Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery | Revista Española de Anestesiología y Reanimación (English Edition)

array:24 ["pii" => "S2341192920300147" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.10.004" "estado" => "S300" "fechaPublicacion" => "2020-02-01" "aid" => "1080" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:55-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935619301987" "issn" => "00349356" "doi" => "10.1016/j.redar.2019.10.007" "estado" => "S300" "fechaPublicacion" => "2020-02-01" "aid" => "1080" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Anestesiol Reanim. 2020;67:55-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 117 "formatos" => array:2 [ "HTML" => 80 "PDF" => 37 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "62" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1759 "Ancho" => 2500 "Tamanyo" => 136637 ] ] "descripcion" => array:1 [ "es" => "Protocolo experimental. IC: índice cardíaco; VPP: variación de presión de pulso; VVS: variación de volumen sistólico." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Miñana, M.J. Parra, J. Carbonell, M. Soro, J. Belda, C. Ferrando" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Miñana" ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Parra" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Carbonell" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Soro" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Belda" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Ferrando" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192920300147" "doi" => "10.1016/j.redare.2019.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300147?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619301987?idApp=UINPBA00004N" "url" => "/00349356/0000006700000002/v2_202002170613/S0034935619301987/v2_202002170613/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192920300160" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.09.006" "estado" => "S300" "fechaPublicacion" => "2020-02-01" "aid" => "1078" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:63-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Comparison of peribulbar block and general anaesthesia in mechanical vitrectomy: A prospective observational study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "63" "paginaFinal" => "67" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de bloqueo peribulbar y anestesia general en vitrectomía mecánica: estudio observacional prospectivo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Carvalho, C. Jantarada, J. Azevedo, P. Maia, L. Guimarães" "autores" => array:5 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Carvalho" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Jantarada" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Azevedo" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Maia" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Guimarães" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935619301963" "doi" => "10.1016/j.redar.2019.09.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619301963?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300160?idApp=UINPBA00004N" "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300160/v1_202002150624/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192920300184" "issn" => "23411929" "doi" => "10.1016/j.redare.2019.11.001" "estado" => "S300" "fechaPublicacion" => "2020-02-01" "aid" => "1089" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2020;67:53-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial article" "titulo" => "Is “normal” arterial blood pressure “optimal” in all patients?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "54" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es la presión arterial “normal” la presión arterial “óptima” para cada uno de nuestros pacientes?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. García-Orellana, R. Valero, N. Fàbregas, N. de Riva" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "García-Orellana" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Valero" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Fàbregas" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "de Riva" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935619302154" "doi" => "10.1016/j.redar.2019.11.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619302154?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300184?idApp=UINPBA00004N" "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300184/v1_202002150624/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "62" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Miñana, M.J. Parra, J. Carbonell, M. Soro, J. Belda, C. Ferrando" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Miñana" "email" => array:1 [ 0 => "amanda.mimoll@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.J." "apellidos" => "Parra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Carbonell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Soro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Belda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "C." "apellidos" => "Ferrando" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Hospital Francesc de Borja, Gandía, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1759 "Ancho" => 2500 "Tamanyo" => 129732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Study protocol. CI: cardiac index; PPV: pulse pressure variation; SSV: stroke volume variation." ] ] ] "textoCompleto" => "IntroductionThe appearance of postoperative pulmonary complications increases morbidity and mortality after lung resection surgery. Acute respiratory distress syndrome (ARDS) is one of the most serious complications, and has a mortality rate of between 22–50%, depending on the type of resection.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Studies have found a strong association between excess perioperative fluid intake (6−8 ml/kg/h) and the onset of ARDS after lung resection surgery.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> For many years now, the gold standard in critically ill patients with ARDS has been restrictive fluid therapy, which has been shown to improve oxygenation and reduce weaning time.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> There is no solid scientific evidence that excessively restrictive therapy can lead to kidney complications; however, many clinicians claim that achieving normovolaemia based on a zero balance target and haemodynamic management with vasopressors will prevent ARDS and hypoperfusion lesions.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a>Goal-directed fluid therapy has achieved excellent results in critically ill patients and moderate to high risk abdominal surgeries,<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> and is now being evaluated as a means of avoiding the risk of organ damage caused by excessively high or low fluid resuscitation in the context of thoracic surgery.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a>The use of dynamic parameters derived from the arterial pulse wave during mechanical ventilation, such as stroke volume variation (SVV) and pulse pressure variation (PPV)<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> optimizes cardiac output (CO) and adjusts intraoperative fluid therapy according to the patient's response.Open lung resection surgery requires one-lung ventilation with tidal volume <8 ml/kg, thoracotomy, and lateral positioning. These circumstances modify the heart-lung interaction during the transpulmonary and pleural pressure changes that occur during inspiration and expiration.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Low tidal volume ventilation and one-lung ventilation alter the sensitivity and specificity of dynamic pulse wave parameters as predictors of volume responsiveness.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> Various studies have shown that during thoracic surgery both SVV and PPV decrease even when haemodynamic status remains unaltered, and therefore lower threshold values give a better indication of a positive response to volume overload.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>In this study, we reduced SVV and VPP cut off values by 30% (SVV ≥ 8% and/or PPV ≥ 10%), and validated their effectiveness as predictors of volume responsiveness in open lung resection surgery.Material and methodsWe conducted a prospective, observational pilot study, which was approved by the Internal Scientific Committee of the Research Foundation of the Valencia Hospital Clínico Universitario on 23 January 2015. All patients were correctly informed and voluntarily signed the consent form.Inclusion criteria were: ASA class I–IV, aged over 18 years, willing to participate in the study and sign the informed consent form. The exclusion criteria were: cardiac arrhythmia, pregnancy, or breastfeeding.General proceduresAnalgesia was delivered through a thoracic epidural catheter, and consisted of intermittent boluses of 0.125% levobupivacaine administered according to the patient's analgesic needs. Anaesthesia was induced with 1.5 μg/kg fentanyl +2 mg/kg propofol +0.6 μg/kg rocuronium, with selective left bronchial intubation. Correct placement of the tracheal tube was confirmed with fibre optic bronchoscopy. Anaesthesia was maintained with sevoflurane for an exhaled concentration (Fet) of 1.5–2 vol%. Neuromuscular blockade was monitored continuously, and doses of 0.15 μg/kg rocuronium were repeated when the train of four (TOF) ratio showed superficial relaxation. Intraoperative fluid levels were maintained with an infusion of crystalloids titrated to 3 ml/kg/h body weight. A central, usually right jugular, venous line was placed using the Seldinger technique under ultrasound guidance for the administration of fluids and drugs and to calibrate the CO monitor using thermodilution. The radial arterial was cannulated to monitor blood pressure and collect blood samples for arterial blood gas determination using a 50 cm, 4F PiCCO™ (Pulsion Medical Systems) radial catheter. Haemodynamic status was monitored by means of transpulmonary thermodilution using the PiCCO monitor to obtain CO and derived parameters. Bipulmonary ventilation was performed in volume-controlled ventilation mode, with a tidal volume (Vt) of 8 ml/kg of ideal body weight while maintaining plateau pressures (Pplat) below 25 cmH2O, FIO2 of 0.8, positive end of expiratory pressure (PEEP) of 5 cmH2O, respiratory rate (RR) to maintain a PaCO2 of between 35 and 45 mmHg, plateau time of 10% inspiratory time, and an inspiration/expiration ratio of 1:2. During one-lung ventilation, Vt was changed to 6 ml/kg and RR was readjusted, if necessary, to maintain PaCO2 between 35 and 45 mmHg. After thoracotomy (with the thorax open and one-lung ventilation started), a pulmonary recruitment manoeuvre was performed and PEEP was adjusted to lung compliance.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a>Study protocolDuring surgery, haemodynamic and ventilatory data were collected after the PiCCO had been calibrated with 15 ml cold saline solution, with the patient supine, with and without one-lung ventilation, and in the lateral position, with and without one-lung ventilation prior to thoracotomy. Before each data collection, the CO monitor was calibrated by performing 3 thermodilutions with 15 ml cold saline solution.Study variables are grouped under: a) demographic variables: age, sex, height, real body weight, ideal body weight, type of lung resection, surgical side, surgery time, and mechanical ventilation time; b) ventilatory variables: Vt, RR, Pplat and mean airway pressure, and c) haemodynamic variables: systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate (HR), global end diastolic volume, systolic volume index (SVI), pulse pressure variation (PPV), stroke volume variation (SVV), left ventricular contractility index (dpmax), cardiac index (CI), and global ejection fraction.Stroke volume variation (SVV) formula:<elsevierMultimedia ident="eq0005"></elsevierMultimedia>pulse pressure variation (PPV) formula:<elsevierMultimedia ident="eq0010"></elsevierMultimedia>The data collection times are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•T1: 10 min after anaesthesia induction. The patient is receiving bipulmonary ventilation (Vt: 8 ml/kg) in the supine position with the chest closed.</li><li class="elsevierStyleListItem" id="lsti0010">•T2: the patient is supine with one-lung ventilation (Vt: 6 ml/kg) and the chest closed.</li><li class="elsevierStyleListItem" id="lsti0015">•T3: the patient is lateral with bipulmonary ventilation (Vt: 8 ml/kg) and the chest closed.</li><li class="elsevierStyleListItem" id="lsti0020">•T4: the patient is lateral with one-lung ventilation (Vt: 6 ml/kg) and the chest closed.</li><li class="elsevierStyleListItem" id="lsti0025">•T5: the patient is lateral with one-lung ventilation (Vt: 6 ml/kg), 15 min after thoracotomy.</li><li class="elsevierStyleListItem" id="lsti0030">•T6 Preload: haemodynamic data collected prior to volume overload, when SVV ≥ 8% or PPV ≥ 10%.</li><li class="elsevierStyleListItem" id="lsti0035">•T6 Afterload: haemodynamic data collected after volume overload with 250 ml crystalloid.</li><li class="elsevierStyleListItem" id="lsti0040">•T7, T8 and T9: these times correspond to subsequent volume overloads if the criteria of the study protocol were met.</li></ul>The study protocol was started once the patient had been placed lateral, with the chest open, and under one-lung ventilation with Vt 6 ml/kg and optimal PEEP (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). For this protocol, we choose SVV ≥ 8% and PPV ≥ 10% thresholds as the starting point for infusion of volume overload. We chose these cut-off points based on the literature previously described,<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> and on an earlier study performed by our research team in patients undergoing pulmonary resection surgery using pulse wave monitoring, in which the influence of one-lung ventilation with VT 6 ml/kg associated with the lateral position.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> These factors reduce PPV and SVV by around 30% — a reduction that cannot be explained by haemodynamic changes. Therefore, in order for volume overload to be an effective predictive tool in lung resection surgery, we believe that the threshold value for the start of administration should be reduced.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>According to our study protocol, if CI < 2.5 ml/min/m2 and SVV ≥ 8% and/or PPV ≥ 10%, a load of 250 ml of crystalloids was administered over 15 min, and the PiCCO monitor was recalibrated. If CI remained at <2.5 ml/min/m2 and SVV ≥ 8% and/or PVV ≥ 10%, fluid was administered until CI > 3.5 ml/min/m2 or SVV < 8% and PVV < 10%.The number of fluid loads administered was not predetermined, but was individualised in each patient according to the parameters of the PiCCO monitor. In our series of 25 patients, 3 received no fluids, 8 received a single load, 9 received 2 loads, 1 received 3 loads, and 4 received up to 4 loads. The PICCO monitor was calibrated before and after each load.If CI was < 2.5 ml/mil/m2 and SVV < 8% and PPV < 10%, ionotropic vasopressors were administered until CI > 2.5 ml/min/m2. After extubation, patients were given 3 ml/kg/h fluids for the first 24 postoperative hours, with no additional volume overload.Statistical analysisThis is a preliminary pilot study for subsequent clinical trials on the use of dynamic pulse wave parameters to discriminate between responders and non-responders in lung resection surgery. It will allow us to select an adequate sample size, estimate optimal SSV and PPV cut-off points, and evaluate the safety of goal-direct fluid therapy in lung resection surgery. The sample size of 25 patients was estimated arbitrarily.