Currently, ARISCAT is the best tool for predicting PPCs in surgical patients.Physiopathological mechanismMechanical ventilation can induce an inflammatory response<a class="elsevierStyleCrossRef" href="#bib0495">15</a> and may interact synergistically with the surgery-induced inflammatory response. This amplified inflammatory cascade contributes to the subsequent pulmonary damage, which is can be followed by systemic multi-organ failure.<a class="elsevierStyleCrossRefs" href="#bib0500">16,17</a>General anaesthesia and mechanical ventilation promote the development of atelectasis and a specific restrictive syndrome.<a class="elsevierStyleCrossRefs" href="#bib0510">18,19</a> In vitro and in vivo studies have revealed that conventional high-volume ventilation (10–15ml/kg) is associated with clinically relevant pulmonary damage.<a class="elsevierStyleCrossRefs" href="#bib0500">16,20</a> The damage is mediated by various mechanisms, including mechanical trauma directed against pneumocytes (barotrauma), hyperinflation (volutrauma), and “shear stress” due to cyclic de-recruitment (atelectrauma) of the pulmonary areas in proximity to the atelectasis areas. A combination of these 3 types of trauma causes the shift from mechanical stimuli to biochemical response by releasing of cytokines and pro-inflammatory mediators that are harmful to the alveolar epithelium and the vascular endothelium (biotrauma).<a class="elsevierStyleCrossRefs" href="#bib0525">21,22</a>During general anaesthesia, the coexistence of de-recruited and recruited alveolar regions exposes the lungs to the deleterious effects of mechanical ventilation forces.<a class="elsevierStyleCrossRefs" href="#bib0535">23,24</a> The ventilation forces in some lung regions may exceed the lung's innate elasticity, even though pressure values are within physiological limits.<a class="elsevierStyleCrossRefs" href="#bib0545">25–28</a> Air inflation into the de-recruited area could cause alveolar impairment due to cyclic inflation and collapse.<a class="elsevierStyleCrossRef" href="#bib0565">29</a> In addition, volutrauma, barotrauma and atelectrauma promote the fragmentation of the extracellular pulmonary matrix.<a class="elsevierStyleCrossRefs" href="#bib0570">30–33</a> Such damage, caused by high tidal volumes, predisposes to interstitial oedema and the activation of inflammatory factors. Fluid overload during major surgical procedures could increase this interstitial oedema by diluting inflammatory mediators and down-regulating the inflammatory process.<a class="elsevierStyleCrossRefs" href="#bib0580">32–36</a>All these mechanical stimuli activate complex cellular signalling pathways<a class="elsevierStyleCrossRefs" href="#bib0605">37,38</a> and the immunological consequences culminate in “biotrauma”.<a class="elsevierStyleCrossRef" href="#bib0615">39</a> In addition, both the endothelial<a class="elsevierStyleCrossRefs" href="#bib0620">40,41</a> and the epithelial<a class="elsevierStyleCrossRef" href="#bib0630">42</a> compartments of the alveolo-capillary units are stressed by mechanical ventilation forces. High volume causes changes in alveolar epithelium permeability and low tidal volume creates a cyclic collapse/re-opening of the lung with negative consequences, leading to cell death.<a class="elsevierStyleCrossRefs" href="#bib0635">43–46</a> Changes in the epithelial and alveolar barriers, together with alveolar fluid, lead to interstitial and alveolar oedema and changes in the lung elastance due to impaired surfactant secretion.<a class="elsevierStyleCrossRef" href="#bib0655">47</a> Surfactant is essential to avoid alveolar collapse and protect against the deterioration of respiratory mechanics and inflammation.<a class="elsevierStyleCrossRef" href="#bib0660">48</a> Changes in the alveolar-capillary membrane with translocation of pathogens generates the substrate that transforms pulmonary damage into a systemic inflammatory process involving other organs.<a class="elsevierStyleCrossRef" href="#bib0500">16</a>Physiopathological mechanism of pulmonary damage induced by anaesthesia ventilationVentilation-induced lung injury (VILI) is a complex syndrome that originates from various stimuli acting on type I and II pneumocytes, endothelial cells, macrophages and the extracellular matrix.<a class="elsevierStyleCrossRef" href="#bib0665">49</a> These forces derive from stress (forces per unit area) and strain (forces along a longitudinal axis) and are able cause direct damage to the alveolar-capillary membrane and the extracellular matrix. High tidal volume with increased transpulmonary pressure at the level of the extracellular matrix causes a release of metalloproteinases due to changes in glycosaminoglycans, particularly at tidal volumes ≥16ml/kg.<a class="elsevierStyleCrossRef" href="#bib0670">50</a>Therefore, VILI is determined by 5 inter-related mechanisms in short-term ventilation<a class="elsevierStyleCrossRef" href="#bib0675">51</a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(1)Lung overdistension;</li><li class="elsevierStyleListItem" id="lsti0010">(2)Anatomical changes in stressed pulmonary areas;</li><li class="elsevierStyleListItem" id="lsti0015">(3)Abrasion of the alveolar epithelium, particularly in low volume ventilation, due to cyclic closing and opening of alveoli subjected to atelectasis phenomena;</li><li class="elsevierStyleListItem" id="lsti0020">(4)Surfactant alteration due to the generation of inactive aggregates related to high alveolar surface oscillations;</li><li class="elsevierStyleListItem" id="lsti0025">(5)Increased intracellular stress forces derived from the alteration of the extracellular matrix interface.</li></ul>Therefore, VILI could be described as the parenchymal response to the application of physical force.<a class="elsevierStyleCrossRefs" href="#bib0680">52–54</a> In VILI, the primary alteration is oedema that (1) reduces lung size,<a class="elsevierStyleCrossRef" href="#bib0695">55</a> (2) increases parenchymal inhomogeneity, (3) multiplies stress<a class="elsevierStyleCrossRef" href="#bib0700">56</a> and facilitates the negative effect of cyclic collapse-reopening.<a class="elsevierStyleCrossRefs" href="#bib0705">57,58</a>The “Mechanical Power” conceptRecently, Gattinoni et al.<a class="elsevierStyleCrossRef" href="#bib0680">52</a> described a single physical variable called “mechanical power”. This variable is the sum of all the causes of VILI presented as an equation.The “mechanical power” equation describes the contribution of mechanical ventilation to the onset or worsening of VILI: tidal volume, respiratory rate, ΔPaw, PEEP, I:E ratio, flow rate.The equation gives considerable weight to lung compliance as a major contributor to VILI, and also considers the double effect of PEEP. In fact, mechanical power increases linearly with PEEP, while PEEP may reduce lung inhomogeneity and alveolar reopening.Finally, mechanical power emphasises the importance of the respiratory rate, a factor that is often neglected.Reducing the magnitude of each component of the mechanical energy equation could reduce the risk of VILI.Ancient and new: protective ventilation from intensive care to the operating roomIn recent years, “protective ventilation”, previously confined to intensive care, has been introduced into the operating room. Historically, the concept of protective ventilation was developed in the treatment of patients with acute respiratory distress syndrome. During ventilation, some pulmonary areas receive most of the tidal volume, causing hyperinflation and over-distension of the alveolar wall, while areas of atelectasis are subjected to recurrent collapse and re-opening, causing “shear stress” and mechanical damage to the alveolar walls.<a class="elsevierStyleCrossRefs" href="#bib0715">59,60</a> In this context, protective mechanical ventilation could reduce VILI. Following these observations, some trials have confirmed the usefulness of protective strategies in short-term ventilation in healthy lungs.<a class="elsevierStyleCrossRefs" href="#bib0725">61–63</a> During general anaesthesia, the reduction of lung expiratory volume (functional residual capacity) and the increase in closed airway volume<a class="elsevierStyleCrossRef" href="#bib0740">64</a> contribute to the formation of atelectasis. The main PPC is atelectasis, which is the primary cause of pneumonia and shunt-related respiratory failure.<a class="elsevierStyleCrossRef" href="#bib0745">65</a>Effectiveness of protective mechanical ventilation in the operating room: scientific evidenceNumerous randomised clinical trials with different primary outcome measures<a class="elsevierStyleCrossRefs" href="#bib0750">66–81</a> have been conducted over the past 15 years. These trials have shown that protective ventilation is associated with low levels of systemic and local inflammatory factors. Recent clinical trials have evaluated the length of hospital stay, the incidence of atelectasis and postoperative respiratory complications, the re-intubation rate, and postoperative pulmonary function. Specifically, authors have investigated tidal volumes between 6 and 8ml/kg with PEEP values of 6 and 12cmH2O. These trials have reported a lower incidence of PPC, shorter hospital stay, a lower incidence of radiographic abnormalities and improved post-operative oxygenation in patients treated with protective ventilation. In a recent randomised trial,<a class="elsevierStyleCrossRef" href="#bib0805">77</a> we compared protective ventilation with recruitment manoeuvres (RM) against conventional techniques using tidal volumes of between 9 and 12ml/kg and zero PEEP (ZEEP). The PROVHILO trial<a class="elsevierStyleCrossRef" href="#bib0795">75</a> compared 2 groups of patients, 1 with high PEEP (12cmH2O) and RMs, and the other with PEEP set at 2cmH2O without RMs; the tidal volume in both patient groups was 8ml/kg. The results of this trial suggest that a low tidal volume associated with RMs are more important than PEEP for lung protection during the intraoperative period.Summary of scientific evidenceThe exclusive use of low tidal volumes does not reduce the incidence of PPCs. Alveolar recruitment and PEEP are the key elements of a protective ventilation strategy. RMs are useful for initial alveolar recruitment, while PEEP prevents alveolar collapse and atelectasis. However, PEEP levels should be low enough to avoid haemodynamic changes. Ladha et al.,<a class="elsevierStyleCrossRef" href="#bib0830">82</a> in a retrospective analysis of a large database of 69,265 patients, reported a low incidence of respiratory complications in patients treated with protective ventilation with PEEP values >5cmH2O and tidal volume <10ml/kg (predicted body weight) to obtain a plateau pressure of less than 30cmH2O (plateau pressure threshold identified as safe for acute respiratory distress syndrome, but not for healthy lungs in anaesthesia scenarios). Multivariate analysis showed that low PEEP pressure and moderate PEEP values were associated with a better outcome. Surprisingly, no tidal volume effects have been reported, and the role of high tidal volume is expressed by an increase in plateau pressure, closely related to pulmonary compliance. The incidence of PPCs increased when plateau pressure exceeded 16cmH2O, suggesting that the pulmonary damage threshold in healthy lungs during general anaesthesia could be lower than expected. This new evidence introduced the concept of “driving pressure”, expressed as the difference between plateau pressure and PEEP level. Recently, Serpa Neto et al. showed that reductions in driving pressure were significantly associated with a reduced incidence of postoperative pulmonary complications.<a class="elsevierStyleCrossRef" href="#bib0835">83</a>Summarising, current evidence suggests that mechanical ventilation during general anaesthesia should include:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">(1)Low tidal volume values, 6–8ml/kg of predicted body weight;</li><li class="elsevierStyleListItem" id="lsti0035">(2)Maintain plateau pressure less than 16cmH2O;</li><li class="elsevierStyleListItem" id="lsti0040">(3)Low PEEP levels, equal to or less than 5cmH2O, ensuring a driving pressure of 13cmH2O or less;</li><li class="elsevierStyleListItem" id="lsti0045">(4)PEEP values between 5 and 10cmH2O should be considered in patients with a body mass index greater than 35kg/m2, patients undergoing laparoscopic surgery in the Trendelenburg position, and in surgical procedures lasting more than 4h.</li></ul>Intraoperative desaturation can be corrected by increasing FIO2 to 70% and then performing periodic recruitment manoeuvres. However, considering all the above, an individualised approach is recommended; every effort must be made to ensure acceptable gas exchange, using tidal volumes, respiratory rate and flow rate and avoiding high driving pressures.<a class="elsevierStyleCrossRef" href="#bib0840">84</a>ConclusionDuring surgical procedures, complex physiopathological mechanisms cause mechanical ventilation-induced pulmonary damage. Following the success of protective ventilation in the management of ARDS patients in the intensive care setting, the concept was introduced into anaesthesia management to improve quality of care.Numerous randomised trials, prospective studies and reviews have showed the benefit of protective ventilation in preventing PPCs. The latest evidences highlight the importance of using low tidal volumes and moderate PEEP levels during intraoperative ventilation, while carefully monitoring the driving pressure and plateau pressure.Further studies into pre- and postoperative ventilation management could give greater insight into the benefits of these strategies.Conflict of interestThe authors declare that there is no conflict of interest regarding the publication of this article." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Postoperative pulmonary complications" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Physiopathological mechanism" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Physiopathological mechanism of pulmonary damage induced by anaesthesia ventilation" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "The “Mechanical Power” concept" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Ancient and new: protective ventilation from intensive care to the operating room" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Effectiveness of protective mechanical ventilation in the operating room: scientific evidence" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Summary of scientific evidence" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-14" "fechaAceptado" => "2017-08-23" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Severgnini P, Bacuzzi A, Guzzetti L, Selmo G, Peluso L, Chiaranda M. Ventilación protectora en anestesia general. ¿Algo nuevo? Rev Esp Anestesiol Reanim. 2018;65:218–224." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "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="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PPC risk variables in logistic regression model</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risk score \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Age (yr)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">51–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Preoperative SpO2, %</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">91–95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory infection in the last month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative anaemia (≤10g/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Surgical incision</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Upper abdominal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intrathoracic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Duration of surgery, h</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≤2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>2–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency procedure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">RISK CLASS, risk score (pulmonary complication rate)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><26 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intermediate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26–44 (13.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>44 (42.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1727294.png" ] ] ] ] "descripcion" => array:1 [ "en" => "The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk score." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:84 [ 0 => array:3 [ "identificador" => "bib0425" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based surgical care and the evolution of fast-track surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Kehlet" 1 => "D.W. Wilmore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31817f2c1a" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2008" "volumen" => "248" "paginaInicial" => "189" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650627" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0430" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful recovery after major surgery: moving beyond length of stay" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.E. Miller" 1 => "M. Mythen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Perioper Med (Lond)" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "4" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0435" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Yang" 1 => "M.C. Grant" 2 => "A. Stone" 3 => "C.L. Wu" 4 => "E.C. Wick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0000000000001443" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2016" "volumen" => "263" "paginaInicial" => "881" "paginaFinal" => "887" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26720429" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0440" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Güldner" 1 => "T. Kiss" 2 => "A. Serpa Neto" 3 => "S.N. Hemmes" 4 => "J. Canet" 5 => "P.M. Spieth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000000754" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2015" "volumen" => "123" "paginaInicial" => "692" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26120769" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0445" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An estimation of the global volume of surgery: a modelling strategy based on available data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.G. Weiser" 1 => "S.E. Regenbogen" 2 => "K.D. Thompson" 3 => "A.B. Haynes" 4 => "S.R. Lipsitz" 5 => "W.R. Berry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(08)60878-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2008" "volumen" => "372" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18582931" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0450" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.G. Noordzij" 1 => "D. Poldermans" 2 => "O. Schouten" 3 => "J.J. Bax" 4 => "F.A. Schreiner" 5 => "E. Boersma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181d5f95c" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2010" "volumen" => "112" "paginaInicial" => "1105" "paginaFinal" => "1115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418691" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0455" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of pulmonary complications after elective abdominal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.A. Lawrence" 1 => "R. Dhanda" 2 => "S.G. Hilsenbeck" 3 => "C.P. Page" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1996" "volumen" => "110" "paginaInicial" => "744" "paginaFinal" => "750" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8797421" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0460" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective external validation of a predictive score for postoperative pulmonary complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Mazo" 1 => "S. Sabaté" 2 => "J. Canet" 3 => "L. Gallart" 4 => "M.G. de Abreu" 5 => "J. Belda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000000334" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2014" "volumen" => "121" "paginaInicial" => "219" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24901240" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0465" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of a score for prediction of postoperative respiratory complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Brueckmann" 1 => "J.L. Villa-Uribe" 2 => "B.T. Bateman" 3 => "M. Grosse-Sundrup" 4 => "D.R. Hess" 5 => "C.L. Schlett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e318293065c" "Revista" => array:7 [ "tituloSerie" => "Anesthesiology" "fecha" => "2013" "volumen" => "118" "paginaInicial" => "1276" "paginaFinal" => "1285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571640" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1474442215002021" "estado" => "S300" "issn" => "14744422" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0470" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting postoperative pulmonary complications in the general population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Canet" 1 => "L. Gallart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e32835e8acd" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "107" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23407154" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0475" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM); Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Jammer" 1 => "N. Wickboldt" 2 => "M. Sander" 3 => "A. Smith" 4 => "M.J. Schultz" 5 => "P. Pelosi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0000000000000118" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2015" "volumen" => "32" "paginaInicial" => "88" "paginaFinal" => "105" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25058504" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0480" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ARISCAT Group Prediction of postoperative pulmonary complications in a population-based surgical cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Canet" 1 => "L. Gallart" 2 => "C. Gomar" 3 => "G. Paluzie" 4 => "J. Vallès" 5 => "J. Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181fc6e0a" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2010" "volumen" => "113" "paginaInicial" => "1338" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045639" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0485" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative respiratory failure: pathogenesis, prediction, and prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Canet" 1 => "L. Gallart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000045" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "56" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24240985" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0490" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American College of Physicians Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.W. Smetana" 1 => "V.A. Lawrence" 2 => "J.E. Cornell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2006" "volumen" => "144" "paginaInicial" => "581" "paginaFinal" => "595" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16618956" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0495" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.M. Ranieri" 1 => "P.M. Suter" 2 => "C. Tortorella" 3 => "R. De Tullio" 4 => "J.M. Dayer" 5 => "A. Brienza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "1999" "volumen" => "282" "paginaInicial" => "54" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10404912" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0500" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Imai" 1 => "J. Parodo" 2 => "O. Kajikawa" 3 => "M. de Perrot" 4 => "S. Fischer" 5 => "V. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.289.16.2104" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2003" "volumen" => "289" "paginaInicial" => "2104" "paginaFinal" => "2112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12709468" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0505" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical ventilation and hemorrhagic shock-resuscitation interact to increase inflammatory cytokine release in rats" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Bouadma" 1 => "D. Dreyfuss" 2 => "J.D. Ricard" 3 => "G. Martet" 4 => "G. Saumon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000286398.78243.CE" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "2601" "paginaFinal" => "2606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17828032" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0510" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atelectasis in the perioperative patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Duggan" 1 => "B.P. Kavanagh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e328011d7e5" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "37" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17211165" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0515" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Hedenstierna" 1 => "A. Strandberg" 2 => "B. Brismar" 3 => "H. Lundquist" 4 => "L. Svensson" 5 => "L. Tokics" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1985" "volumen" => "62" "paginaInicial" => "247" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3977112" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0520" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Lellouche" 1 => "S. Dionne" 2 => "S. Simard" 3 => "J. Bussières" 4 => "F. Dagenais" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3182522df5" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2012" "volumen" => "116" "paginaInicial" => "1072" "paginaFinal" => "1082" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22450472" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0525" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extracellular matrix and mechanical ventilation in healthy lungs: back to baro/volotrauma?