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>Demographic data are shown as mean ± standard deviation and the p value in the Kolmogorov-Smirnov normality test. The categorical variables “sex” and “type of surgery” were analysed using the chi-square goodness of fit test in order to determine the homogeneity of the sample.The CI and SVI variables are described as mean and standard deviation, differentiating between data collection times and preload or afterload values. Mixed linear regression models were used to assess whether differences between preload and afterload values were statistically significant. A random "patient" effects factor was included to correct the non-independence of the data, given the existence of repeated measures. The data were plotted on box and whisker charts. All analyses were performed using the statistical software R (version 3.5.2) and the NMF (version 0.21.0), lme4 (version 1.1–20) and clicR (version 0.4.20) packages.To answer our primary objective, patient loads were classified into 2 groups according to their response to volume expansion; fluid load responders (increase in CI ≥ 10% and/or SVI ≥ 10%) and non-responders (no increase or increase in CI < 10% and/or SVI < 10%). We constructed 2 logistic regression models to determine the optimal cut-off point that maximizes the sensitivity and specificity of the area under the curve (AUC): one where the explanatory variable was PPV, and another where it was SVV. The odds ratio and its confidence interval and the AUC and its confidence interval were calculated for each model using the statistics programme pROC (version 1.14.0).ResultsA total of 25 patients who met the inclusion criteria were included between January and May 2015. All patients completed the study.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics of the study sample.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Predictive capacity of SVV and PPV variablesAfter data collection, a total of 39 loads were obtained, of which 22 were fluid responders (56.41%) and 17 (43.58%) were fluid non-responders.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the haemodynamic variables (expressed as means) collected before and after fluid load at collection times T6 to T9, and grouped according to responders or non-responders.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the CI and SVI variables (expressed as mean + standard deviation), differentiating between collection times T6 to T9 and preload or afterload values.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> gives a box and whisker plot showing the changes in these variables before and after each fluid load. CI and SVI values increase after fluid load, except at T9. Overall, statistically significant differences between preload and afterload are observed, showing an average increase in CI of 0.31 (95% confidence interval [CI]): 0.03–0.59; p = 0.042) and an average increase in SVI of 4.14 (95% CI: 0.34–7.93; p = 0.045). Although there appears to be a tendency for CI and SVI to increase as the number of load increases, the differences are no statistically significant.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The odds ratio for the SVV variable was 0.94, with 95% CI: 0.75–1.17 p = 0.59. The odds ratio for the PPV variable was 0.96, with 95% CI: 0.82–1.13 p = 0.62. In the ROC curve analysis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) the AUC was not as expected, since a discriminative value was not obtained: AUC for SVV: 0.47, with 95% CI: 0.30–0.65; AUC for PPV: 0.50, with 95% CI: 0.33–0.68.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThis study shows that dynamic volume responsiveness, stroke volume variation and pulse pressure variation parameters cannot be used to predict response to volume overload during lung resection surgery with protective mechanical ventilation. These results were obtained even after lowering the threshold for start of volume overload to adapt it to previously published evidence.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17,21,23</a>In an earlier study, we described the behaviour of these parameters under different circumstance during lung resection surgery. Both one-lung ventilation and lateral position generate a shunt of between 20% and 30% in the unventilated lung.<a class="elsevierStyleCrossRefs" href="#bib0065">13,23</a> This shunt does not contribute to PPV due to the absence of ventilation-induced cyclic changes in the non-ventilated lung; therefore, the PPV value can be diminished during one-lung ventilation. This physiological process was also observed by Nieves et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> in a study involving 50 patients undergoing lung resection surgery. In this case, a decrease in PPV of up to 50% was observed during the establishment of one-lung ventilation and thoracotomy.Heart-lung interaction is the physiological basis of dynamic volume responsiveness parameters. This explains the effect of the amount of tidal volume administered on SVV and PPV values: venous return decreases significantly with Vt > 8 ml/kg and less markedly with Vt < 8 ml/kg.In our study, we were unable to show that a decrease in the threshold value of PPV and SVV improves the capacity of these parameters to predict volume responsiveness; however, this does not mean that this parameter adjustment is not needed to maximise the predictive value of dynamic volume responsiveness parameters in thoracic surgery, since the physiological basis has been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0080">16,21,23</a>Our results are consistent with other studies on the use of predictive volume responsiveness parameters during open chest surgery, in which statistically significant results in the AUC analysis were not obtained. Jeong et al.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> studied 80 patients undergoing lobectomy (40 thoracoscopies; 40 thoracotomies) who received 7 ml/kg colloids. They found that SVV has no value in discriminating between responders and non-responders. However, they did observe differences in PPV between responders and non-responders (6.9 ± 3.0% vs. 8.4 ± 3.2%; p = 0.045), as well as an AUC of 0.63 (95% CI: 0.52–0.74; p = 0.041), albeit with low sensitivity (58%) and specificity (62%). They observed no differences between open or thoracoscopic surgery, and concluded that dynamic volume responsiveness parameters are not useful in open or thoracoscopic surgery. Fu et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> evaluated 30 patients scheduled for open lobectomy with one-lung ventilation, and obtained no differences in SVV between responders and non-responders. Their AUC was very similar to ours (0.507; 95% CI: 0.294–0.72), and the authors concluded that the Vigileo-Flotrac® pulse wave monitor does not predict response to fluids in open lobectomies with one-lung ventilation.Some studies, however, have shown that dynamic SVV and PPV parameters can predict fluid responsiveness when the cut-off point for PPV is around 5.8%,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Vt is 6 ml/kg, the patient is positioned lateral, and the chest is open. The authors attributed this lower cut-off point to the decrease in tidal volume. Other authors have shown the interdependence between the amount of tidal volume administered and the value of SVV and PPV, irrespective of the patient’s haemodynamic status. SVV and PPV increase if Vt > 10 ml/kg, and decrease if Vt < 8 ml/kg.<a class="elsevierStyleCrossRefs" href="#bib0085">17,27</a>Suehiro and Okutani,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> in contrast, conducted a study in 30 patients undergoing lung resection surgery with pulse wave monitoring, and obtained an SVV cut-off value of 10.5%, with an AUC of 0.9 (95% CI: 0.809–0.991), a sensitivity of 82.4%, and a specificity of 92.3%.LimitationsThe main limitation of this study, which is merely a pilot study, is that both the results and conclusions reached are limited by the lack of statistical power. Therefore, further studies with larger samples are needed to validate these parameters and obtain an optimal threshold value for the prediction of volume responsiveness in lung resection surgery.Secondly, in respect of other similar studies where cutoff values of 5.8% were obtained for PPV, the threshold values used for starting volume load (PPV ≥ 10% and SVV ≥ 8%) in our study could have been too high to validate PPV and SVV in lung resection surgery.Thirdly, our ventilatory variables did not include PEEP values, even though this variable was individualised for each patient and could have altered intrathoracic pressure, thereby modifying the value of dynamic fluid responsiveness pulse wave parameters. Neither did we record the vasopressor doses administered. Volume responsiveness may be determined by a decrease in intravascular volume or by a decrease in vascular tone, particularly when local epidural anaesthetics are administered during surgery.Finally, intraoperative temperature data were not recorded. This parameter should be monitored in future studies, since hypothermia can alter thermodilution parameters.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>ConclusionsDespite lowering the PPV and SVV volume overload threshold by 30%, the predictive power of these parameters to discriminate between volume responders and non-responders during lung resection surgery could not be statistically demonstrated.FundingThis study was not funded by grants from the public sector, trade sector or non-profit entities.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1308771" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1208274" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1308770" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1208275" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "General procedures" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Predictive capacity of SVV and PPV variables" ] ] ] 7 => array:3 [ "identificador" => "sec0040" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-27" "fechaAceptado" => "2019-10-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1208274" "palabras" => array:5 [ 0 => "Lung resection surgery" 1 => "Goal directed fluid therapy" 2 => "Stroke volume variation (SVV)" 3 => "Pulse pressure variation (PPV)" 4 => "One-lung ventilation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1208275" "palabras" => array:5 [ 0 => "Cirugía de resección pulmonar" 1 => "Fluidoterapia guiada por objetivos" 2 => "Variación de volumen sistólico (VVS)" 3 => "Variación presión de pulso (VPP)" 4 => "Ventilación unipulmonar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionIn lung resection surgery, restrictive fluid therapy is recommended due to the risk of acute lung injury. In contrast, this recommendation increases the risk of hypoperfusion. Guided fluid therapy allows individualization of fluid intake. The use of dynamic volume response parameters is not validated during one-lung ventilation. The main objective is the validation of dynamic parameters, stroke volume variation (SVV) and pulse pressure variation (PPV), during lung resection surgery as fluid response predictors, after the administration of 250 ml crystalloid volume loads, if IC < 2.5 ml/min/m2 and if SVV ≥ 8% and/or PPV ≥ 10%. Material and methodsPilot, prospective, observational and single centre study. Twenty-five patients monitored with the PiCCO system were included during open lung resection surgery with the patient in a lateral position, one lung ventilation with tidal volume (TV): 6 ml/kg and open chest. Hemodynamic variables were collected before and after volume loading. The results were classified into two groups: volume responders (increase IC ≥ 10% and/or VSI ≥ 10% after volume loading) and non-responders (no increase or increase IC < 10% and/or VSI < 10% after volume loading). We assess the diagnostic efficacy of SVV and PPV by analyzing the AUC (area under curve) in the ROC curves. ResultsIn the analysis of ROC curves, SVV and PPV did not reach a discriminative value (AUC SVV: 0.47; AUC PPV: 0.50), despite the decrease in the threshold value of SVV and PPV to initiate an overload of volume during one-lung ventilation, in lateral position and open chest. ConclusionsThe results obtained show that the values of the dynamic parameters of volume response (SVV ≥ 8% and PPV ≥ 10%) do not discriminate against responders patients and nonresponders during open lung resection surgery." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEn cirugía de resección pulmonar, se recomienda la fluidoterapia restrictiva debido al riesgo de lesión pulmonar aguda. Por contra, esta recomendación aumenta el riesgo de hipoperfusión. La terapia guiada por objetivos permite individualizar el aporte de fluidos. El uso de parámetros dinámicos de respuesta a volumen no está validado durante la ventilación unipulmonar. El objetivo principal es la validación de los parámetros dinámicos, variación de volumen sistólico (VVS) y presión de pulso (VPP), durante cirugía de resección pulmonar como predictores de respuesta a fluidos, tras la administración de cargas de volumen de 250 ml de cristaloides, si IC < 2.5 ml/min/m2 y si VVS ≥ 8% y/o VPP ≥ 10%. Material y MétodosEstudio piloto, prospectivo, observacional y unicéntrico. Se incluyeron 25 pacientes monitorizados con el sistema PiCCO durante la cirugía abierta de resección pulmonar con el paciente en posición de decúbito lateral, ventilación unipulmonar con VC: 6 ml/kg y tórax abierto. Se recogieron variables hemodinámicas antes y después de la carga de volumen. Los resultados se clasificaron en dos grupos: respondedores a volumen (aumento de IC ≥ 10% y/o VSI ≥ 10% tras la carga de volumen) y los no respondedores (no aumento o aumento del IC < 10% y/o VSI < 10% tras la carga de volumen). Evaluamos la eficacia diagnóstica de VVS y VPP mediante el estudio del AUC (área bajo a curva) de las curvas ROC. ResultadosEn el análisis de curvas ROC, VVS y VPP no alcanzaron un valor discriminativo (AUC VVS: 0,47; AUC VPP: 0,50), a pesar de la disminución del valor umbral de VVS y VPP para iniciar una sobrecarga de volumen durante la ventilación unipulmonar, en decúbito lateral y con el tórax abierto. ConclusionesLos resultados obtenidos muestran que los valores de los parámetros dinámicos de respuesta a volumen (VVS ≥ 8% y VPP ≥ 10%) no discriminan a los pacientes respondedores y los no respondedores durante la cirugía de resección pulmonar abierta." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Miñana A, Parra MJ, Carbonell J, Soro M, Belda J, Ferrando C. Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar. Rev Esp Anestesiol Reanim. 2020;67:55–62." ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1759 "Ancho" => 2500 "Tamanyo" => 129732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Study protocol. CI: cardiac index; PPV: pulse pressure variation; SSV: stroke volume variation." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 921 "Ancho" => 2520 "Tamanyo" => 101660 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Box and whisker plot of cardiac index (CI) and stroke volume index (SVI) parameters." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 843 "Ancho" => 2544 "Tamanyo" => 136933 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curves for stroke volume variation (SVV) and pulse pressure variation (PPV). Nota de la traductora: cambiar comas decimales a puntos." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: body mass index; MV: mechanical ventilation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Demographic variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard deviation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p (Kolmogorov–Smirnov) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">167 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Real weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ideal weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MV time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">209.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242725.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient demographics." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "dPmax: maximum left ventricular contractility; GEDI: global end-diastole index; GEF: global ejection fraction; CFI: coronary function index; CI: cardiac index; PPV: pulse pressure variation; SVI: stroke volume index; SVV: stroke volume." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Responders (n = 22)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-responders (n = 17)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PPV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SVV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SVI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DPMAX \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">638.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">771.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">611.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">729.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GEDI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">720.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">712.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">743.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">687.80 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GEF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CFI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242723.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Haemodynamic variables before and after loading at times t6–t9." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CI: cardiac index; SVI: stroke volume index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SVI</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.89 (0.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 (0.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.64 (10.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.76 (10.12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.96 (0.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.36 (0.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.86 (9.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.77 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.22 (0.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.62 (0.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.83 (6.31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.83 (4.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">T9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.73 (0.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.52 (0.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (7.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.5 (0.71) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242724.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Preload and afterload IC and SVI values at each load time." ] ] 6 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "SVV= SVmax-SVmin1/2SVmax+SVminx100" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 2760 "Alto" => 34 "Ancho" => 196 ] ] 7 => array:5 [ "identificador" => "eq0010" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "PPV= PPmax-PPmin1/2PPmax+PPminx100" "Fichero" => "STRIPIN_si2.jpeg" "Tamanyo" => 2807 "Alto" => 34 "Ancho" => 197 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.J. Jung" 1 => "J.H. Cho" 2 => "T.H. Hong" 3 => "H.K. Kim" 4 => "Y.S. Choi" 5 => "J. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/1759-7714.12406" "Revista" => array:6 [ "tituloSerie" => "Thorac Cancer" "fecha" => "2017" "volumen" => "8" "paginaInicial" => "33" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27925393" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unplanned readmission after lung resection: Complete follow-up in a 1-year cohort with identification of associated risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.J. Dickinson" 1 => "J.B. Taswell" 2 => "M.S. Allen" 3 => "S.H. Blackmon" 4 => "F.C. Nichols 3rd" 5 => "R. Shen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2016.09.065" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2017" "volumen" => "103" "paginaInicial" => "1084" "paginaFinal" => "1091" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27993376" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.K. Arslantas" 1 => "H.V. Kara" 2 => "B.B. Tuncer" 3 => "B. Yildizeli" 4 => "M. Yuksel" 5 => "K. Bostanci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtcvs.2014.08.071" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2015" "volumen" => "149" "paginaInicial" => "314" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25304302" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of intraoperative fluid management on postoperative outcomes after lobectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Wu" 1 => "R. Yang" 2 => "J. Xu" 3 => "A. Rusidanmu" 4 => "X. Zhang" 5 => "J. Hu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2018.12.013" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2019" "volumen" => "107" "paginaInicial" => "1663" "paginaFinal" => "1669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30641068" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National heart lung and blood institute acute respiratory distress syndrome clinical trials network. Comparison of two fluid-management strategies in acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.P. Wiedemann" 1 => "A.P. Wheeler" 2 => "G.R. Bernard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "354" "paginaInicial" => "1564" "paginaFinal" => "1575" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid Therapy in Thoracic Surgery: A Zero-Balance Target is Always Best!" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Licker" 1 => "F. Triponez" 2 => "C. Ellenberger" 3 => "W. Karenovics" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5152/TJAR.2016.006" "Revista" => array:7 [ "tituloSerie" => "Turk J Anaesthesiol Reanim" "fecha" => "2016" "volumen" => "44" "paginaInicial" => "227" "paginaFinal" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27909600" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022202X1831858X" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid administration during lung resection: what is the optimum?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.F. Batirel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.21037/jtd.2019.05.16" "Revista" => array:6 [ "tituloSerie" => "J Thorac Dis" "fecha" => "2019" "volumen" => "11" "paginaInicial" => "1746" "paginaFinal" => "1748" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31285864" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: A multi-center, prospective, randomized study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Salzwedel" 1 => "J. Puig" 2 => "A. Carstens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc12885" "Revista" => array:4 [ "tituloSerie" => "Crit Care" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "1" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Pearse" 1 => "D. Dawson" 2 => "J. Fawcett" 3 => "A. Rhodes" 4 => "R.M. Grounds" 5 => "E. Bennett" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc3887" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2005" "volumen" => "9" "paginaInicial" => "R687" "paginaFinal" => "R693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16356219" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid Management in Thoracic Surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.P. Searl" 1 => "A. Perrino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anclin.2012.08.009" "Revista" => array:6 [ "tituloSerie" => "Anesthesiol Clin" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "641" "paginaFinal" => "655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23089500" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fluid management in thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Assaad" 1 => "W. Popescu" 2 => "A. Perrino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0b013e32835c5cf5" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "31" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262471" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional hemodynamic monitoring and dynamic indices of fluid responsiveness" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Cavallaro" 1 => "C. Sandroni" 2 => "M. Antonelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aet429" "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2008" "volumen" => "74" "paginaInicial" => "123" "paginaFinal" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18212731" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Slagt" 1 => "I. Malagon" 2 => "A.B.J. Groeneveld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aet429" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2014" "volumen" => "112" "paginaInicial" => "626" "paginaFinal" => "637" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24431387" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy: Randomised controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.H. Lee" 1 => "Y. Jeon" 2 => "J.H. Bahk" 3 => "N.S. Gil" 4 => "D.M. Hong" 5 => "J.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0b013e32834089cf" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "39" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21088596" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemodynamic monitoring in thoracic surgical patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Raphael" 1 => "L.A. Regali" 2 => "R.H. Thiele" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ACO.0000000000000408" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Anaesthesiol" "fecha" => "2017" "volumen" => "30" "paginaInicial" => "7" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28030449" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monitoring pulse pressure variation during lung resection surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Nieves Alonso" 1 => "E. Alday Muñoz" 2 => "A. Planas Roca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2018.08.003" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2019" "volumen" => "66" "paginaInicial" => "78" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30314679" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Freitas" 1 => "A. Bafi" 2 => "A. Nascente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aes398" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2013" "volumen" => "110" "paginaInicial" => "402" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23161359" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recruitment maneuvers for one-lung ventilation during thoracic anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Tusman" 1 => "S.H. Bohm" 2 => "F. Suarez-Sipmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s40140-014-0054-9" "Revista" => array:4 [ "tituloSerie" => "Curr Anesthesiol Rep" "fecha" => "2014" "volumen" => "4" "paginaInicial" => "160" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Ferrando" 1 => "A. Mugarra" 2 => "A. Gutierrez" 3 => "M. Soro" 4 => "G. Tusman" 5 => "F.J. Belda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000105" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2014" "volumen" => "118" "paginaInicial" => "657" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557111" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Suehiro" 1 => "R. Okutani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jvca.2010.03.014" "Revista" => array:6 [ "tituloSerie" => "J Cardiothorac Vasc Anesth" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "772" "paginaFinal" => "775" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638869" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Zhang" 1 => "C. Chen" 2 => "X. Lei" 3 => "Z. Feng" 4 => "S. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.6061/clinics/2013(07)27" "Revista" => array:6 [ "tituloSerie" => "Clinics" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "1065" "paginaFinal" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23917675" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Huang" 1 => "J. Fu" 2 => "H. Hu" 3 => "K.C. Kao" 4 => "N.H. Chen" 5 => "M.J. Hsieh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e318186b74e" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2008" "volumen" => "36" "paginaInicial" => "2810" "paginaFinal" => "2816" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18766099" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dynamic predictors of fluid responsiveness during thoracic surgery. A descriptive prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Socorro" 1 => "A. Miñana" 2 => "C. Ferrando" 3 => "A. Katime" 4 => "I. Leon" 5 => "J. Belda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Eur J Anesthesiol" "fecha" => "2015" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A tutorial on pilot studies: the what, why and how" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Thabane" 1 => "J. Ma" 2 => "R. Chu" 3 => "C.H. Goldsmith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2288-10-1" "Revista" => array:5 [ "tituloSerie" => "BMC Med Res Methodol" "fecha" => "2010" "volumen" => "10" "paginaInicial" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20053272" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke volume variation and pulse pressure variation are not useful for predicting fluid responsiveness in thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.M. Jeong" 1 => "H.J. Ahn" 2 => "H.W. Park" 3 => "M. Yang" 4 => "J.A. Kim" 5 => "J. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000002056" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2017" "volumen" => "125" "paginaInicial" => "1158" "paginaFinal" => "1165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28504996" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Q. Fu" 1 => "F. Zhao" 2 => "W. Mi" 3 => "H. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5582/bst.8.59" "Revista" => array:5 [ "tituloSerie" => "Biosci Trends" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "59" "paginaFinal" => "63" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Reuter" 1 => "F.C. Weis" 2 => "P. Lamm" 3 => "A.E. Goetz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-003-1649-7" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2003" "volumen" => "29" "paginaInicial" => "476" "paginaFinal" => "480" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12579420" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PiCCO monitoring accuracy in low body temperature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Sami" 1 => "A. Sami" 2 => "N. Rochdil" 3 => "K. Hatem" 4 => "B.L. Salah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2006.11.046" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "845" "paginaFinal" => "846" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17870495" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300147/v1_202002150624/en/main.assets" "Apartado" => array:4 [ "identificador" => "34051" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006700000002/v1_202002150624/S2341192920300147/v1_202002150624/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300147?idApp=UINPBA00004N"]

Statistics

Original article

Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery

Estudio de validación de los parámetros dinámicos de onda de pulso en cirugía de resección pulmonar

A. Miñanaa,

Corresponding author

amanda.mimoll@gmail.com

Corresponding author.

, M.J. Parrab, J. Carbonellb, M. Sorob, J. Beldab, C. Ferrandoc,d

a Servicio de Anestesiología, Hospital Francesc de Borja, Gandía, Valencia, Spain

b Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Clínico Universitario de Valencia, Valencia, Spain

c Servicio de Anestesiología y Reanimación, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain

d CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain

Read

Not available

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341192920300147"
  "issn" => "23411929"
  "doi" => "10.1016/j.redare.2019.10.004"
  "estado" => "S300"
  "fechaPublicacion" => "2020-02-01"
  "aid" => "1080"
  "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2020;67:55-62"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0034935619301987"
      "issn" => "00349356"
      "doi" => "10.1016/j.redar.2019.10.007"
      "estado" => "S300"
      "fechaPublicacion" => "2020-02-01"
      "aid" => "1080"
      "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Anestesiol Reanim. 2020;67:55-62"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 117
        "formatos" => array:2 [
          "HTML" => 80
          "PDF" => 37
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Estudio de validaci&#243;n de los par&#225;metros din&#225;micos de onda de pulso en cirug&#237;a de resecci&#243;n pulmonar"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "55"
            "paginaFinal" => "62"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1759
                "Ancho" => 2500
                "Tamanyo" => 136637
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Protocolo experimental&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IC&#58; &#237;ndice card&#237;aco&#59; VPP&#58; variaci&#243;n de presi&#243;n de pulso&#59; VVS&#58; variaci&#243;n de volumen sist&#243;lico&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; Mi&#241;ana, M&#46;J&#46; Parra, J&#46; Carbonell, M&#46; Soro, J&#46; Belda, C&#46; Ferrando"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Mi&#241;ana"
              ]
              1 => array:2 [
                "nombre" => "M&#46;J&#46;"
                "apellidos" => "Parra"
              ]
              2 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Carbonell"
              ]
              3 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Soro"
              ]
              4 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Belda"
              ]
              5 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Ferrando"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341192920300147"
          "doi" => "10.1016/j.redare.2019.10.004"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300147?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619301987?idApp=UINPBA00004N"
      "url" => "/00349356/0000006700000002/v2_202002170613/S0034935619301987/v2_202002170613/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341192920300160"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2019.09.006"
    "estado" => "S300"
    "fechaPublicacion" => "2020-02-01"
    "aid" => "1078"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2020;67:63-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Comparison of peribulbar block and general anaesthesia in mechanical vitrectomy&#58; A prospective observational study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "63"
          "paginaFinal" => "67"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Comparaci&#243;n de bloqueo peribulbar y anestesia general en vitrectom&#237;a mec&#225;nica&#58; estudio observacional prospectivo"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "B&#46; Carvalho, C&#46; Jantarada, J&#46; Azevedo, P&#46; Maia, L&#46; Guimar&#227;es"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Carvalho"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Jantarada"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Azevedo"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Maia"
            ]
            4 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Guimar&#227;es"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935619301963"
        "doi" => "10.1016/j.redar.2019.09.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619301963?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300160?idApp=UINPBA00004N"
    "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300160/v1_202002150624/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341192920300184"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2019.11.001"
    "estado" => "S300"
    "fechaPublicacion" => "2020-02-01"
    "aid" => "1089"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2020;67:53-4"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>"
      "titulo" => "Is &#8220;normal&#8221; arterial blood pressure &#8220;optimal&#8221; in all patients&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "53"
          "paginaFinal" => "54"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Es la presi&#243;n arterial &#8220;normal&#8221; la presi&#243;n arterial &#8220;&#243;ptima&#8221; para cada uno de nuestros pacientes&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Garc&#237;a-Orellana, R&#46; Valero, N&#46; F&#224;bregas, N&#46; de Riva"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Garc&#237;a-Orellana"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Valero"
            ]
            2 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "F&#224;bregas"
            ]
            3 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "de Riva"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935619302154"
        "doi" => "10.1016/j.redar.2019.11.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935619302154?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300184?idApp=UINPBA00004N"
    "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300184/v1_202002150624/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Validation study of the dynamic parameters of pulse wave in pulmonary resection surgery"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "55"
        "paginaFinal" => "62"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Mi&#241;ana, M&#46;J&#46; Parra, J&#46; Carbonell, M&#46; Soro, J&#46; Belda, C&#46; Ferrando"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "A&#46;"
            "apellidos" => "Mi&#241;ana"
            "email" => array:1 [
              0 => "amanda.mimoll@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;J&#46;"
            "apellidos" => "Parra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Carbonell"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Soro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Belda"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Ferrando"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a&#44; Hospital Francesc de Borja&#44; Gand&#237;a&#44; Valencia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del dolor&#44; Hospital Cl&#237;nico Universitario de Valencia&#44; Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Anestesiolog&#237;a y Reanimaci&#243;n&#44; Hospital Cl&#237;nic i Provincial de Barcelona&#44; Barcelona&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "CIBER de Enfermedades Respiratorias&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estudio de validaci&#243;n de los par&#225;metros din&#225;micos de onda de pulso en cirug&#237;a de resecci&#243;n pulmonar"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1759
            "Ancho" => 2500
            "Tamanyo" => 129732
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Study protocol&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CI&#58; cardiac index&#59; PPV&#58; pulse pressure variation&#59; SSV&#58; stroke volume variation&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The appearance of postoperative pulmonary complications increases morbidity and mortality after lung resection surgery&#46; Acute respiratory distress syndrome &#40;ARDS&#41; is one of the most serious complications&#44; and has a mortality rate of between 22&#8211;50&#37;&#44; depending on the type of resection&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Studies have found a strong association between excess perioperative fluid intake &#40;6&#8722;8&#8239;ml&#47;kg&#47;h&#41; and the onset of ARDS after lung resection surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> For many years now&#44; the gold standard in critically ill patients with ARDS has been restrictive fluid therapy&#44; which has been shown to improve oxygenation and reduce weaning time&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> There is no solid scientific evidence that excessively restrictive therapy can lead to kidney complications&#59; however&#44; many clinicians claim that achieving normovolaemia based on a zero balance target and haemodynamic management with vasopressors will prevent ARDS and hypoperfusion lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Goal-directed fluid therapy has achieved excellent results in critically ill patients and moderate to high risk abdominal surgeries&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> and is now being evaluated as a means of avoiding the risk of organ damage caused by excessively high or low fluid resuscitation in the context of thoracic surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of dynamic parameters derived from the arterial pulse wave during mechanical ventilation&#44; such as stroke volume variation &#40;SVV&#41; and pulse pressure variation &#40;PPV&#41;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> optimizes cardiac output &#40;CO&#41; and adjusts intraoperative fluid therapy according to the patient&#39;s response&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Open lung resection surgery requires one-lung ventilation with tidal volume &#60;8&#8239;ml&#47;kg&#44; thoracotomy&#44; and lateral positioning&#46; These circumstances modify the heart-lung interaction during the transpulmonary and pleural pressure changes that occur during inspiration and expiration&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Low tidal volume ventilation and one-lung ventilation alter the sensitivity and specificity of dynamic pulse wave parameters as predictors of volume responsiveness&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Various studies have shown that during thoracic surgery both SVV and PPV decrease even when haemodynamic status remains unaltered&#44; and therefore lower threshold values give a better indication of a positive response to volume overload&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study&#44; we reduced SVV and VPP cut off values by 30&#37; &#40;SVV&#8239;&#8805;&#8239;8&#37; and&#47;or PPV&#8239;&#8805;&#8239;10&#37;&#41;&#44; and validated their effectiveness as predictors of volume responsiveness in open lung resection surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a prospective&#44; observational pilot study&#44; which was approved by the Internal Scientific Committee of the Research Foundation of the Valencia Hospital Cl&#237;nico Universitario on 23 January 2015&#46; All patients were correctly informed and voluntarily signed the consent form&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Inclusion criteria were&#58; ASA class I&#8211;IV&#44; aged over 18 years&#44; willing to participate in the study and sign the informed consent form&#46; The exclusion criteria were&#58; cardiac arrhythmia&#44; pregnancy&#44; or breastfeeding&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">General procedures</span><p id="par0040" class="elsevierStylePara elsevierViewall">Analgesia was delivered through a thoracic epidural catheter&#44; and consisted of intermittent boluses of 0&#46;125&#37; levobupivacaine administered according to the patient&#39;s analgesic needs&#46; Anaesthesia was induced with 1&#46;5&#8239;&#956;g&#47;kg fentanyl &#43;2&#8239;mg&#47;kg propofol &#43;0&#46;6&#8239;&#956;g&#47;kg rocuronium&#44; with selective left bronchial intubation&#46; Correct placement of the tracheal tube was confirmed with fibre optic bronchoscopy&#46; Anaesthesia was maintained with sevoflurane for an exhaled concentration &#40;Fet&#41; of 1&#46;5&#8211;2&#8239;vol&#37;&#46; Neuromuscular blockade was monitored continuously&#44; and doses of 0&#46;15&#8239;&#956;g&#47;kg rocuronium were repeated