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Pelosi" 1 => "D. Negrini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e3282f25162" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "16" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195621" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0530" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protect the lungs during abdominal surgery: it may change the postoperative outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.F. Melo" 1 => "M. Eikermann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3182910309" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2013" "volumen" => "118" "paginaInicial" => "1254" "paginaFinal" => "1257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23535504" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0535" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of airway wall compliance on epithelial cell injury and adhesion during interfacial flows" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Higuita-Castro" 1 => "C. Mihai" 2 => "D.J. Hansford" 3 => "S.N. Ghadiali" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "2014" "volumen" => "117" "paginaInicial" => "1231" "paginaFinal" => "1242" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0540" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress distribution in lungs: a model of pulmonary elasticity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Mead" 1 => "T. Takishima" 2 => "D. Leith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/jappl.1970.28.5.596" "Revista" => array:6 [ "tituloSerie" => "J Appl Physiol" "fecha" => "1970" "volumen" => "28" "paginaInicial" => "596" "paginaFinal" => "608" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5442255" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0545" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.M. Needham" 1 => "E. Colantuoni" 2 => "P.A. Mendez-Tellez" 3 => "V.D. Dinglas" 4 => "J.E. Sevransky" 5 => "C.R. Dennison Himmelfarb" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "344" "paginaInicial" => "e2124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22491953" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0550" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ARDS Clinical Trials Network Tidal volume reduction in patients with acute lung injury when plateau pressures are not high" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.N. Hager" 1 => "J.A. Krishnan" 2 => "D.L. Hayden" …1 ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200501-048CP" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2005" "volumen" => "172" "paginaInicial" => "1241" "paginaFinal" => "1245" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S1526590013009103" "estado" => "S300" "issn" => "15265900" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0555" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200710-1589OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2008" "volumen" => "178" "paginaInicial" => "346" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0560" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung stress and strain during mechanical ventilation: any safe threshold?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201010-1757OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "183" "paginaInicial" => "1354" "paginaFinal" => "1362" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0565" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cyclic stretch-induced oxidative stress increases pulmonary alveolar epithelial permeability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1165/rcmb.2012-0252OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Cell Mol Biol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "156" "paginaFinal" => "164" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0570" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajplung.00437.2012" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol" "fecha" => "2013" "volumen" => "305" "paginaInicial" => "L478" "paginaFinal" => "L484" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0575" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epithelial and endothelial damage induced by mechanical ventilation modes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000043" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "17" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0580" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proteoglycan fragmentation and respiratory mechanics in mechanically ventilated healthy rats" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "2007" "volumen" => "103" "paginaInicial" => "747" "paginaFinal" => "756" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0585" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of respiratory pattern on lung mechanics and interstitial proteoglycans in spontaneously breathing anaesthetized healthy rats" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Physiol (Oxf)" "fecha" => "2011" "volumen" => "203" "paginaInicial" => "331" "paginaFinal" => "341" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0590" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of mechanical ventilation on the extracellular matrix" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-007-0964-9" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "631" "paginaFinal" => "639" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0595" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of proteoglycans in pulmonary edema development" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-007-0962-y" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2008" "volumen" => "34" "paginaInicial" => "610" "paginaFinal" => "618" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0600" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of mechanical ventilation and fluid load on pulmonary glycosaminoglycans" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resp.2012.03.013" "Revista" => array:6 [ "tituloSerie" => "Respir Physiol Neurobiol" "fecha" => "2012" "volumen" => "181" "paginaInicial" => "308" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0605" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanotransduction in the lungs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2014" "volumen" => "80" "paginaInicial" => "933" "paginaFinal" => "941" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0610" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathophysiology of ventilator-associated lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e32834f8c7f" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "123" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0615" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation-induced lung injury and mechanotransduction: stretching it too far?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajplung.00124.2001" "Revista" => array:6 [ "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol" "fecha" => "2002" "volumen" => "282" "paginaInicial" => "L892" "paginaFinal" => "L896" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0620" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung edema caused by high peak inspiratory pressures in dogs. Role of increased microvascular filtration pressure and permeability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm/142.2.321" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1990" "volumen" => "142" "paginaInicial" => "321" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0625" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress failure in pulmonary capillaries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "1991" "volumen" => "70" "paginaInicial" => "1731" "paginaFinal" => "1742" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0630" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of stretch on tight junction structure in alveolar epithelial cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1165/ajrcmb.25.5.4486" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Cell Mol Biol" "fecha" => "2001" "volumen" => "25" "paginaInicial" => "584" "paginaFinal" => "591" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0635" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung inflation, lung solute permeability, and alveolar edema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ …1] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/jappl.1982.53.1.121" "Revista" => array:6 [ "tituloSerie" => "J Appl Physiol Respir Environ Exerc Physiol" "fecha" => "1982" "volumen" => "53" "paginaInicial" => "121" "paginaFinal" => "125" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0640" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased surface tension favors pulmonary edema formation in anesthetized dogs’ lungs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI109369" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "1979" "volumen" => "63" "paginaInicial" => "1015" "paginaFinal" => "1018" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0645" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma membrane disruptions with different modes of injurious mechanical ventilation in normal rat lungs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318232da2b" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "869" "paginaFinal" => "875" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0650" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytokine release, small airway injury, and parenchymal damage during mechanical ventilation in normal open-chest rats" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "2008" "volumen" => "104" "paginaInicial" => "41" "paginaFinal" => "49" ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0655" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regulation and repair of the alveolar-capillary barrier in acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev-physiol-030212-183756" "Revista" => array:6 [ "tituloSerie" => "Annu Rev Physiol" "fecha" => "2013" "volumen" => "75" "paginaInicial" => "593" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0660" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The biophysical function of pulmonary surfactant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resp.2008.05.018" "Revista" => array:6 [ "tituloSerie" => "Respir Physiol Neurobiol" "fecha" => "2008" "volumen" => "163" "paginaInicial" => "244" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0665" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invited review: mechanisms of ventilator-induced lung injury: a perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Physiol (1985)" "fecha" => "2000" "volumen" => "89" "paginaInicial" => "1645" "paginaFinal" => "1655" ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0670" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in proteoglycans and lung tissue mechanics during excessive mechanical ventilation in rats" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1152/ajplung.2001.281.5.L1078" "Revista" => array:7 [ "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol" "fecha" => "2001" "volumen" => "281" "paginaInicial" => "L1078" "paginaFinal" => "L1087" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S014067360961922X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0675" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms of ventilator-induced lung injury in healthy lungs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bpa.2015.08.004" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Anaesthesiol" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "301" "paginaFinal" => "313" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0680" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilator-related causes of lung injury: the mechanical power" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4505-2" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "1567" "paginaFinal" => "1575" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0685" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of decreased respiratory frequency on ventilator-induced lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.161.2.9811008" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2000" "volumen" => "161" "paginaInicial" => "463" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0690" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power and development of ventilator-induced lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000001056" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2016" "volumen" => "124" "paginaInicial" => "1100" "paginaFinal" => "1108" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0695" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm/136.3.730" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1987" "volumen" => "136" "paginaInicial" => "730" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0700" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung inhomogeneity in patients with acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201308-1567OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2014" "volumen" => "189" "paginaInicial" => "149" "paginaFinal" => "158" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0705" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.151.6.7767524" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1995" "volumen" => "151" "paginaInicial" => "1807" "paginaFinal" => "1814" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0710" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ …4] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1172/JCI119259" "Revista" => array:6 [ "tituloSerie" => "J Clin Invest" "fecha" => "1997" "volumen" => "99" "paginaInicial" => "944" "paginaFinal" => "952" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0715" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilator-induced lung injury: from the bench to the bedside" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-005-2817-8" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2006" "volumen" => "32" "paginaInicial" => "24" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0720" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilatory support for acute respiratory failure: new and ongoing pathophysiological, diagnostic and therapeutic developments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e32833500bc" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2010" "volumen" => "16" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0725" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Anesthesiology" "fecha" => "2006" "volumen" => "105" "paginaInicial" => "689" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ …2] ] "itemHostRev" => array:3 [ "pii" => "S0967586809007243" "estado" => "S300" "issn" => "09675868" ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0730" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.anes.0000296068.80921.10" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2008" "volumen" => "108" "paginaInicial" => "46" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 62 => array:3 [ "identificador" => "bib0735" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2005.10.007" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "889" "paginaFinal" => "895" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0740" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway closure: the silent killer of peripheral airways" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc5692" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2007" "volumen" => "11" "paginaInicial" => "114" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0745" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noninvasive respiratory support in the perioperative period" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ …2] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e328335daec" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "233" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 65 => array:3 [ "identificador" => "bib0750" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2004" "volumen" => "98" "paginaInicial" => "775" "paginaFinal" => "781" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 66 => array:3 [ "identificador" => "bib0755" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/01.ane.0000172112.02902.77" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2005" "volumen" => "101" "paginaInicial" => "957" "paginaFinal" => "965" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 67 => array:3 [ "identificador" => "bib0760" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2006" "volumen" => "105" "paginaInicial" => "911" "paginaFinal" => "919" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 68 => array:3 [ "identificador" => "bib0765" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aep319" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2010" "volumen" => "104" "paginaInicial" => "16" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 69 => array:3 [ "identificador" => "bib0770" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of the lung protective ventilatory strategy on proinflammatory cytokine release during one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ai Zheng" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "870" "paginaFinal" => "873" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 70 => array:3 [ "identificador" => "bib0775" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aer415" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2012" "volumen" => "108" "paginaInicial" => "517" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 71 => array:3 [ "identificador" => "bib0780" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-003-2104-5" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2004" "volumen" => "30" "paginaInicial" => "620" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 72 => array:3 [ "identificador" => 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Protective ventilation in general anesthesia. Anything new?

Ventilación protectora en anestesia general. ¿Algo nuevo?

P. Severgninia,

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paolo.severgnini@uninsubria.it

Corresponding author.

, A. Bacuzzib, L. Guzzettib, G. Selmob, L. Pelusoc, M. Chiarandac

a Department of Biotechnology and Sciences of Life, University of Insubria, Anesthesia and Intensive Care, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

b Department of Anesthesia, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

c Department of Biotechnology and Sciences of Life, University of Insubria, Cardiac Anesthesia and Cardio-surgical Intensive Care, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anaesthesia management now plays a key role in guaranteeing a high standard of patient care&#44; and an integrated multidisciplinary approach in the perioperative period is the pillar of &#8220;Enhanced Recovery After Surgery&#8221; &#40;ERAS&#41; protocols&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">1&#44;2</span></a> ERAS protocols are characterised by a series of key procedures along a continuum of care&#44; starting with the preoperative evaluation and ending with discharge&#44; including the surgical&#44; anaesthesiology&#44; nursing and rehabilitation teams&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this context&#44; the importance of anaesthesia management has increased&#44; and an appropriate mechanical ventilation strategy<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">3</span></a> in the operating room reduces the incidence of postoperative pulmonary complications &#40;PPCs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Around 230 million surgeries are performed worldwide each year&#44; with a morbidity rate of 3&#8211;16&#37; &#40;7&#44;020&#44;000&#8211;37&#44;440&#44;000 patients&#41;&#44; and a mortality rate of 0&#46;4&#8211;0&#46;8&#37; &#40;936&#44;000&#8211;1&#44;872&#44;000 patients&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Thoracic surgery&#44; major abdominal surgery&#44; neurosurgery and vascular surgery have the highest rate of post-operative morbidity&#47;mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">6</span></a> About 5&#37; of surgical patients develop PPCs&#44; of whom 9&#8211;40&#37; undergo major abdominal surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">5&#44;7</span></a> PPCs increase the risk of short-term mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">8</span></a> In particular&#44; early re-intubation for respiratory failure before the third postoperative day increases the risk of intra-hospital death&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Below&#44; we discuss protective ventilation strategies in general anaesthesia&#44; focusing on the physiopathological basis of PPCs and the safest approach to ventilator management&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Postoperative pulmonary complications</span><p id="par0030" class="elsevierStylePara elsevierViewall">PPCs&#44; which occur within 5&#8211;7 days after surgery&#44; include several physiopathological entities&#44; such as respiratory failure&#44; pneumonia&#44; prolonged mechanical ventilation or unexpected re-intubation&#44; hypoxia&#44; atelectasis&#44; bronchospasm&#44; pleural effusion and respiratory depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0470"><span class="elsevierStyleSup">10&#8211;13</span></a> Due to their impact on surgical outcomes&#44; it is important to identify the risk factors for PPCs and to take all possible preventive measures&#46; In 2006&#44; the American College of Physicians published a systematic review of the literature relating to PPC risk factors&#44;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">14</span></a> and since then other studies have contributed more updated findings&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the risk factors for the development of PPCs&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">About 50&#37; of the risk factors in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> are attributable to the patient&#39;s conditions&#44; while the remaining 50&#37; are related to surgical and anaesthesia procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">12</span></a> The ARISCAT &#40;Assess Respiratory Risk in Surgical Patients in Catalonia&#41; score evaluates 7 independent risk factors&#44; and a score of more than 26 indicates a high or intermediate risk for developing PPCs&#46; Recently&#44; ARISCAT has been validated by the PERISCOPE study &#40;Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlication in Europe study&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">8</span></a> which assessed the ability of the score to discriminate 3 different levels of PPCs &#40;low&#44; intermediate&#44; high&#41;&#46; Currently&#44; ARISCAT is the best tool for predicting PPCs in surgical patients&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Physiopathological mechanism</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mechanical ventilation can induce an inflammatory response<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">15</span></a> and may interact synergistically with the surgery-induced inflammatory response&#46; This amplified inflammatory cascade contributes to the subsequent pulmonary damage&#44; which is can be followed by systemic multi-organ failure&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">General anaesthesia and mechanical ventilation promote the development of atelectasis and a specific restrictive syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">18&#44;19</span></a> In vitro and in vivo studies have revealed that conventional high-volume ventilation &#40;10&#8211;15<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#41; is associated with clinically relevant pulmonary damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">16&#44;20</span></a> The damage is mediated by various mechanisms&#44; including mechanical trauma directed against pneumocytes &#40;barotrauma&#41;&#44; hyperinflation &#40;volutrauma&#41;&#44; and &#8220;shear stress&#8221; due to cyclic de-recruitment &#40;atelectrauma&#41; of the pulmonary areas in proximity to the atelectasis areas&#46; A combination of these 3 types of trauma causes the shift from mechanical stimuli to biochemical response by releasing of cytokines and pro-inflammatory mediators that are harmful to the alveolar epithelium and the vascular endothelium &#40;biotrauma&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">21&#44;22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">During general anaesthesia&#44; the coexistence of de-recruited and recruited alveolar regions exposes the lungs to the deleterious effects of mechanical ventilation forces&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">23&#44;24</span></a> The ventilation forces in some lung regions may exceed the lung&#39;s innate elasticity&#44; even though pressure values are within physiological limits&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">25&#8211;28</span></a> Air inflation into the de-recruited area could cause alveolar impairment due to cyclic inflation and collapse&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">29</span></a> In addition&#44; volutrauma&#44; barotrauma and atelectrauma promote the fragmentation of the extracellular pulmonary matrix&#46;<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">30&#8211;33</span></a> Such damage&#44; caused by high tidal volumes&#44; predisposes to interstitial oedema and the activation of inflammatory factors&#46; Fluid overload during major surgical procedures could increase this interstitial oedema by diluting inflammatory mediators and down-regulating the inflammatory process&#46;<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">32&#8211;36</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">All these mechanical stimuli activate complex cellular signalling pathways<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">37&#44;38</span></a> and the immunological consequences culminate in &#8220;biotrauma&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">39</span></a> In addition&#44; both the endothelial<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">40&#44;41</span></a> and the epithelial<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">42</span></a> compartments of the alveolo-capillary units are stressed by mechanical ventilation forces&#46; High volume causes changes in alveolar epithelium permeability and low tidal volume creates a cyclic collapse&#47;re-opening of the lung with negative consequences&#44; leading to cell death&#46;<a class="elsevierStyleCrossRefs" href="#bib0635"><span class="elsevierStyleSup">43&#8211;46</span></a> Changes in the epithelial and alveolar barriers&#44; together with alveolar fluid&#44; lead to interstitial and alveolar oedema and changes in the lung elastance due to impaired surfactant secretion&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">47</span></a> Surfactant is essential to avoid alveolar collapse and protect against the deterioration of respiratory mechanics and inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">48</span></a> Changes in the alveolar-capillary membrane with translocation of pathogens generates the substrate that transforms pulmonary damage into a systemic inflammatory process involving other organs&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Physiopathological mechanism of pulmonary damage induced by anaesthesia ventilation</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ventilation-induced lung injury &#40;VILI&#41; is a complex syndrome that originates from various stimuli acting on type I and II pneumocytes&#44; endothelial cells&#44; macrophages and the extracellular matrix&#46;<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">49</span></a> These forces derive from stress &#40;forces per unit area&#41; and strain &#40;forces along a longitudinal axis&#41; and are able cause direct damage to the alveolar-capillary membrane and the extracellular matrix&#46; High tidal volume with increased transpulmonary pressure at the level of the extracellular matrix causes a release of metalloproteinases due to changes in glycosaminoglycans&#44; particularly at tidal volumes &#8805;16<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46;<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">50</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Therefore&#44; VILI is determined by 5 inter-related mechanisms in short-term ventilation<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">51</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Lung overdistension&#59;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Anatomical changes in stressed pulmonary areas&#59;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Abrasion of the alveolar epithelium&#44; particularly in low volume ventilation&#44; due to cyclic closing and opening of alveoli subjected to atelectasis phenomena&#59;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Surfactant alteration due to the generation of inactive aggregates related to high alveolar surface oscillations&#59;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Increased intracellular stress forces derived from the alteration of the extracellular matrix interface&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">Therefore&#44; VILI could be described as the parenchymal response to the application of physical force&#46;<a class="elsevierStyleCrossRefs" href="#bib0680"><span class="elsevierStyleSup">52&#8211;54</span></a> In VILI&#44; the primary alteration is oedema that &#40;1&#41; reduces lung size&#44;<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">55</span></a> &#40;2&#41; increases parenchymal inhomogeneity&#44; &#40;3&#41; multiplies stress<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">56</span></a> and facilitates the negative effect of cyclic collapse-reopening&#46;<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">57&#44;58</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">The &#8220;Mechanical Power&#8221; concept</span><p id="par0105" class="elsevierStylePara elsevierViewall">Recently&#44; Gattinoni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">52</span></a> described a single physical variable called &#8220;mechanical power&#8221;&#46; This variable is the sum of all the causes of VILI presented as an equation&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The &#8220;mechanical power&#8221; equation describes the contribution of mechanical ventilation to the onset or worsening of VILI&#58; tidal volume&#44; respiratory rate&#44; &#916;P<span class="elsevierStyleInf">aw</span>&#44; PEEP&#44; I&#58;E ratio&#44; flow rate&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The equation gives considerable weight to lung compliance as a major contributor to VILI&#44; and also considers the double effect of PEEP&#46; In fact&#44; mechanical power increases linearly with PEEP&#44; while PEEP may reduce lung inhomogeneity and alveolar reopening&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally&#44; mechanical power emphasises the importance of the respiratory rate&#44; a factor that is often neglected&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Reducing the magnitude of each component of the mechanical energy equation could reduce the risk of VILI&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Ancient and new&#58; protective ventilation from intensive care to the operating room</span><p id="par0130" class="elsevierStylePara elsevierViewall">In recent years&#44; &#8220;protective ventilation&#8221;&#44; previously confined to intensive care&#44; has been introduced into the operating room&#46; Historically&#44; the concept of protective ventilation was developed in the treatment of patients with acute respiratory distress syndrome&#46; During ventilation&#44; some pulmonary areas receive most of the tidal volume&#44; causing hyperinflation and over-distension of the alveolar wall&#44; while areas of atelectasis are subjected to recurrent collapse and re-opening&#44; causing &#8220;shear stress&#8221; and mechanical damage to the alveolar walls&#46;<a class="elsevierStyleCrossRefs" href="#bib0715"><span class="elsevierStyleSup">59&#44;60</span></a> In this context&#44; protective mechanical ventilation could reduce VILI&#46; Following these observations&#44; some trials have confirmed the usefulness of protective strategies in short-term ventilation in healthy lungs&#46;<a class="elsevierStyleCrossRefs" href="#bib0725"><span class="elsevierStyleSup">61&#8211;63</span></a> During general anaesthesia&#44; the reduction of lung expiratory volume &#40;functional residual capacity&#41; and the increase in closed airway volume<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">64</span></a> contribute to the formation of atelectasis&#46; The main PPC is atelectasis&#44; which is the primary cause of pneumonia and shunt-related respiratory failure&#46;<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">65</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Effectiveness of protective mechanical ventilation in the operating room&#58; scientific evidence</span><p id="par0135" class="elsevierStylePara elsevierViewall">Numerous randomised clinical trials with different primary outcome measures<a class="elsevierStyleCrossRefs" href="#bib0750"><span class="elsevierStyleSup">66&#8211;81</span></a> have been conducted over the past 15 years&#46; These trials have shown that protective ventilation is associated with low levels of systemic and local inflammatory factors&#46; Recent clinical trials have evaluated the length of hospital stay&#44; the incidence of atelectasis and postoperative respiratory complications&#44; the re-intubation rate&#44; and postoperative pulmonary function&#46; Specifically&#44; authors have investigated tidal volumes between 6 and 8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg with PEEP values of 6 and 12<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#46; These trials have reported a lower incidence of PPC&#44; shorter hospital stay&#44; a lower incidence of radiographic abnormalities and improved post-operative oxygenation in patients treated with protective ventilation&#46; In a recent randomised trial&#44;<a class="elsevierStyleCrossRef" href="#bib0805"><span class="elsevierStyleSup">77</span></a> we compared protective ventilation with recruitment manoeuvres &#40;RM&#41; against conventional techniques using tidal volumes of between 9 and 12<span class="elsevierStyleHsp" style=""></span>ml&#47;kg and zero PEEP &#40;ZEEP&#41;&#46; The PROVHILO trial<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">75</span></a> compared 2 groups of patients&#44; 1 with high PEEP &#40;12<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#41; and RMs&#44; and the other with PEEP set at 2<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O without RMs&#59; the tidal volume in both patient groups was 8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#46; The results of this trial suggest that a low tidal volume associated with RMs are more important than PEEP for lung protection during the intraoperative period&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Summary of scientific evidence</span><p id="par0140" class="elsevierStylePara elsevierViewall">The exclusive use of low tidal volumes does not reduce the incidence of PPCs&#46; Alveolar recruitment and PEEP are the key elements of a protective ventilation strategy&#46; RMs are useful for initial alveolar recruitment&#44; while PEEP prevents alveolar collapse and atelectasis&#46; However&#44; PEEP levels should be low enough to avoid haemodynamic changes&#46; Ladha et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0830"><span class="elsevierStyleSup">82</span></a> in a retrospective analysis of a large database of 69&#44;265 patients&#44; reported a low incidence of respiratory complications in patients treated with protective ventilation with PEEP values &#62;5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O and tidal volume &#60;10<span class="elsevierStyleHsp" style=""></span>ml&#47;kg &#40;predicted body weight&#41; to obtain a plateau pressure of less than 30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O &#40;plateau pressure threshold identified as safe for acute respiratory distress syndrome&#44; but not for healthy lungs in anaesthesia scenarios&#41;&#46; Multivariate analysis showed that low PEEP pressure and moderate PEEP values were associated with a better outcome&#46; Surprisingly&#44; no tidal volume effects have been reported&#44; and the role of high tidal volume is expressed by an increase in plateau pressure&#44; closely related to pulmonary compliance&#46; The incidence of PPCs increased when plateau pressure exceeded 16<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; suggesting that the pulmonary damage threshold in healthy lungs during general anaesthesia could be lower than expected&#46; This new evidence introduced the concept of &#8220;driving pressure&#8221;&#44; expressed as the difference between plateau pressure and PEEP level&#46; Recently&#44; Serpa Neto et al&#46; showed that reductions in driving pressure were significantly associated with a reduced incidence of postoperative pulmonary complications&#46;<a class="elsevierStyleCrossRef" href="#bib0835"><span class="elsevierStyleSup">83</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Summarising&#44; current evidence suggests that mechanical ventilation during general anaesthesia should include&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Low tidal volume values&#44; 6&#8211;8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg of predicted body weight&#59;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Maintain plateau pressure less than 16<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#59;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Low PEEP levels&#44; equal to or less than 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#44; ensuring a driving pressure of 13<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O or less&#59;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0165" class="elsevierStylePara elsevierViewall">PEEP values between 5 and 10<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O should be considered in patients with a body mass index greater than 35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; patients undergoing laparoscopic surgery in the Trendelenburg position&#44; and in surgical procedures lasting more than 4<span class="elsevierStyleHsp" style=""></span>h&#46;</p></li></ul></p><p id="par0170" class="elsevierStylePara elsevierViewall">Intraoperative desaturation can be corrected by increasing F<span class="elsevierStyleInf">I</span>O2 to 70&#37; and then performing periodic recruitment manoeuvres&#46; However&#44; considering all the above&#44; an individualised approach is recommended&#59; every effort must be made to ensure acceptable gas exchange&#44; using tidal volumes&#44; respiratory rate and flow rate and avoiding high driving pressures&#46;<a class="elsevierStyleCrossRef" href="#bib0840"><span class="elsevierStyleSup">84</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0175" class="elsevierStylePara elsevierViewall">During surgical procedures&#44; complex physiopathological mechanisms cause mechanical ventilation-induced pulmonary damage&#46; Following the success of protective ventilation in the management of ARDS patients in the intensive care setting&#44; the concept was introduced into anaesthesia management to improve quality of care&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Numerous randomised trials&#44; prospective studies and reviews have showed the benefit of protective ventilation in preventing PPCs&#46; The latest evidences highlight the importance of using low tidal volumes and moderate PEEP levels during intraoperative ventilation&#44; while carefully monitoring the driving pressure and plateau pressure&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Further studies into pre- and postoperative ventilation management could give greater insight into the benefits of these strategies&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest regarding the publication of this article&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Postoperative pulmonary complications"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Physiopathological mechanism"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Physiopathological mechanism of pulmonary damage induced by anaesthesia ventilation"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "The &#8220;Mechanical Power&#8221; concept"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Ancient and new&#58; protective ventilation from intensive care to the operating room"
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Effectiveness of protective mechanical ventilation in the operating room&#58; scientific evidence"
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Summary of scientific evidence"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflict of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-08-14"
    "fechaAceptado" => "2017-08-23"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Severgnini P&#44; Bacuzzi A&#44; Guzzetti L&#44; Selmo G&#44; Peluso L&#44; Chiaranda M&#46; Ventilaci&#243;n protectora en anestesia general&#46; &#191;Algo nuevo&#63; Rev Esp Anestesiol Reanim&#46; 2018&#59;65&#58;218&#8211;224&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PPC risk variables in logistic regression model</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Risk score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;yr&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>51&#8211;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Preoperative SpO</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#44; &#37;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>91&#8211;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper abdominal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#8211;44 &#40;13&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Assess Respiratory Risk in Surgical Patients in Catalonia &#40;ARISCAT&#41; risk score&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0425"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evidence-based surgical care and the evolution of fast-track surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Kehlet"
                            1 => "D&#46;W&#46; Wilmore"
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                    0 => array:2 [
                      "doi" => "10.1097/SLA.0b013e31817f2c1a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2008"
                        "volumen" => "248"
                        "paginaInicial" => "189"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0430"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful recovery after major surgery&#58; moving beyond length of stay"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;E&#46; Miller"
                            1 => "M&#46; Mythen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Perioper Med &#40;Lond&#41;"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0435"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications&#58; is low tidal volume alone sufficient to protect healthy lungs&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Yang"
                            1 => "M&#46;C&#46; Grant"
                            2 => "A&#46; Stone"
                            3 => "C&#46;L&#46; Wu"
                            4 => "E&#46;C&#46; Wick"
                          ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/SLA.0000000000001443"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2016"
                        "volumen" => "263"
                        "paginaInicial" => "881"
                        "paginaFinal" => "887"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26720429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0440"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "An estimation of the global volume of surgery&#58; a modelling strategy based on available data"
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                            3 => "A&#46;B&#46; Haynes"
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                            5 => "W&#46;R&#46; Berry"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2008"
                        "volumen" => "372"
                        "paginaInicial" => "139"
                        "paginaFinal" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18582931"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative mortality in The Netherlands&#58; a population-based analysis of surgery-specific risk in adults"
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                          "etal" => false
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                            0 => "P&#46;G&#46; Noordzij"
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                            2 => "O&#46; Schouten"
                            3 => "J&#46;J&#46; Bax"
                            4 => "F&#46;A&#46; Schreiner"
                            5 => "E&#46; Boersma"
                          ]
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                        "volumen" => "112"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418691"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Risk of pulmonary complications after elective abdominal surgery"
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                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46;A&#46; Lawrence"
                            1 => "R&#46; Dhanda"
                            2 => "S&#46;G&#46; Hilsenbeck"
                            3 => "C&#46;P&#46; Page"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Chest"
                        "fecha" => "1996"
                        "volumen" => "110"
                        "paginaInicial" => "744"
                        "paginaFinal" => "750"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8797421"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0460"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective external validation of a predictive score for postoperative pulmonary complications"
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                          "autores" => array:6 [
                            0 => "V&#46; Mazo"
                            1 => "S&#46; Sabat&#233;"
                            2 => "J&#46; Canet"
                            3 => "L&#46; Gallart"
                            4 => "M&#46;G&#46; de Abreu"
                            5 => "J&#46; Belda"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0000000000000334"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2014"
                        "volumen" => "121"
                        "paginaInicial" => "219"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24901240"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Development and validation of a score for prediction of postoperative respiratory complications"
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                            1 => "J&#46;L&#46; Villa-Uribe"
                            2 => "B&#46;T&#46; Bateman"
                            3 => "M&#46; Grosse-Sundrup"
                            4 => "D&#46;R&#46; Hess"
                            5 => "C&#46;L&#46; Schlett"
                          ]
                        ]
                      ]
                    ]
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                        "paginaFinal" => "1285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23571640"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting postoperative pulmonary complications in the general population"
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                          "autores" => array:2 [
                            0 => "J&#46; Canet"
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                        "tituloSerie" => "Curr Opin Anaesthesiol"
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                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23407154"
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                    0 => array:2 [
                      "titulo" => "European Society of Anaesthesiology &#40;ESA&#41; and the European Society of Intensive Care Medicine &#40;ESICM&#41;&#59; Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine&#58; European Perioperative Clinical Outcome &#40;EPCO&#41; definitions&#58; a statement from the ESA-ESICM joint taskforce on perioperative outcome measures"
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                            2 => "M&#46; Sander"
                            3 => "A&#46; Smith"
                            4 => "M&#46;J&#46; Schultz"
                            5 => "P&#46; Pelosi"
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                    0 => array:2 [
                      "doi" => "10.1097/EJA.0000000000000118"
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                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2015"
                        "volumen" => "32"
                        "paginaInicial" => "88"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25058504"
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              "identificador" => "bib0480"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ARISCAT Group Prediction of postoperative pulmonary complications in a population-based surgical cohort"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Canet"
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                            3 => "G&#46; Paluzie"
                            4 => "J&#46; Vall&#232;s"
                            5 => "J&#46; Castillo"
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                          0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Postoperative respiratory failure&#58; pathogenesis&#44; prediction&#44; and prevention"
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                          "autores" => array:2 [
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                    0 => array:2 [
                      "doi" => "10.1097/MCC.0000000000000045"
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                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "56"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24240985"
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              "identificador" => "bib0490"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "American College of Physicians Preoperative pulmonary risk stratification for noncardiothoracic surgery&#58; systematic review for the American College of Physicians"
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                        0 => array:2 [
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2006"
                        "volumen" => "144"
                        "paginaInicial" => "581"
                        "paginaFinal" => "595"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16618956"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome&#58; a randomized controlled trial"
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                        "paginaInicial" => "54"
                        "paginaFinal" => "61"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10404912"
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              "identificador" => "bib0500"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome"
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                          "etal" => true
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                            2 => "O&#46; Kajikawa"
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                            4 => "S&#46; Fischer"
                            5 => "V&#46; Edwards"
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                        "volumen" => "289"
                        "paginaInicial" => "2104"
                        "paginaFinal" => "2112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12709468"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0505"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Mechanical ventilation and hemorrhagic shock-resuscitation interact to increase inflammatory cytokine release in rats"
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                          "etal" => false
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                            4 => "G&#46; Saumon"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000286398.78243.CE"
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "2601"
                        "paginaFinal" => "2606"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17828032"
                            "web" => "Medline"
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              ]
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              "identificador" => "bib0510"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atelectasis in the perioperative patient"
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                    0 => array:2 [
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                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "37"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17211165"
                            "web" => "Medline"
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                    ]
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                ]
              ]
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              "identificador" => "bib0515"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Functional residual capacity&#44; thoracoabdominal dimensions&#44; and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            4 => "L&#46; Svensson"
                            5 => "L&#46; Tokics"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
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                        "paginaInicial" => "247"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3977112"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery"
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                          "autores" => array:5 [
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                            2 => "S&#46; Simard"
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                            4 => "F&#46; Dagenais"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2012"
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                        "paginaFinal" => "1082"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22450472"
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              "identificador" => "bib0525"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extracellular matrix and mechanical ventilation in healthy lungs&#58; back to baro&#47;volotrauma&#63;"
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                          "etal" => false
                          "autores" => array:2 [
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e3282f25162"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "16"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18195621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0530"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protect the lungs during abdominal surgery&#58; it may change the postoperative outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;F&#46; Melo"
                            1 => "M&#46; Eikermann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e3182910309"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2013"
                        "volumen" => "118"
                        "paginaInicial" => "1254"
                        "paginaFinal" => "1257"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23535504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0535"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of airway wall compliance on epithelial cell injury and adhesion during interfacial flows"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Higuita-Castro"
                            1 => "C&#46; Mihai"
                            2 => "D&#46;J&#46; Hansford"
                            3 => "S&#46;N&#46; Ghadiali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "2014"
                        "volumen" => "117"
                        "paginaInicial" => "1231"
                        "paginaFinal" => "1242"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0540"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stress distribution in lungs&#58; a model of pulmonary elasticity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Mead"
                            1 => "T&#46; Takishima"
                            2 => "D&#46; Leith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/jappl.1970.28.5.596"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol"
                        "fecha" => "1970"
                        "volumen" => "28"
                        "paginaInicial" => "596"
                        "paginaFinal" => "608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5442255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0545"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung protective mechanical ventilation and two year survival in patients with acute lung injury&#58; prospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Needham"
                            1 => "E&#46; Colantuoni"
                            2 => "P&#46;A&#46; Mendez-Tellez"
                            3 => "V&#46;D&#46; Dinglas"
                            4 => "J&#46;E&#46; Sevransky"
                            5 => "C&#46;R&#46; Dennison Himmelfarb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2012"
                        "volumen" => "344"
                        "paginaInicial" => "e2124"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22491953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0550"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ARDS Clinical Trials Network Tidal volume reduction in patients with acute lung injury when plateau pressures are not high"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;N&#46; Hager"
                            1 => "J&#46;A&#46; Krishnan"
                            2 => "D&#46;L&#46; Hayden"
                             …1
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200501-048CP"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "172"
                        "paginaInicial" => "1241"
                        "paginaFinal" => "1245"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1526590013009103"
                          "estado" => "S300"
                          "issn" => "15265900"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0555"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200710-1589OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "178"
                        "paginaInicial" => "346"
                        "paginaFinal" => "355"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0560"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung stress and strain during mechanical ventilation&#58; any safe threshold&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201010-1757OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "1354"
                        "paginaFinal" => "1362"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0565"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cyclic stretch-induced oxidative stress increases pulmonary alveolar epithelial permeability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1165/rcmb.2012-0252OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Cell Mol Biol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "156"
                        "paginaFinal" => "164"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0570"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/ajplung.00437.2012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol"
                        "fecha" => "2013"
                        "volumen" => "305"
                        "paginaInicial" => "L478"
                        "paginaFinal" => "L484"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0575"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epithelial and endothelial damage induced by mechanical ventilation modes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0000000000000043"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "17"
                        "paginaFinal" => "24"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0580"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proteoglycan fragmentation and respiratory mechanics in mechanically ventilated healthy rats"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "2007"
                        "volumen" => "103"
                        "paginaInicial" => "747"
                        "paginaFinal" => "756"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0585"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of respiratory pattern on lung mechanics and interstitial proteoglycans in spontaneously breathing anaesthetized healthy rats"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Physiol &#40;Oxf&#41;"
                        "fecha" => "2011"
                        "volumen" => "203"
                        "paginaInicial" => "331"
                        "paginaFinal" => "341"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0590"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of mechanical ventilation on the extracellular matrix"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-007-0964-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "631"
                        "paginaFinal" => "639"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0595"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of proteoglycans in pulmonary edema development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-007-0962-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "610"
                        "paginaFinal" => "618"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0600"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of mechanical ventilation and fluid load on pulmonary glycosaminoglycans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resp.2012.03.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Physiol Neurobiol"
                        "fecha" => "2012"
                        "volumen" => "181"
                        "paginaInicial" => "308"
                        "paginaFinal" => "320"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0605"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanotransduction in the lungs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2014"
                        "volumen" => "80"
                        "paginaInicial" => "933"
                        "paginaFinal" => "941"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0610"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of ventilator-associated lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0b013e32834f8c7f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "123"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0615"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilation-induced lung injury and mechanotransduction&#58; stretching it too far&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/ajplung.00124.2001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol"
                        "fecha" => "2002"
                        "volumen" => "282"
                        "paginaInicial" => "L892"
                        "paginaFinal" => "L896"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0620"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung edema caused by high peak inspiratory pressures in dogs&#46; Role of increased microvascular filtration pressure and permeability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/142.2.321"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1990"
                        "volumen" => "142"
                        "paginaInicial" => "321"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0625"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stress failure in pulmonary capillaries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "1991"
                        "volumen" => "70"
                        "paginaInicial" => "1731"
                        "paginaFinal" => "1742"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0630"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of stretch on tight junction structure in alveolar epithelial cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1165/ajrcmb.25.5.4486"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Cell Mol Biol"
                        "fecha" => "2001"
                        "volumen" => "25"
                        "paginaInicial" => "584"
                        "paginaFinal" => "591"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0635"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung inflation&#44; lung solute permeability&#44; and alveolar edema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [ …1]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/jappl.1982.53.1.121"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol Respir Environ Exerc Physiol"
                        "fecha" => "1982"
                        "volumen" => "53"
                        "paginaInicial" => "121"
                        "paginaFinal" => "125"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0640"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased surface tension favors pulmonary edema formation in anesthetized dogs&#8217; lungs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI109369"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "1979"
                        "volumen" => "63"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1018"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0645"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plasma membrane disruptions with different modes of injurious mechanical ventilation in normal rat lungs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e318232da2b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "869"
                        "paginaFinal" => "875"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0650"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cytokine release&#44; small airway injury&#44; and parenchymal damage during mechanical ventilation in normal open-chest rats"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "2008"
                        "volumen" => "104"
                        "paginaInicial" => "41"
                        "paginaFinal" => "49"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0655"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regulation and repair of the alveolar-capillary barrier in acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1146/annurev-physiol-030212-183756"
                      "Revista" => array:6 [
                        "tituloSerie" => "Annu Rev Physiol"
                        "fecha" => "2013"
                        "volumen" => "75"
                        "paginaInicial" => "593"
                        "paginaFinal" => "615"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0660"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The biophysical function of pulmonary surfactant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resp.2008.05.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Physiol Neurobiol"
                        "fecha" => "2008"
                        "volumen" => "163"
                        "paginaInicial" => "244"
                        "paginaFinal" => "255"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0665"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Invited review&#58; mechanisms of ventilator-induced lung injury&#58; a perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Physiol &#40;1985&#41;"
                        "fecha" => "2000"
                        "volumen" => "89"
                        "paginaInicial" => "1645"
                        "paginaFinal" => "1655"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0670"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changes in proteoglycans and lung tissue mechanics during excessive mechanical ventilation in rats"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1152/ajplung.2001.281.5.L1078"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Physiol Lung Cell Mol Physiol"
                        "fecha" => "2001"
                        "volumen" => "281"
                        "paginaInicial" => "L1078"
                        "paginaFinal" => "L1087"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S014067360961922X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0675"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanisms of ventilator-induced lung injury in healthy lungs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [ …3]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.bpa.2015.08.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Best Pract Res Clin Anaesthesiol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "301"
                        "paginaFinal" => "313"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0680"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilator-related causes of lung injury&#58; the mechanical power"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-016-4505-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "paginaInicial" => "1567"
                        "paginaFinal" => "1575"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0685"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of decreased respiratory frequency on ventilator-induced lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.161.2.9811008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2000"
                        "volumen" => "161"
                        "paginaInicial" => "463"
                        "paginaFinal" => "468"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0690"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical power and development of ventilator-induced lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0000000000001056"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2016"
                        "volumen" => "124"
                        "paginaInicial" => "1100"
                        "paginaFinal" => "1108"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0695"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pressure-volume curve of total respiratory system in acute respiratory failure&#46; Computed tomographic scan study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm/136.3.730"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis"
                        "fecha" => "1987"
                        "volumen" => "136"
                        "paginaInicial" => "730"
                        "paginaFinal" => "736"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0700"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung inhomogeneity in patients with acute respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201308-1567OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "189"
                        "paginaInicial" => "149"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0705"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of positive end-expiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.151.6.7767524"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1995"
                        "volumen" => "151"
                        "paginaInicial" => "1807"
                        "paginaFinal" => "1814"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0710"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1172/JCI119259"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Invest"
                        "fecha" => "1997"
                        "volumen" => "99"
                        "paginaInicial" => "944"
                        "paginaFinal" => "952"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0715"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilator-induced lung injury&#58; from the bench to the bedside"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-005-2817-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2006"
                        "volumen" => "32"
                        "paginaInicial" => "24"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib0720"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilatory support for acute respiratory failure&#58; new and ongoing pathophysiological&#44; diagnostic and therapeutic developments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCC.0b013e32833500bc"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib0725"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2006"
                        "volumen" => "105"
                        "paginaInicial" => "689"
                        "paginaFinal" => "695"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0967586809007243"
                          "estado" => "S300"
                          "issn" => "09675868"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib0730"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.anes.0000296068.80921.10"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2008"
                        "volumen" => "108"
                        "paginaInicial" => "46"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib0735"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilation according to the open lung concept attenuates pulmonary inflammatory response in cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2005.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2005"
                        "volumen" => "28"
                        "paginaInicial" => "889"
                        "paginaFinal" => "895"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib0740"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Airway closure&#58; the silent killer of peripheral airways"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc5692"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2007"
                        "volumen" => "11"
                        "paginaInicial" => "114"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib0745"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Noninvasive respiratory support in the perioperative period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0b013e328335daec"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2010"
                        "volumen" => "23"
                        "paginaInicial" => "233"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib0750"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2004"
                        "volumen" => "98"
                        "paginaInicial" => "775"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib0755"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/01.ane.0000172112.02902.77"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2005"
                        "volumen" => "101"
                        "paginaInicial" => "957"
                        "paginaFinal" => "965"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib0760"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protective ventilation influences systemic inflammation after esophagectomy&#58; a randomized controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2006"
                        "volumen" => "105"
                        "paginaInicial" => "911"
                        "paginaFinal" => "919"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib0765"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of two ventilatory strategies in elderly patients undergoing major abdominal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aep319"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2010"
                        "volumen" => "104"
                        "paginaInicial" => "16"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib0770"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of the lung protective ventilatory strategy on proinflammatory cytokine release during one-lung ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ai Zheng"
                        "fecha" => "2008"
                        "volumen" => "27"
                        "paginaInicial" => "870"
                        "paginaFinal" => "873"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib0775"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alveolar recruitment improves ventilation during thoracic surgery&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [ …5]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aer415"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2012"
                        "volumen" => "108"
                        "paginaInicial" => "517"
                        "paginaFinal" => "524"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib0780"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-2104-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2004"
                        "volumen" => "30"
                        "paginaInicial" => "620"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib0785"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mechanical ventilation affects inflammatory mediators in patients undergoing cardiopulmonary bypass for cardiac surgery&#58; a randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2004.11.061"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2005"
                        "volumen" => "130"
                        "paginaInicial" => "378"
                        "paginaFinal" => "383"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib0790"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of tidal volume on pulmonary complications following minimally invasive esophagectomy&#58; a randomized and controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.06.043"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2013"
                        "volumen" => "146"
                        "paginaInicial" => "1267"
                        "paginaFinal" => "1273"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib0795"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery &#40;PRoVhILo trial&#41;&#58; a multicentre randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)60416-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2014"
                        "volumen" => "384"
                        "paginaInicial" => "495"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib0800"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventilation with low tidal volumes during upper abdominal surgery does not improve postoperative lung function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aes140"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2012"
                        "volumen" => "109"
                        "paginaInicial" => "263"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib0805"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e31829102de"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2013"
                        "volumen" => "118"
                        "paginaInicial" => "1307"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib0810"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized comparison of different ventilator strategies during thoracotomy for pulmonary resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2013.01.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2013"
                        "volumen" => "146"
                        "paginaInicial" => "38"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib0815"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of low tidal volume ventilation on time to extubation in cardiac surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ALN.0b013e318215e254"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "2011"
                        "volumen" => "114"
                        "paginaInicial" => "1102"
                        "paginaFinal" => "1110"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib0820"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of lung protection mechanical ventilation on respiratory function in the elderly undergoing spinal fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3969/j.issn.1672-7347.2013.01.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Zhong Nan Da Xue Xue Bao yi Xue Ban"
                        "fecha" => "2013"
                        "volumen" => "38"
                        "paginaInicial" => "81"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib0825"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A trial of intraoperative low-tidal-volume ventilation in abdominal surgery"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "IMPRoVe Study Group"
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1301082"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "369"
                        "paginaInicial" => "428"
                        "paginaFinal" => "437"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib0830"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications&#58; hospital based registry study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2015"
                        "volumen" => "351"
                        "paginaInicial" => "h3646"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib0835"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between driving pressure and development of postoperative pulmonary complication in patient undergoing mechanical ventilation for general anaesthesia&#58; a meta-analysis of individual patient data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [ …6]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(16)00057-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "paginaInicial" => "272"
                        "paginaFinal" => "280"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib0840"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative mechanical ventilation in patients with non-injured lungs&#58; time to talk about tailored protective ventilation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2305-5839.2015.12.30"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Transl Med"
                        "fecha" => "2016"
                        "volumen" => "4"
                        "paginaInicial" => "17"
                        "link" => array:1 [
                          0 => array:2 [ …2]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2018.02.011

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