when the train of four &#40;TOF&#41; ratio showed superficial relaxation&#46; Intraoperative fluid levels were maintained with an infusion of crystalloids titrated to 3&#8239;ml&#47;kg&#47;h body weight&#46; A central&#44; usually right jugular&#44; venous line was placed using the Seldinger technique under ultrasound guidance for the administration of fluids and drugs and to calibrate the CO monitor using thermodilution&#46; The radial arterial was cannulated to monitor blood pressure and collect blood samples for arterial blood gas determination using a 50&#8239;cm&#44; 4F PiCCO&#8482; &#40;Pulsion Medical Systems&#41; radial catheter&#46; Haemodynamic status was monitored by means of transpulmonary thermodilution using the PiCCO monitor to obtain CO and derived parameters&#46; Bipulmonary ventilation was performed in volume-controlled ventilation mode&#44; with a tidal volume &#40;Vt&#41; of 8&#8239;ml&#47;kg of ideal body weight while maintaining plateau pressures &#40;Pplat&#41; below 25&#8239;cmH<span class="elsevierStyleInf">2</span>O&#44; FIO<span class="elsevierStyleInf">2</span> of 0&#46;8&#44; positive end of expiratory pressure &#40;PEEP&#41; of 5&#8239;cmH<span class="elsevierStyleInf">2</span>O&#44; respiratory rate &#40;RR&#41; to maintain a PaCO<span class="elsevierStyleInf">2</span> of between 35 and 45&#8239;mmHg&#44; plateau time of 10&#37; inspiratory time&#44; and an inspiration&#47;expiration ratio of 1&#58;2&#46; During one-lung ventilation&#44; Vt was changed to 6&#8239;ml&#47;kg and RR was readjusted&#44; if necessary&#44; to maintain PaCO<span class="elsevierStyleInf">2</span> between 35 and 45&#8239;mmHg&#46; After thoracotomy &#40;with the thorax open and one-lung ventilation started&#41;&#44; a pulmonary recruitment manoeuvre was performed and PEEP was adjusted to lung compliance&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study protocol</span><p id="par0045" class="elsevierStylePara elsevierViewall">During surgery&#44; haemodynamic and ventilatory data were collected after the PiCCO had been calibrated with 15&#8239;ml cold saline solution&#44; with the patient supine&#44; with and without one-lung ventilation&#44; and in the lateral position&#44; with and without one-lung ventilation prior to thoracotomy&#46; Before each data collection&#44; the CO monitor was calibrated by performing 3 thermodilutions with 15&#8239;ml cold saline solution&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Study variables are grouped under&#58; a&#41; demographic variables&#58; age&#44; sex&#44; height&#44; real body weight&#44; ideal body weight&#44; type of lung resection&#44; surgical side&#44; surgery time&#44; and mechanical ventilation time&#59; b&#41; ventilatory variables&#58; Vt&#44; RR&#44; Pplat and mean airway pressure&#44; and c&#41; haemodynamic variables&#58; systolic blood pressure&#44; diastolic blood pressure&#44; mean blood pressure&#44; heart rate &#40;HR&#41;&#44; global end diastolic volume&#44; systolic volume index &#40;SVI&#41;&#44; pulse pressure variation &#40;PPV&#41;&#44; stroke volume variation &#40;SVV&#41;&#44; left ventricular contractility index &#40;dpmax&#41;&#44; cardiac index &#40;CI&#41;&#44; and global ejection fraction&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Stroke volume variation &#40;SVV&#41; formula&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia>pulse pressure variation &#40;PPV&#41; formula&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0060" class="elsevierStylePara elsevierViewall">The data collection times are as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">T1&#58; 10&#8239;min after anaesthesia induction&#46; The patient is receiving bipulmonary ventilation &#40;Vt&#58; 8&#8239;ml&#47;kg&#41; in the supine position with the chest closed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">T2&#58; the patient is supine with one-lung ventilation &#40;Vt&#58; 6&#8239;ml&#47;kg&#41; and the chest closed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">T3&#58; the patient is lateral with bipulmonary ventilation &#40;Vt&#58; 8&#8239;ml&#47;kg&#41; and the chest closed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">T4&#58; the patient is lateral with one-lung ventilation &#40;Vt&#58; 6&#8239;ml&#47;kg&#41; and the chest closed&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">T5&#58; the patient is lateral with one-lung ventilation &#40;Vt&#58; 6&#8239;ml&#47;kg&#41;&#44; 15&#8239;min after thoracotomy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">T6 Preload&#58; haemodynamic data collected prior to volume overload&#44; when SVV&#8239;&#8805;&#8239;8&#37; or PPV&#8239;&#8805;&#8239;10&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">T6 Afterload&#58; haemodynamic data collected after volume overload with 250&#8239;ml crystalloid&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">T7&#44; T8 and T9&#58; these times correspond to subsequent volume overloads if the criteria of the study protocol were met&#46;</p></li></ul></p><p id="par0105" class="elsevierStylePara elsevierViewall">The study protocol was started once the patient had been placed lateral&#44; with the chest open&#44; and under one-lung ventilation with Vt 6&#8239;ml&#47;kg and optimal PEEP &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; For this protocol&#44; we choose SVV&#8239;&#8805;&#8239;8&#37; and PPV&#8239;&#8805;&#8239;10&#37; thresholds as the starting point for infusion of volume overload&#46; We chose these cut-off points based on the literature previously described&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> and on an earlier study performed by our research team in patients undergoing pulmonary resection surgery using pulse wave monitoring&#44; in which the influence of one-lung ventilation with VT 6&#8239;ml&#47;kg associated with the lateral position&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> These factors reduce PPV and SVV by around 30&#37; &#8212; a reduction that cannot be explained by haemodynamic changes&#46; Therefore&#44; in order for volume overload to be an effective predictive tool in lung resection surgery&#44; we believe that the threshold value for the start of administration should be reduced&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">According to our study protocol&#44; if CI&#8239;&#60;&#8239;2&#46;5&#8239;ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> and SVV&#8239;&#8805;&#8239;8&#37; and&#47;or PPV&#8239;&#8805;&#8239;10&#37;&#44; a load of 250&#8239;ml of crystalloids was administered over 15&#8239;min&#44; and the PiCCO monitor was recalibrated&#46; If CI remained at &#60;2&#46;5&#8239;ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> and SVV&#8239;&#8805;&#8239;8&#37; and&#47;or PVV&#8239;&#8805;&#8239;10&#37;&#44; fluid was administered until CI&#8239;&#62;&#8239;3&#46;5&#8239;ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> or SVV&#8239;&#60;&#8239;8&#37; and PVV&#8239;&#60;&#8239;10&#37;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The number of fluid loads administered was not predetermined&#44; but was individualised in each patient according to the parameters of the PiCCO monitor&#46; In our series of 25 patients&#44; 3 received no fluids&#44; 8 received a single load&#44; 9 received 2 loads&#44; 1 received 3 loads&#44; and 4 received up to 4 loads&#46; The PICCO monitor was calibrated before and after each load&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">If CI was &#60; 2&#46;5&#8239;ml&#47;mil&#47;m<span class="elsevierStyleSup">2</span> and SVV&#8239;&#60;&#8239;8&#37; and PPV&#8239;&#60;&#8239;10&#37;&#44; ionotropic vasopressors were administered until CI&#8239;&#62;&#8239;2&#46;5&#8239;ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#46; After extubation&#44; patients were given 3&#8239;ml&#47;kg&#47;h fluids for the first 24 postoperative hours&#44; with no additional volume overload&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">This is a preliminary pilot study for subsequent clinical trials on the use of dynamic pulse wave parameters to discriminate between responders and non-responders in lung resection surgery&#46; It will allow us to select an adequate sample size&#44; estimate optimal SSV and PPV cut-off points&#44; and evaluate the safety of goal-direct fluid therapy in lung resection surgery&#46; The sample size of 25 patients was estimated arbitrarily&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Demographic data are shown as mean&#8239;&#177;&#8239;standard deviation and the p value in the Kolmogorov-Smirnov normality test&#46; The categorical variables &#8220;sex&#8221; and &#8220;type of surgery&#8221; were analysed using the chi-square goodness of fit test in order to determine the homogeneity of the sample&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The CI and SVI variables are described as mean and standard deviation&#44; differentiating between data collection times and preload or afterload values&#46; Mixed linear regression models were used to assess whether differences between preload and afterload values were statistically significant&#46; A random &#34;patient&#34; effects factor was included to correct the non-independence of the data&#44; given the existence of repeated measures&#46; The data were plotted on box and whisker charts&#46; All analyses were performed using the statistical software R &#40;version 3&#46;5&#46;2&#41; and the NMF &#40;version 0&#46;21&#46;0&#41;&#44; lme4 &#40;version 1&#46;1&#8211;20&#41; and clicR &#40;version 0&#46;4&#46;20&#41; packages&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">To answer our primary objective&#44; patient loads were classified into 2 groups according to their response to volume expansion&#59; fluid load responders &#40;increase in CI&#8239;&#8805;&#8239;10&#37; and&#47;or SVI&#8239;&#8805;&#8239;10&#37;&#41; and non-responders &#40;no increase or increase in CI&#8239;&#60;&#8239;10&#37; and&#47;or SVI&#8239;&#60;&#8239;10&#37;&#41;&#46; We constructed 2 logistic regression models to determine the optimal cut-off point that maximizes the sensitivity and specificity of the area under the curve &#40;AUC&#41;&#58; one where the explanatory variable was PPV&#44; and another where it was SVV&#46; The odds ratio and its confidence interval and the AUC and its confidence interval were calculated for each model using the statistics programme pROC &#40;version 1&#46;14&#46;0&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0145" class="elsevierStylePara elsevierViewall">A total of 25 patients who met the inclusion criteria were included between January and May 2015&#46; All patients completed the study&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic characteristics of the study sample&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Predictive capacity of SVV and PPV variables</span><p id="par0155" class="elsevierStylePara elsevierViewall">After data collection&#44; a total of 39 loads were obtained&#44; of which 22 were fluid responders &#40;56&#46;41&#37;&#41; and 17 &#40;43&#46;58&#37;&#41; were fluid non-responders&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the haemodynamic variables &#40;expressed as means&#41; collected before and after fluid load at collection times T6 to T9&#44; and grouped according to responders or non-responders&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the CI and SVI variables &#40;expressed as mean&#8239;&#43;&#8239;standard deviation&#41;&#44; differentiating between collection times T6 to T9 and preload or afterload values&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> gives a box and whisker plot showing the changes in these variables before and after each fluid load&#46; CI and SVI values increase after fluid load&#44; except at T9&#46; Overall&#44; statistically significant differences between preload and afterload are observed&#44; showing an average increase in CI of 0&#46;31 &#40;95&#37; confidence interval &#91;CI&#93;&#41;&#58; 0&#46;03&#8211;0&#46;59&#59; p&#8239;&#61;&#8239;0&#46;042&#41; and an average increase in SVI of 4&#46;14 &#40;95&#37; CI&#58; 0&#46;34&#8211;7&#46;93&#59; p&#8239;&#61;&#8239;0&#46;045&#41;&#46; Although there appears to be a tendency for CI and SVI to increase as the number of load increases&#44; the differences are no statistically significant&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">The odds ratio for the SVV variable was 0&#46;94&#44; with 95&#37; CI&#58; 0&#46;75&#8211;1&#46;17 p&#8239;&#61;&#8239;0&#46;59&#46; The odds ratio for the PPV variable was 0&#46;96&#44; with 95&#37; CI&#58; 0&#46;82&#8211;1&#46;13 p&#8239;&#61;&#8239;0&#46;62&#46; In the ROC curve analysis &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; the AUC was not as expected&#44; since a discriminative value was not obtained&#58; AUC for SVV&#58; 0&#46;47&#44; with 95&#37; CI&#58; 0&#46;30&#8211;0&#46;65&#59; AUC for PPV&#58; 0&#46;50&#44; with 95&#37; CI&#58; 0&#46;33&#8211;0&#46;68&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">This study shows that dynamic volume responsiveness&#44; stroke volume variation and pulse pressure variation parameters cannot be used to predict response to volume overload during lung resection surgery with protective mechanical ventilation&#46; These results were obtained even after lowering the threshold for start of volume overload to adapt it to previously published evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17&#44;21&#44;23</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In an earlier study&#44; we described the behaviour of these parameters under different circumstance during lung resection surgery&#46; Both one-lung ventilation and lateral position generate a shunt of between 20&#37; and 30&#37; in the unventilated lung&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;23</span></a> This shunt does not contribute to PPV due to the absence of ventilation-induced cyclic changes in the non-ventilated lung&#59; therefore&#44; the PPV value can be diminished during one-lung ventilation&#46; This physiological process was also observed by Nieves et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in a study involving 50 patients undergoing lung resection surgery&#46; In this case&#44; a decrease in PPV of up to 50&#37; was observed during the establishment of one-lung ventilation and thoracotomy&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Heart-lung interaction is the physiological basis of dynamic volume responsiveness parameters&#46; This explains the effect of the amount of tidal volume administered on SVV and PPV values&#58; venous return decreases significantly with Vt&#8239;&#62;&#8239;8&#8239;ml&#47;kg and less markedly with Vt&#8239;&#60;&#8239;8&#8239;ml&#47;kg&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">In our study&#44; we were unable to show that a decrease in the threshold value of PPV and SVV improves the capacity of these parameters to predict volume responsiveness&#59; however&#44; this does not mean that this parameter adjustment is not needed to maximise the predictive value of dynamic volume responsiveness parameters in thoracic surgery&#44; since the physiological basis has been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;21&#44;23</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Our results are consistent with other studies on the use of predictive volume responsiveness parameters during open chest surgery&#44; in which statistically significant results in the AUC analysis were not obtained&#46; Jeong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> studied 80 patients undergoing lobectomy &#40;40 thoracoscopies&#59; 40 thoracotomies&#41; who received 7&#8239;ml&#47;kg colloids&#46; They found that SVV has no value in discriminating between responders and non-responders&#46; However&#44; they did observe differences in PPV between responders and non-responders &#40;6&#46;9&#8239;&#177;&#8239;3&#46;0&#37; vs&#46; 8&#46;4&#8239;&#177;&#8239;3&#46;2&#37;&#59; p&#8239;&#61;&#8239;0&#46;045&#41;&#44; as well as an AUC of 0&#46;63 &#40;95&#37; CI&#58; 0&#46;52&#8211;0&#46;74&#59; p&#8239;&#61;&#8239;0&#46;041&#41;&#44; albeit with low sensitivity &#40;58&#37;&#41; and specificity &#40;62&#37;&#41;&#46; They observed no differences between open or thoracoscopic surgery&#44; and concluded that dynamic volume responsiveness parameters are not useful in open or thoracoscopic surgery&#46; Fu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> evaluated 30 patients scheduled for open lobectomy with one-lung ventilation&#44; and obtained no differences in SVV between responders and non-responders&#46; Their AUC was very similar to ours &#40;0&#46;507&#59; 95&#37; CI&#58; 0&#46;294&#8211;0&#46;72&#41;&#44; and the authors concluded that the Vigileo-Flotrac&#174; pulse wave monitor does not predict response to fluids in open lobectomies with one-lung ventilation&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Some studies&#44; however&#44; have shown that dynamic SVV and PPV parameters can predict fluid responsiveness when the cut-off point for PPV is around 5&#46;8&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Vt is 6&#8239;ml&#47;kg&#44; the patient is positioned lateral&#44; and the chest is open&#46; The authors attributed this lower cut-off point to the decrease in tidal volume&#46; Other authors have shown the interdependence between the amount of tidal volume administered and the value of SVV and PPV&#44; irrespective of the patient&#8217;s haemodynamic status&#46; SVV and PPV increase if Vt&#8239;&#62;&#8239;10&#8239;ml&#47;kg&#44; and decrease if Vt&#8239;&#60;&#8239;8&#8239;ml&#47;kg&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;27</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Suehiro and Okutani&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in contrast&#44; conducted a study in 30 patients undergoing lung resection surgery with pulse wave monitoring&#44; and obtained an SVV cut-off value of 10&#46;5&#37;&#44; with an AUC of 0&#46;9 &#40;95&#37; CI&#58; 0&#46;809&#8211;0&#46;991&#41;&#44; a sensitivity of 82&#46;4&#37;&#44; and a specificity of 92&#46;3&#37;&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0215" class="elsevierStylePara elsevierViewall">The main limitation of this study&#44; which is merely a pilot study&#44; is that both the results and conclusions reached are limited by the lack of statistical power&#46; Therefore&#44; further studies with larger samples are needed to validate these parameters and obtain an optimal threshold value for the prediction of volume responsiveness in lung resection surgery&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Secondly&#44; in respect of other similar studies where cutoff values of 5&#46;8&#37; were obtained for PPV&#44; the threshold values used for starting volume load &#40;PPV&#8239;&#8805;&#8239;10&#37; and SVV&#8239;&#8805;&#8239;8&#37;&#41; in our study could have been too high to validate PPV and SVV in lung resection surgery&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Thirdly&#44; our ventilatory variables did not include PEEP values&#44; even though this variable was individualised for each patient and could have altered intrathoracic pressure&#44; thereby modifying the value of dynamic fluid responsiveness pulse wave parameters&#46; Neither did we record the vasopressor doses administered&#46; Volume responsiveness may be determined by a decrease in intravascular volume or by a decrease in vascular tone&#44; particularly when local epidural anaesthetics are administered during surgery&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Finally&#44; intraoperative temperature data were not recorded&#46; This parameter should be monitored in future studies&#44; since hypothermia can alter thermodilution parameters&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0235" class="elsevierStylePara elsevierViewall">Despite lowering the PPV and SVV volume overload threshold by 30&#37;&#44; the predictive power of these parameters to discriminate between volume responders and non-responders during lung resection surgery could not be statistically demonstrated&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0240" class="elsevierStylePara elsevierViewall">This study was not funded by grants from the <span class="elsevierStyleGrantSponsor" id="gs0005">public sector&#44; trade sector or non-profit entities</span>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1308771"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1208274"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1308770"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1208275"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "General procedures"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Study protocol"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Predictive capacity of SVV and PPV variables"
            ]
          ]
        ]
        7 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-06-27"
    "fechaAceptado" => "2019-10-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1208274"
          "palabras" => array:5 [
            0 => "Lung resection surgery"
            1 => "Goal directed fluid therapy"
            2 => "Stroke volume variation &#40;SVV&#41;"
            3 => "Pulse pressure variation &#40;PPV&#41;"
            4 => "One-lung ventilation"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1208275"
          "palabras" => array:5 [
            0 => "Cirug&#237;a de resecci&#243;n pulmonar"
            1 => "Fluidoterapia guiada por objetivos"
            2 => "Variaci&#243;n de volumen sist&#243;lico &#40;VVS&#41;"
            3 => "Variaci&#243;n presi&#243;n de pulso &#40;VPP&#41;"
            4 => "Ventilaci&#243;n unipulmonar"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">In lung resection surgery&#44; restrictive fluid therapy is recommended due to the risk of acute lung injury&#46; In contrast&#44; this recommendation increases the risk of hypoperfusion&#46; Guided fluid therapy allows individualization of fluid intake&#46; The use of dynamic volume response parameters is not validated during one-lung ventilation&#46; The main objective is the validation of dynamic parameters&#44; stroke volume variation &#40;SVV&#41; and pulse pressure variation &#40;PPV&#41;&#44; during lung resection surgery as fluid response predictors&#44; after the administration of 250 ml crystalloid volume loads&#44; if IC&#8239;&#60;&#8239;2&#46;5&#8239;ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> and if SVV&#8239;&#8805;&#8239;8&#37; and&#47;or PPV&#8239;&#8805;&#8239;10&#37;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pilot&#44; prospective&#44; observational and single centre study&#46; Twenty-five patients monitored with the PiCCO system were included during open lung resection surgery with the patient in a lateral position&#44; one lung ventilation with tidal volume &#40;TV&#41;&#58; 6&#8239;ml&#47;kg and open chest&#46; Hemodynamic variables were collected before and after volume loading&#46; The results were classified into two groups&#58; volume responders &#40;increase IC&#8239;&#8805;&#8239;10&#37; and&#47;or VSI&#8239;&#8805;&#8239;10&#37; after volume loading&#41; and non-responders &#40;no increase or increase IC&#8239;&#60;&#8239;10&#37; and&#47;or VSI&#8239;&#60;&#8239;10&#37; after volume loading&#41;&#46; We assess the diagnostic efficacy of SVV and PPV by analyzing the AUC &#40;area under curve&#41; in the ROC curves&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">In the analysis of ROC curves&#44; SVV and PPV did not reach a discriminative value &#40;AUC SVV&#58; 0&#46;47&#59; AUC PPV&#58; 0&#46;50&#41;&#44; despite the decrease in the threshold value of SVV and PPV to initiate an overload of volume during one-lung ventilation&#44; in lateral position and open chest&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The results obtained show that the values of the dynamic parameters of volume response &#40;SVV&#8239;&#8805;&#8239;8&#37; and PPV&#8239;&#8805;&#8239;10&#37;&#41; do not discriminate against responders patients and nonresponders during open lung resection surgery&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">En cirug&#237;a de resecci&#243;n pulmonar&#44; se recomienda la fluidoterapia restrictiva debido al riesgo de lesi&#243;n pulmonar aguda&#46; Por contra&#44; esta recomendaci&#243;n aumenta el riesgo de hipoperfusi&#243;n&#46; La terapia guiada por objetivos permite individualizar el aporte de fluidos&#46; El uso de par&#225;metros din&#225;micos de respuesta a volumen no est&#225; validado durante la ventilaci&#243;n unipulmonar&#46; El objetivo principal es la validaci&#243;n de los par&#225;metros din&#225;micos&#44; variaci&#243;n de volumen sist&#243;lico &#40;VVS&#41; y presi&#243;n de pulso &#40;VPP&#41;&#44; durante cirug&#237;a de resecci&#243;n pulmonar como predictores de respuesta a fluidos&#44; tras la administraci&#243;n de cargas de volumen de 250&#8239;ml de cristaloides&#44; si IC&#8239;&#60;&#8239;2&#46;5&#8239;ml&#47;min&#47;m2 y si VVS&#8239;&#8805;&#8239;8&#37; y&#47;o VPP&#8239;&#8805;&#8239;10&#37;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y M&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Estudio piloto&#44; prospectivo&#44; observacional y unic&#233;ntrico&#46; Se incluyeron 25 pacientes monitorizados con el sistema PiCCO durante la cirug&#237;a abierta de resecci&#243;n pulmonar con el paciente en posici&#243;n de dec&#250;bito lateral&#44; ventilaci&#243;n unipulmonar con VC&#58; 6&#8239;ml&#47;kg y t&#243;rax abierto&#46; Se recogieron variables hemodin&#225;micas antes y despu&#233;s de la carga de volumen&#46; Los resultados se clasificaron en dos grupos&#58; respondedores a volumen &#40;aumento de IC&#8239;&#8805;&#8239;10&#37; y&#47;o VSI&#8239;&#8805;&#8239;10&#37; tras la carga de volumen&#41; y los no respondedores &#40;no aumento o aumento del IC&#8239;&#60;&#8239;10&#37; y&#47;o VSI&#8239;&#60;&#8239;10&#37; tras la carga de volumen&#41;&#46; Evaluamos la eficacia diagn&#243;stica de VVS y VPP mediante el estudio del AUC &#40;&#225;rea bajo a curva&#41; de las curvas ROC&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">En el an&#225;lisis de curvas ROC&#44; VVS y VPP no alcanzaron un valor discriminativo &#40;AUC VVS&#58; 0&#44;47&#59; AUC VPP&#58; 0&#44;50&#41;&#44; a pesar de la disminuci&#243;n del valor umbral de VVS y VPP para iniciar una sobrecarga de volumen durante la ventilaci&#243;n unipulmonar&#44; en dec&#250;bito lateral y con el t&#243;rax abierto&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Los resultados obtenidos muestran que los valores de los par&#225;metros din&#225;micos de respuesta a volumen &#40;VVS&#8239;&#8805;&#8239;8&#37; y VPP&#8239;&#8805;&#8239;10&#37;&#41; no discriminan a los pacientes respondedores y los no respondedores durante la cirug&#237;a de resecci&#243;n pulmonar abierta&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mi&#241;ana A&#44; Parra MJ&#44; Carbonell J&#44; Soro M&#44; Belda J&#44; Ferrando C&#46; Estudio de validaci&#243;n de los par&#225;metros din&#225;micos de onda de pulso en cirug&#237;a de resecci&#243;n pulmonar&#46; Rev Esp Anestesiol Reanim&#46; 2020&#59;67&#58;55&#8211;62&#46;</p>"
      ]
    ]
    "multimedia" => array:8 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1759
            "Ancho" => 2500
            "Tamanyo" => 129732
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Study protocol&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CI&#58; cardiac index&#59; PPV&#58; pulse pressure variation&#59; SSV&#58; stroke volume variation&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 921
            "Ancho" => 2520
            "Tamanyo" => 101660
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Box and whisker plot of cardiac index &#40;CI&#41; and stroke volume index &#40;SVI&#41; parameters&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 843
            "Ancho" => 2544
            "Tamanyo" => 136933
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ROC curves for stroke volume variation &#40;SVV&#41; and pulse pressure variation &#40;PPV&#41;&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Nota de la traductora&#58; cambiar comas decimales a puntos&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#59; MV&#58; mechanical ventilation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Demographic variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Standard deviation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p &#40;Kolmogorov&#8211;Smirnov&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Real weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ideal weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surgery time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MV time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2242725.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Patient demographics&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">dPmax&#58; maximum left ventricular contractility&#59; GEDI&#58; global end-diastole index&#59; GEF&#58; global ejection fraction&#59; CFI&#58; coronary function index&#59; CI&#58; cardiac index&#59; PPV&#58; pulse pressure variation&#59; SVI&#58; stroke volume index&#59; SVV&#58; stroke volume&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Responders &#40;n&#8239;&#61;&#8239;22&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-responders &#40;n&#8239;&#61;&#8239;17&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SVV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SVI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DPMAX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">638&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">771&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">611&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">729&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GEDI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">720&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">712&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">743&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">687&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GEF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CFI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2242723.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Haemodynamic variables before and after loading at times t6&#8211;t9&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CI&#58; cardiac index&#59; SVI&#58; stroke volume index&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SVI</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Preload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Afterload&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;89 &#40;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2 &#40;0&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;64 &#40;10&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;76 &#40;10&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;96 &#40;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;36 &#40;0&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;86 &#40;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;77 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;22 &#40;0&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;62 &#40;0&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;83 &#40;6&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;83 &#40;4&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;73 &#40;0&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;52 &#40;0&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;7&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;5 &#40;0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2242724.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Preload and afterload IC and SVI values at each load time&#46;</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "eq0005"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "SVV&#61;&#8239;SVmax-SVmin1&#47;2SVmax&#43;SVminx100"
          "Fichero" => "STRIPIN_si1.jpeg"
          "Tamanyo" => 2760
          "Alto" => 34
          "Ancho" => 196
        ]
      ]
      7 => array:5 [
        "identificador" => "eq0010"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "PPV&#61;&#8239;PPmax-PPmin1&#47;2PPmax&#43;PPminx100"
          "Fichero" => "STRIPIN_si2.jpeg"
          "Tamanyo" => 2807
          "Alto" => 34
          "Ancho" => 197
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care unit &#40;ICU&#41; readmission after major lung resection&#58; Prevalence&#44; patterns&#44; and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Jung"
                            1 => "J&#46;H&#46; Cho"
                            2 => "T&#46;H&#46; Hong"
                            3 => "H&#46;K&#46; Kim"
                            4 => "Y&#46;S&#46; Choi"
                            5 => "J&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1759-7714.12406"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorac Cancer"
                        "fecha" => "2017"
                        "volumen" => "8"
                        "paginaInicial" => "33"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27925393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unplanned readmission after lung resection&#58; Complete follow-up in a 1-year cohort with identification of associated risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;J&#46; Dickinson"
                            1 => "J&#46;B&#46; Taswell"
                            2 => "M&#46;S&#46; Allen"
                            3 => "S&#46;H&#46; Blackmon"
                            4 => "F&#46;C&#46; Nichols 3rd"
                            5 => "R&#46; Shen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2016.09.065"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2017"
                        "volumen" => "103"
                        "paginaInicial" => "1084"
                        "paginaFinal" => "1091"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27993376"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of the amount of intraoperative fluid administration on postoperative pulmonary complications following anatomic lung resections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;K&#46; Arslantas"
                            1 => "H&#46;V&#46; Kara"
                            2 => "B&#46;B&#46; Tuncer"
                            3 => "B&#46; Yildizeli"
                            4 => "M&#46; Yuksel"
                            5 => "K&#46; Bostanci"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2014.08.071"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2015"
                        "volumen" => "149"
                        "paginaInicial" => "314"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25304302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of intraoperative fluid management on postoperative outcomes after lobectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46; Wu"
                            1 => "R&#46; Yang"
                            2 => "J&#46; Xu"
                            3 => "A&#46; Rusidanmu"
                            4 => "X&#46; Zhang"
                            5 => "J&#46; Hu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2018.12.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2019"
                        "volumen" => "107"
                        "paginaInicial" => "1663"
                        "paginaFinal" => "1669"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30641068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National heart lung and blood institute acute respiratory distress syndrome clinical trials network&#46; Comparison of two fluid-management strategies in acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;P&#46; Wiedemann"
                            1 => "A&#46;P&#46; Wheeler"
                            2 => "G&#46;R&#46; Bernard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2006"
                        "volumen" => "354"
                        "paginaInicial" => "1564"
                        "paginaFinal" => "1575"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid Therapy in Thoracic Surgery&#58; A Zero-Balance Target is Always Best&#33;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Licker"
                            1 => "F&#46; Triponez"
                            2 => "C&#46; Ellenberger"
                            3 => "W&#46; Karenovics"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5152/TJAR.2016.006"
                      "Revista" => array:7 [
                        "tituloSerie" => "Turk J Anaesthesiol Reanim"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "paginaInicial" => "227"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27909600"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0022202X1831858X"
                          "estado" => "S300"
                          "issn" => "0022202X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid administration during lung resection&#58; what is the optimum&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;F&#46; Batirel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/jtd.2019.05.16"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2019"
                        "volumen" => "11"
                        "paginaInicial" => "1746"
                        "paginaFinal" => "1748"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31285864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery&#58; A multi-center&#44; prospective&#44; randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Salzwedel"
                            1 => "J&#46; Puig"
                            2 => "A&#46; Carstens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc12885"
                      "Revista" => array:4 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "1"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early goal-directed therapy after major surgery reduces complications and duration of hospital stay&#46; A randomised&#44; controlled trial &#91;ISRCTN38797445&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Pearse"
                            1 => "D&#46; Dawson"
                            2 => "J&#46; Fawcett"
                            3 => "A&#46; Rhodes"
                            4 => "R&#46;M&#46; Grounds"
                            5 => "E&#46; Bennett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc3887"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "R687"
                        "paginaFinal" => "R693"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16356219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid Management in Thoracic Surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;P&#46; Searl"
                            1 => "A&#46; Perrino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anclin.2012.08.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiol Clin"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "641"
                        "paginaFinal" => "655"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23089500"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fluid management in thoracic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Assaad"
                            1 => "W&#46; Popescu"
                            2 => "A&#46; Perrino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0b013e32835c5cf5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2013"
                        "volumen" => "26"
                        "paginaInicial" => "31"
                        "paginaFinal" => "39"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23262471"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Functional hemodynamic monitoring and dynamic indices of fluid responsiveness"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Cavallaro"
                            1 => "C&#46; Sandroni"
                            2 => "M&#46; Antonelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aet429"
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Anestesiol"
                        "fecha" => "2008"
                        "volumen" => "74"
                        "paginaInicial" => "123"
                        "paginaFinal" => "135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18212731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review of uncalibrated arterial pressure waveform analysis to determine cardiac output and stroke volume variation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Slagt"
                            1 => "I&#46; Malagon"
                            2 => "A&#46;B&#46;J&#46; Groeneveld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aet429"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2014"
                        "volumen" => "112"
                        "paginaInicial" => "626"
                        "paginaFinal" => "637"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24431387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy&#58; Randomised controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;H&#46; Lee"
                            1 => "Y&#46; Jeon"
                            2 => "J&#46;H&#46; Bahk"
                            3 => "N&#46;S&#46; Gil"
                            4 => "D&#46;M&#46; Hong"
                            5 => "J&#46;H&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/EJA.0b013e32834089cf"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Anaesthesiol"
                        "fecha" => "2011"
                        "volumen" => "28"
                        "paginaInicial" => "39"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21088596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hemodynamic monitoring in thoracic surgical patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Raphael"
                            1 => "L&#46;A&#46; Regali"
                            2 => "R&#46;H&#46; Thiele"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ACO.0000000000000408"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Anaesthesiol"
                        "fecha" => "2017"
                        "volumen" => "30"
                        "paginaInicial" => "7"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28030449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monitoring pulse pressure variation during lung resection surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Nieves Alonso"
                            1 => "E&#46; Alday Mu&#241;oz"
                            2 => "A&#46; Planas Roca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.redar.2018.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanim"
                        "fecha" => "2019"
                        "volumen" => "66"
                        "paginaInicial" => "78"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30314679"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Freitas"
                            1 => "A&#46; Bafi"
                            2 => "A&#46; Nascente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/bja/aes398"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Anaesth"
                        "fecha" => "2013"
                        "volumen" => "110"
                        "paginaInicial" => "402"
                        "paginaFinal" => "408"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23161359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recruitment maneuvers for one-lung ventilation during thoracic anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Tusman"
                            1 => "S&#46;H&#46; Bohm"
                            2 => "F&#46; Suarez-Sipmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40140-014-0054-9"
                      "Revista" => array:4 [
                        "tituloSerie" => "Curr Anesthesiol Rep"
                        "fecha" => "2014"
                        "volumen" => "4"
                        "paginaInicial" => "160"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Setting individualized positive end-expiratory pressure level with a positive end-expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Ferrando"
                            1 => "A&#46; Mugarra"
                            2 => "A&#46; Gutierrez"
                            3 => "M&#46; Soro"
                            4 => "G&#46; Tusman"
                            5 => "F&#46;J&#46; Belda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000000105"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2014"
                        "volumen" => "118"
                        "paginaInicial" => "657"
                        "paginaFinal" => "665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Suehiro"
                            1 => "R&#46; Okutani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jvca.2010.03.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cardiothorac Vasc Anesth"
                        "fecha" => "2010"
                        "volumen" => "24"
                        "paginaInicial" => "772"
                        "paginaFinal" => "775"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20638869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations&#58; a pilot study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Zhang"
                            1 => "C&#46; Chen"
                            2 => "X&#46; Lei"
                            3 => "Z&#46; Feng"
                            4 => "S&#46; Zhu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.6061/clinics/2013(07)27"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinics"
                        "fecha" => "2013"
                        "volumen" => "68"
                        "paginaInicial" => "1065"
                        "paginaFinal" => "1070"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23917675"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Huang"
                            1 => "J&#46; Fu"
                            2 => "H&#46; Hu"
                            3 => "K&#46;C&#46; Kao"
                            4 => "N&#46;H&#46; Chen"
                            5 => "M&#46;J&#46; Hsieh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e318186b74e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2008"
                        "volumen" => "36"
                        "paginaInicial" => "2810"
                        "paginaFinal" => "2816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18766099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dynamic predictors of fluid responsiveness during thoracic surgery&#46; A descriptive prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Socorro"
                            1 => "A&#46; Mi&#241;ana"
                            2 => "C&#46; Ferrando"
                            3 => "A&#46; Katime"
                            4 => "I&#46; Leon"
                            5 => "J&#46; Belda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Eur J Anesthesiol"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A tutorial on pilot studies&#58; the what&#44; why and how"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Thabane"
                            1 => "J&#46; Ma"
                            2 => "R&#46; Chu"
                            3 => "C&#46;H&#46; Goldsmith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2288-10-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Med Res Methodol"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20053272"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke volume variation and pulse pressure variation are not useful for predicting fluid responsiveness in thoracic surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;M&#46; Jeong"
                            1 => "H&#46;J&#46; Ahn"
                            2 => "H&#46;W&#46; Park"
                            3 => "M&#46; Yang"
                            4 => "J&#46;A&#46; Kim"
                            5 => "J&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1213/ANE.0000000000002056"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2017"
                        "volumen" => "125"
                        "paginaInicial" => "1158"
                        "paginaFinal" => "1165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28504996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Q&#46; Fu"
                            1 => "F&#46; Zhao"
                            2 => "W&#46; Mi"
                            3 => "H&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5582/bst.8.59"
                      "Revista" => array:5 [
                        "tituloSerie" => "Biosci Trends"
                        "fecha" => "2014"
                        "volumen" => "8"
                        "paginaInicial" => "59"
                        "paginaFinal" => "63"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;A&#46; Reuter"
                            1 => "F&#46;C&#46; Weis"
                            2 => "P&#46; Lamm"
                            3 => "A&#46;E&#46; Goetz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-1649-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "476"
                        "paginaFinal" => "480"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12579420"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PiCCO monitoring accuracy in low body temperature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Sami"
                            1 => "A&#46; Sami"
                            2 => "N&#46; Rochdil"
                            3 => "K&#46; Hatem"
                            4 => "B&#46;L&#46; Salah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2006.11.046"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2007"
                        "volumen" => "25"
                        "paginaInicial" => "845"
                        "paginaFinal" => "846"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17870495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23411929/0000006700000002/v1_202002150624/S2341192920300147/v1_202002150624/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "34051"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006700000002/v1_202002150624/S2341192920300147/v1_202002150624/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192920300147?idApp=UINPBA00004N"
]

Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2019.10.004

The statistics are updated each day

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter