Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study | Revista Española de Anestesiología y Reanimación (English Edition)

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Martín-Serrano, E. Alday-Muñoz, A. Planas-Roca, E. Martín-Pérez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Martín-Serrano" "email" => array:1 [ 0 => "patrims_91@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Alday-Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Planas-Roca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Martín-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Anestesiología y Reanimación, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas, Las Palmas de Gran Canaria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cirugía General y Digestivo, Hospital de La Princesa, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso del contenido de fluido torácico para la predicción del balance hídrico y las complicaciones pulmonares postoperatorias tras cirugía abdominal mayor" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1836 "Ancho" => 1627 "Tamanyo" => 88170 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "TFCd0% correlation at 24 h and fluid balance." ] ] ] "textoCompleto" => "IntroductionThe harmful effects of excess fluids frequently manifest in the lungs. So much so that postoperative pulmonary complications are the most common non-surgical complications. In major abdominal surgery they can affect 5%–40% of patients.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>Among them, postoperative atelectasis can complicate the evolution of patients after major abdominal surgery. They are found in 20%–70% of cases of severe postoperative hypoxemia.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> Variation in perioperative fluid administration within the range of usual clinical practice can be associated with its appearance.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Bioreactance is a non-invasive tool to monitor changes in electrical impedance of the chest. Thoracic fluid content (TFC) is a variable provided by the STARLING™ Bioreactance Cardiac Output Monitor. It is the inverse of the transthoracic electrical impedance (Z0) and represents the total volume of fluid in the chest.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The main objective of the study was to analyse the association of TFCd0% (percentage of change in thoracic fluid content with respect to its baseline value, acquired in the first five readings, considering that the monitor automatically measures its parameters every 8 seconds), measured 24 h after surgery, with the fluid balance of the patients. The secondary objective was to analyse the relationship between TFC and the appearance of postoperative atelectasis measured by lung ultrasound, as well as pulmonary congestion. The relationship between TFC during the surgical procedure with intraoperative fluid balance and surgical stress was analysed, measured through the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scale.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Material and methodsA prospective and analytical observational study was carried out.Patients scheduled for major abdominal surgery at a tertiary university hospital between August 9, 2018 and November 25, 2019 were included. The study was previously approved by the CEIm of the La Princesa University Hospital (07/26/2018).The inclusion criteria were: patients undergoing scheduled major abdominal surgery for whom monitoring was performed with the STARLING™ non-invasive hemodynamic monitor and with a scheduled stay in Resuscitation of at least 18−24 hours. Patients who did not give their consent to participate, who were admitted to the resuscitation unit undergoing mechanical ventilation or with a contraindication for bioreactance monitoring (aortic disease, complex congenital heart disease or previous lung resection) were excluded.Study protocolAfter obtaining informed consent and prior to anaesthetic induction, the two pairs of sensors of the STARLING™ non-invasive hemodynamic monitor were placed on the patient's back. The baseline values obtained were recorded and the TFC at that time was recorded as the baseline value, from which the TFCd0% would be calculated at different times from then on. This bioreactance technology (patented and exclusive to this monitor) is a non-invasive tool to monitor changes in electrical impedance of the chest. It is based on the analysis of the phase change that occurs in the electrical frequency wave that is emitted to the thorax due to changes in blood volume.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> It is considered a diagnostic technique to measure the electrical properties of biological tissues in the chest. The principle of this technique consists of applying a current of known frequency between the external pairs of sensors and subsequently a signal is recorded between the internal pairs of sensors. When the heart dilates and contracts, the bloodstream creates a delay, or phase shift, in the flow. The monitor uses this phase change as a starting point for measuring systolic volume.Monitoring was maintained throughout the intraoperative period and the first 24 h postoperatively.Management was carried out according to the anaesthetic criteria of the anaesthetist in charge of the operating room. Mechanical ventilation was performed with a protective and open lung ventilation strategy according to the protocol published in the iPROVE<a class="elsevierStyleCrossRef" href="#bib0045">9</a> study. Alveolar recruitment manoeuvres were performed in those patients in whom the appearance of atelectasis was suspected due to unexplained loss of pulmonary compliance coupled with a positive AirTest.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Intraoperative maintenance fluid therapy was performed with balanced crystalloid solutions at 1−3 ml/kg/hour in laparoscopic surgery and 4−7 ml/kg/hour in open surgery. Bleeding was replaced with colloids in a 1:1 ratio. When the administration of blood products was necessary, they were transfused according to the transfusion guidelines of the National Institute for Health Care and Excellence (NICE).<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Given the suspicion of hypovolemia based on haemodynamic monitoring data, tests were performed with 250 cc crystalloid boluses guided by the haemodynamic response of the STARLING™ monitor.After surgery, the patients were extubated to the resuscitation unit, where after 15 min they would undergo an AirTest<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and a first lung ultrasound, following the modified protocol described by Volpicelli et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> (excluding the bilateral anteroinferior areas). Patterns that could indicate pathology were looked for: presence of  B lines, pleural effusion and consolidations suggestive of atelectasis. Image captures were made of each of the explored fields and stored to measure the area of atelectasis with the ImageJ software. A new lung ultrasound was performed 24 h later by the same researcher.All Resuscitation care was carried out in accordance with usual practice. In no case were fluids administered or restricted taking into account the value of TFC or TFCd0%.The fluid balance balance of the first 24 h was also counted in the usual way by adding inputs and subtracting diuresis, vomiting, drainage outputs, including blood and insensible losses. Insensible losses were counted as .5 ml/kg/hour.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Collection of variablesThe anthropometric characteristics of the patients (age, weight and height), the risk classification of complications (ASA, ARISCAT, rCRI), the characteristics of the anaesthetic management (use of epidural anaesthesia, administered fluid therapy…) and surgical management (type of intervention, open or laparoscopic approach, time in surgery) were collected.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> The level of surgical stress was estimated according to the scale for estimating physiological capacity and surgical stress (E-PASS).<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The lung ultrasound and AirTest were performed 15 min after arrival at the Resuscitation Unit and were repeated the next morning after surgery. The presence of  B lines and their score according to the Simplified Ultrasound Comet Tail Grading Scoring, the appearance and size of consolidations, and the presence or absence of pleural effusion were recorded.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>TFC and TFCd0% values were collected at different times: baseline (prior to the induction of general anaesthesia), at the beginning of intraoperative mechanical ventilation, at the end of surgery prior to awakening, after extubation 15 min after arrival at Resuscitation and the day after surgery.During the first 15 min after extubation and the next day after surgery, the following were recorded: the presence of B-lines, pleural effusion and atelectasis on postoperative ultrasound, as well as hypoxemia or the need for invasive or non-invasive mechanical ventilation. <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Atelectasis was diagnosed as an image of pulmonary consolidation with static air bronchogram ultrasound.</li><li class="elsevierStyleListItem" id="lsti0010">•Pleural effusion was defined as a homogeneous hypoechoic or anechoic collection in the dependent part of the thoracic cavity, above the line of the diaphragm.</li><li class="elsevierStyleListItem" id="lsti0015">•B lines were defined as vertical, hyperechoic artifacts originating from the pleural line and extending to the bottom of the screen moving synchronously with respiration. They were considered pathological if three or more vertical  B lines appeared with loss of the  A lines between two ribs.<a class="elsevierStyleCrossRef" href="#bib0085">17</a></li><li class="elsevierStyleListItem" id="lsti0020">•Hypoxemia was defined as arterial oxygen pressure (PaO2) <80 mmHg.<a class="elsevierStyleCrossRef" href="#bib0090">18</a></li><li class="elsevierStyleListItem" id="lsti0025">•The AirTest was considered positive with values of 96% or less, and negative if it was greater than 96%.<a class="elsevierStyleCrossRef" href="#bib0050">10</a></li></ul>Like Gustafsson et al., the variable “pulmonary congestion” was defined taking into account findings suggestive of pulmonary congestion (B lines and/or pleural effusion) as an indirect measure to quantify lung fluid and changes in fluids in the pleural space or the lung parenchyma.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a>Statistical analysisThe sample size calculation was carried out with the GRANMO programme version 7.12.For the descriptive statistics of the variables, the mean, standard deviation, median and the 25th and 75th percentiles were calculated for the quantitative variables. Frequency and percentage were calculated in the qualitative variables.The Shapiro–Wilk test was used to check the normality of the data.Logistic regression was used to predict dichotomous variables and the area under the ROC curve was used to test goodness of fit. The variance inflation factor (VIF) statistic was used to check the multicollinearity of the variables.A logistic regression was performed to predict the appearance of atelectasis and pulmonary congestion at 24 h, where the TFC and TFCd0% values at different times were included. The optimal model was obtained, composed of three variables that measured the evolution of thoracic fluid content at different moments in time: baseline TFC, TFCd0% before extubation and TFC at 24 h.The Pearson correlation coefficient was calculated to check the association between numerical variables. A means comparison test was used to analyse quantitative variables that followed a normal distribution (Student's t).Values of p ≤ .05 were considered statistically significant in drawing up the conclusions.ResultsA total of 54 patients were included, of which 4 abandoned the study due to loss of bioreactance monitoring (7.41%), leaving a total of 50 patients. The characteristics of the patients and the surgical procedures, as well as the distribution of the TFC at different times, are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>The findings of the ultrasounds performed and other respiratory complications in the first 24 h postoperatively, starting from admission to Resuscitation, are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The r-Pearson correlation for postoperative balance with TFCd0% measured on the morning of the first postoperative day had r = .44 (p = .002; 95% CI: .17–.65), as seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. TFCd0% before extubation did not correlate with intraoperative fluid balance, with the r-Pearson being .104, with p = .474.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>There was a relationship between the duration of the intervention and the TFC before extubation (r = .466; p = .001). There was a slight correlation (r = .285; p = .45) between the TFCd0% before extubation and the Comprehensive risk score, and a moderate correlation (r = .308; p = .029) with the Surgical stress score.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Once the multivariate analysis was carried out with the optimal model (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), it was observed that the TFC at 24 h was a risk factor for the appearance of atelectasis at 24 h, with an odds ratio (OR) of 1.24 (95% CI: 1.06–1.53; p = .021).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>We observed that an increase in TFC at 24 h (TFCd0% at 24 h) increased the risk of developing pulmonary congestion, with an OR of 1.3 (95% CI: 1.06–2.77) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>The TFCd0% at 24 h was also higher in patients who presented B-lines defined as pathological (three or more vertical B-lines with loss of A-lines between two ribs) with a value of 34.25 ± 16.79%, compared to 26.01 ± 13.33% in those patients without B lines or with less than three (p = .065).DiscussionUse of variation in thoracic fluid content to predict postoperative fluid balanceThe TFC increased throughout the perioperative process. The variation in thoracic fluid content measured 24 h after surgery and considering the TFC obtained before anesthetic induction as the baseline value (45 kΩ–1), was related to the postoperative fluid balance of the patients, calculated at that same moment, with r = .44.The bioreactance monitoring system has shown that there is a relationship between TFC and fluid balance during a heamodialysis session. Specifically, in 2009, Kossari et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> found a strong correlation of TFC with the amount of fluid extracted (r = .8; p < .0001), studying 25 patients with chronic renal failure who underwent routine haemodialysis sessions.It is likely that this difference in the strength of the correlation was due to the heterogeneity of the surgical population and its interventions, as well as the variability in the response to stress, which could imply this lower correlation.The study population by Kossari et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> was fairly uniform: 25 patients with stable chronic renal failure without overt heart failure undergoing routine haemodialysis sessions: a process with relatively stable physiological stress. Considering that thoracic fluid content provides only a relative measure of changes in thoracic fluid (water, fat, bone, lung tissue and muscles), the difference in result could be partially justified by changes in the distribution of our population, with a lower average age, typical of the surgical population (65.82 ± 12.85 years compared to almost 12 years more for patients undergoing haemodialysis), and also an inversion of the male: female ratio, this being 1:1.6, typical of the representative population in our environment, and invested in our baseline study (1.5:1). There were also subtle differences in weight and height. All of this would invariably change the thoracic configuration and the TFC results.Important changes were also found that justified the heterogeneity of the study in the great variety of procedures that our patients underwent. These were very varied major abdominal surgery processes, 46% being laparoscopic compared to 54% open, and including among them colorectal, hepatobiliary, pancreatic, intestinal surgeries, etc.This heterogeneity found is typical of a surgical population, and the correlation of r = .44 in our study has moderate strength to predict the fluid balance of patients in an effective, quantifiable, monitorable, observer-independent, and economical and non-invasive manner.Nowadays, thoracic fluid content can be measured either by subjective and imprecise indirect measurements (such as lung auscultation, degree of dyspnoea, interpretation of chest x-ray or even fluid balance itself), or by objective measurements but more invasive and with greater financial expense, such as the use of Swan-Ganz catheters to measure pulmonary capillary wedge pressure or the right atrium, or through serial determination of pro-B type natriuretic peptide (proBNP).<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Alternatively, bioreactance devices could be used in a non-invasive and reliable manner, not only to perform goal-directed fluid therapy, avoiding excessively liberal fluid administration, but to continuously monitor and predict postoperative fluid balance and initiate early treatment for possible effects derived from overload or lack of fluids.Just as we used the variation in thoracic fluid content to predict postoperative fluid balance in our patients, we wanted to check if this same correlation was true intraoperatively. However, TFCd0% before extubation (mean 21.27 ± 14.40%) did not correlate with intraoperative fluid balance, with a median of 175.5 ml (IQR: −427.25–698.12), where practically 75% of the patients obtained a neutral balance (between −500 ml and +500 ml), as dictated by the protocol.In our study, fluid balance during surgery and TFC were not correlated; However, there was a relationship between the duration of the intervention and the TFC before extubation (r = .466; p = .001), with 243.92 ± 95.23 min; This relationship was probably due to the greater endothelial damage produced in the context of the surgical trauma of long-term surgery.<a class="elsevierStyleCrossRefs" href="#bib0115">23–25</a>Surgical stress was highly variable depending on the type of surgery, with a median in the E-PASS classification, Comprehensive risk score, of .29, but with a very wide range from −.22 to +1.08 and there was a slight correlation (r = .285; p = .45) between the TFCd0% before extubation and the comprehensive risk score, and a moderate one (r = .308; p = .029) with the surgical stress score. Similarly to surgical time (which is included in this equation), greater stress or surgical aggression can produce greater detachment of the endothelial glycocalyx and, thus, increase its dysfunction and increase TFC.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Use of postoperative thoracic fluid content variation to determine the incidence of postoperative pulmonary complicationsPostoperative pulmonary complications are the most common nonsurgical complications and increase postoperative length of stay, mortality, and costs. This figure is variable in the literature, usually approximately 6.8% in major abdominal surgery, but since the criteria used to define respiratory complications are very inconsistent, some authors estimate them as high as 40%.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a>The increase in TFC at 24 h was a risk factor for the appearance of atelectasis at 24 h.A ROC curve was created with an area under the curve of .78 (95% CI: .62–.94) with the predictive probabilities obtained in this model, obtaining a high sensitivity of 94.1%. In other words, with a high possibility that the patient with atelectasis had a high TFC, but a low specificity, of 60%, so there could be a rate of up to 40% of patients with high TFC who did not present atelectasis, i.e, false positives. Therefore, as a screening test it could be acceptable, but, given its low specificity, the diagnosis would have to be confirmed with a second test.In our study, this test was lung ultrasound. There are multiple publications aimed at evaluating the performance of lung ultrasound in the detection of postoperative atelectasis after general anaesthesia. The accuracy of ultrasound is usually evaluated in comparison with chest CT as the gold standard. Lung ultrasound is an excellent tool for the diagnosis of postoperative atelectasis, with a sensitivity of 87.7%, a specificity of 92.1% and a diagnostic accuracy of 90.8%. Therefore, it provides a rapid, reliable, and radiation-free method to identify perioperative atelectasis in adults.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> 20% of the patients presented mild pleural effusion in the lung ultrasound performed 15 min after arrival at Resuscitation, doubling this figure (42%) at 24 h. Up to 90% of patients presented some B line in the first ultrasound, and 82% in the one performed 24 h postoperatively). Since the diagnosis of alveolointerstitial syndrome is given if three or more vertical B lines appear with loss of A lines between two ribs, this would correspond to 28 and 59.2% of patients, respectively. In our case, furthermore, the TFCd0% at 24 h was considerably higher in this group of patients who presented pathological B lines compared to those that can be considered physiological. In those who presented B lines, the mean Simplified Ultrasound Comet Tail Grading Scoring scores were 3.68 ± 2.54/18 at 15 min and 4.67 ± 3.13/18 at 24 h.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>These other two postoperative pulmonary complications were collected in the study together as the variable: "pulmonary congestion." In 2015, Gustafsson al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> reported that the finding of any sign of pulmonary congestion (B lines, pleural effusion) increased the rate of hospitalisation or death in patients with chronic heart failure, compared to those who did not present any of these signs. To see if the TFC was capable of predicting the appearance of these signs of pulmonary congestion, a logistic regression similar to that used to predict the appearance of atelectasis was performed. According to this analysis, we observed that an increase in TFC at 24 h (TFCd0% at 24 h, with a median of 27.1% [IQR: 20.3–37.5]) increased the risk of appearance of pulmonary congestion (OR: 1.3; 95% CI: 1.06–2.77).The TFC had already been used successfully before, with similar objectives, to detect pulmonary oedema. In 2016, Facchini et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> detected a correlation between the TFC value and the number of B lines presented by their patients with heart failure, and both indices had very good sensitivity and specificity for detecting pulmonary oedema, which increased even further if they were taken into consideration at the same time. In this same study, pro-BNP levels and TFC values were mutually related and correctly identified pulmonary congestion even when clinical signs were not evident. Furthermore, they changed in the same direction and by a similar amount when patients improved after diuretic treatment.Another example in the literature is a work carried out in 2019 by Hammad et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> in women in labour with preeclampsia. In this case, the presence of pulmonary oedema was evaluated by both ultrasound and CFT, and both methods showed an excellent ability to detect pulmonary oedema (ROC AUC: .961; 95% CI: .887–.994; and ROC AUC: .941; 95% CI: .849–.986, respectively), also showing very good correlation between both parameters (Spearman correlation coefficient r = .816; 95% CI: .709–.886). When comparing patients with or without pulmonary oedema, those with pulmonary oedema had a higher TFC.This strong correlation that Hammad and Facchini found between TFC and ultrasound is a point to take into account, since the presence of  B lines in lung ultrasound for the diagnosis of alveolointerstitial syndrome has a sensitivity of 93.4% and a specificity of 93%.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> For pleural effusion, sensitivity is 100% and specificity is 99.7%.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>With these data it is difficult to justify the superiority of TFC over ultrasound, but as suggested in Facchini's article, it can be used in conjunction with other methods to monitor these postoperative pulmonary complications. First, to suspect its diagnosis in the event of an increase in TFCd0%, and second, to carry out continuous and quantitative monitoring of this value, in response to the treatment established. Also of consideration is that this monitor does not require the learning curve required by lung ultrasound expertise, it has no interoperator variability and allows minute-by-minute values.An interesting addition to the use of TFC for the prediction of postoperative pulmonary complications would be that suggested by Hammad himself in his study on preeclampsia, where he proposes a cut-off point of 40 KΩ−1, with a sensitivity of 100% and a specificity of 85.2% to detect pulmonary oedema (median 29 KΩ−1; IQR: 27–40).<a class="elsevierStyleCrossRef" href="#bib0140">28</a> Something similar is proposed by Fathy et al.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> to predict failure to wean from mechanical ventilation, establishing a cut-off point of 50 KΩ–1, with a sensitivity of 65.2% and a specificity of 75.6%. Due to the design of our study, created to see the correspondence between the TFC and the fluid balance, we did not indicate a cut-off point in our sample, but these authors create an interesting precedent and make us consider what the cut-off point of a surgical population from which postoperative pulmonary complications will begin to develop. Finding that point would make the TFC a much more useful tool as it is easily interpretable, both quantitatively and continuously.Conclusions<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030">1FCd0% measured 24 h after surgery presents a moderate correlation (r = .44) with postoperative fluid balance. However, TFCd0% before extubation did not correlate with intraoperative fluid balance.</li><li class="elsevierStyleListItem" id="lsti0035">2The increase in TFC at 24 h is a risk factor for the appearance of atelectasis at 24 h.</li><li class="elsevierStyleListItem" id="lsti0040">3An increase in TFC at 24 h increases the odds ratio of the appearance of pulmonary congestion.</li></ul>FundingThe authors declare no funding was received for the study design and development.Conflict of interestsThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2165845" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 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" => "xpalclavsec1836874" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2165844" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 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" => "xpalclavsec1836875" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Study protocol" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Collection of variables" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Use of variation in thoracic fluid content to predict postoperative fluid balance" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Use of postoperative thoracic fluid content variation to determine the incidence of postoperative pulmonary complications" ] ] ] 11 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 12 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 13 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interests" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-10-14" "fechaAceptado" => "2023-08-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1836874" "palabras" => array:6 [ 0 => "Bioreactance" 1 => "Thoracic fluid content" 2 => "Fluid balance" 3 => "Postoperative pulmonary complications" 4 => "Atelectasis" 5 => "Lung congestion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1836875" "palabras" => array:6 [ 0 => "Biorreactancia" 1 => "Contenido de fluido torácico" 2 => "Balance de fluidos" 3 => "Complicaciones pulmonares postoperatorias" 4 => "Atelectasia" 5 => "Congestión pulmonar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesThe harmful effects of excess fluids frequently manifest in the lungs. Thoracic fluid content (TFC) is a variable provided by the STARLINGTM bioreactance monitor, which represents the total volume of fluid in the chest. The objective is to analyse the association between the variation in TFC values (TFCd0%) at 24 h postoperatively, postoperative fluid balance, and postoperative pulmonary complications. Material and methodsProspective and analytical observational study. Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included. They were monitored during the intervention and the first 24 postoperative hours with the monitor. STARLINGTM, measuring TFC and its variation in different stages of the perioperative period. Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded. Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion. The Pearson correlation coefficient was calculated to verify the association between TFC and fluid balance. Results50 patients were analyzed. TFCd0% measured on the morning of the first postoperative day increased by a median of 27.1% [IQR: 20.3–37.5] and was correlated at r = 0.44 with the postoperative balance of 677 ml [IQR: 125.5−1,412]. Increased TFC was related to a higher risk of atelectasis (OR = 1.24) and pulmonary congestion (OR = 1.3). ConclusionsTFCd0% measured 24 h after surgery presents a moderate correlation with postoperative fluid balance. Its increase is a risk factor for the appearance of postoperative pulmonary complications." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 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" => "Antecedentes y objetivosLos efectos nocivos del exceso de líquidos se manifiestan frecuentemente en los pulmones. El TFC (Thoracic Fluid Content) es una variable que proporciona el monitor por biorreactancia STARLING™, que representa el volumen total de líquido en el tórax. El objetivo es analizar la asociación entre la variación de los valores del TFC (TFCd0%) a las 24 horas postoperatorias, el balance hídrico postoperatorio y las complicaciones pulmonares postoperatorias (CPP). Material y métodosEstudio observacional prospectivo y analítico. Se incluyeron pacientes programados para cirugía abdominal mayor en un hospital universitario de tercer nivel. Fueron monitorizados durante la intervención y las 24 primeras horas postoperatorias con el monitor STARLING™, midiendo el TFC y su variación en distintas etapas del perioperatorio. Se realizaron ecografías pulmonares seriadas y se recogieron las CPP. Se realizó una regresión logística para predecir la aparición de atelectasias y congestión pulmonar. Se calculó el coeficiente de correlación de Pearson para comprobar la asociación entre TFC y balance hídrico. ResultadosSe analizaron 50 pacientes. El TFCd0% medido en la mañana del primer día postoperatorio aumentó una mediana de un 27,1% [IQR:20,3–37,5] y se correlacionó con una r = 0,44 con el balance postoperatorio de 677 ml [IQR: 125,5–1412]. El aumento del TFC se relacionó con un mayor riesgo de sufrir atelectasias (OR = 1,24) y congestión pulmonar (OR = 1,3). ConclusionesEl TFCd0% medido a las 24 horas de la cirugía presenta una correlación moderada con el balance hídrico postoperatorio. Su incremento es un factor de riesgo para la aparición de complicaciones pulmonares postoperatorias." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1977 "Ancho" => 2470 "Tamanyo" => 127721 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "TFC value throughout perioperative period." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1836 "Ancho" => 1627 "Tamanyo" => 88170 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "TFCd0% correlation at 24 h and fluid balance." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1983 "Ancho" => 2458 "Tamanyo" => 171196 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curve of the optimum model for predicting atelectasias at 24 h according to TFC." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1888 "Ancho" => 2458 "Tamanyo" => 160789 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curve of the optimal model to predict pulmonary congestion at 24 h according to TFC." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BMI: Body Mass Index; IQR: Interquartile Range; n: cases; SD: Standard Deviation." "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">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">n \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 (years), mean (SD) \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">65.82 (12.65) \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">Sex (males), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (38) \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 (kg/m2), mean (SD) \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">26.68 (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">ASA: I / II / III, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2)/25 (50/24 (48) \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">Lee index: I / II / III / IV, n (%)<a class="elsevierStyleCrossRef" href="#bib0060">12</a> \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 (12)/35 (70)/6 (12)/3 (6) \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">ARISCAT: low risk (< 26 points) / intermediate risk (26−44 points) / high risk (> 45 points), n (%)<a class="elsevierStyleCrossRef" href="#bib0055">11</a> \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 (0)/34 (68)/16 (32) \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">Use of epidural, n (%) \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">34 (68.0) \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">Duration of surgery (min), mean (SD) \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">243.92 (95.23) \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">Approach: laparoscopic/open; n (%) \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">23 (46.0)/27 (54.0) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of surgery</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">Colorrectal, n (%) \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 (50.0) \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">Intestinal, n (%) \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">4 (8.0) \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">Oesophagogastric, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.0) \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">Hepatobiliary, n (%) \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">13 (26.0) \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">Pancreatic, n (%) \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 (12.0) \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">Endocrine (paraganglioma), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.0) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E-PASS<a class="elsevierStyleCrossRef" href="#bib0030">6</a></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">Preoperative Risk Score (PRS), median [IQR] \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">.47 [0,42 to 0,58] \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">Surgical Stress Score (SSS), median [IQR] \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">.13 [–0,18 to 0,22] \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">Comprehensive Risk Score (CRS), median [IQR] \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">.29 [–0,04 to 0,39] \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fluid balance</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">Intraoperative (ml), median [IQR] \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">175.5 ml [−427,25 to +698,12] \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">Postoperative at 24 h (ml), median [IQR] \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">677 ml [+125,5 to +1,412] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3568535.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the patients and the procedure." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "LUS: Lung ultrasound; n: cases; PaO2: oxygen blood pressure¸ SD: Standard Deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resuscitation at 15 min \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">Resuscitation at 24 h \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atelectasis (LUS)</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">Of the total, n (%) \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">24 (48.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (70.0) \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">Size (cm), mean (SD) \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">13.65 (10.09) \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">12.82 (9.02) \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pleural effusion (LUS)</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">Of the total, n (%) \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 (20.0) \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">21 (42.0) \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B lines (LUS)</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">Of the total, n (%) \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 (90.0) \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">41 (82.0) \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">Ultrasounds with pathological B lines, n (%) \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">14 (28.0) \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">29 (59.2) \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">Simplified Ultrasound Comet Tail Grading Scoring, mean (SD)<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \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">3.68 (2.54)/18 \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">4.67 (3.13)/18 \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CPulmonary congestion (LUS)</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">Of the total, n (%)<a class="elsevierStyleCrossRef" href="#bib0090">18</a> \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">46 (92.0) \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 (90.0) \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoxemia<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a></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">PaO2 < 80 with ambient air, n (%) \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 (54.35) \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">23 (50.0) \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">PaO2/FiO2, mean (SD) \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">387.58 (119.46) \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">394.56 (108.10) \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">Positive air test, n (%)<a class="elsevierStyleCrossRef" href="#bib0035">7</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (70.0) \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">41 (82.0) \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-invasive mechanical ventilation</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">Of the total, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0.0) \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 " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Invasive mechanical ventilation (re-intubation)</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">Of the total, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3568534.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Postoperative complications after admission to resuscitation: findings on lung ultrasound and other respiratory complications." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative respiratory failure: pathogenesis, prediction, and prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Canet" 1 => "L. Gallart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0000000000000045" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "56" "paginaFinal" => "62" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24240985" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative pulmonary complications following major elective abdominal surgery: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Patel" 1 => "F. Hadian" 2 => "A. Ali" 3 => "G. Broadley" 4 => "K. Evans" 5 => "C. Horder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13741-016-0037-0" "Revista" => array:5 [ "tituloSerie" => "Perioper Med (Lond)." "fecha" => "2016" "volumen" => "5" "paginaInicial" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27222707" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of general anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Harris" 1 => "F. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Plastic Surg." "fecha" => "2013" "volumen" => "40" "numero" => "4" "paginaInicial" => "503" "paginaFinal" => "513" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory complications after major surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Ferreyra" 1 => "Y. Long" 2 => "V.M. Ranieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCC.0b013e32832e0669" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care." "fecha" => "2009" "volumen" => "15" "paginaInicial" => "342" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19542885" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery: a randomized-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Alday" 1 => "M. Muñoz" 2 => "A. Planas" 3 => "E. Mata" 4 => "C. Alvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-019-01419-3" "Revista" => array:7 [ "tituloSerie" => "Can J Anaesth." "fecha" => "2019" "volumen" => "66" "numero" => "11" "paginaInicial" => "1328" "paginaFinal" => "1337" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31165457" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impedance cardiography: recent applications and developments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Mansouri" 1 => "T. Alhadidi" 2 => "S. Chanchoub" 3 => "R. Ben Salah" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biomed Res." "fecha" => "2018" "volumen" => "29" "numero" => "19" "paginaInicial" => "3542" "paginaFinal" => "3552" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimation of physiologic ability and surgical stress (E-PASS) for a surgical audit in elective digestive surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Haga" 1 => "Y. Wada" 2 => "H. Takeuchi" 3 => "O. Kimura" 4 => "T. Furuya" 5 => "H. Sameshima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.surg.2003.11.012" "Revista" => array:7 [ "tituloSerie" => "Surgery." "fecha" => "2004" "volumen" => "135" "numero" => "6" "paginaInicial" => "586" "paginaFinal" => "594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15179364" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monitorización hemodinámica no invasiva o mínimamente invasiva en el paciente crítico en los servicios de urgencias y emergencias" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Almela Quilis" 1 => "J. Millán Soria" 2 => "J.M. Alonso Íñigo" 3 => "P. García Bermejo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Emergencias." "fecha" => "2015" "volumen" => "27" "numero" => "6" "paginaInicial" => "386" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29094841" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Ferrando" 1 => "M. Soro" 2 => "Unzueta C on behalf of the iPROVE-O2 Network Group" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Open" "fecha" => "2017" "volumen" => "7" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The accuracy of postoperative, non-invasive Air-Test to diagnose atelectasis in healthy patients after surgery: a prospective, diagnostic pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Ferrando" 1 => "C. Romero" 2 => "G. Tusman" 3 => "F. Suarez-Sipmann" 4 => "J. Canet" 5 => "R. Dosdá" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Open" "fecha" => "2017" "volumen" => "7" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National Institute for Health and Care Excellence" "etal" => false ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "Blood transfusion. (NICE guideline 24)" "fecha" => "2015" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "www.nice.org.uk/guidance/NG24" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside lung ultrasound in the assessment of alveolar-interstitial síndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Volpicelli" 1 => "A. Mussa" 2 => "G. Garofalo" 3 => "L. Cardinale" 4 => "G. Casoli" 5 => "F. Perotto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajem.2006.02.013" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med." "fecha" => "2006" "volumen" => "24" "paginaInicial" => "689" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16984837" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balance hídrico y contextualización en el plan de cuidados enfermero" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. González Navas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2015" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of postoperative pulmonary complications in a population-based surgical cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Canet" 1 => "L. Gallart" 2 => "C. Gomar" 3 => "G. Paluzie" 4 => "J. Vallès" 5 => "J. Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181fc6e0a" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2010" "volumen" => "113" "paginaInicial" => "1338" "paginaFinal" => "1350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045639" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.K. Ford" 1 => "W.S. Beattie" 2 => "D.N. Wijeysundera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-152-1-201001050-00007" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2010" "volumen" => "152" "paginaInicial" => "26" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20048269" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A simplified ultrasound comet tail grading scoring to assess pulmonary congestion in patients with heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Li" 1 => "Y.D. Li" 2 => "W.W. Zhu" 3 => "L.Y. Kong" 4 => "X.G. Ye" 5 => "Q.Z. Cai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Biomed Res Int." "fecha" => "2018" "volumen" => "2018" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care lung ultrasound in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.S. Shrestha" 1 => "D. Weeratunga" 2 => "K. Baker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/1574887112666170911125750" "Revista" => array:7 [ "tituloSerie" => "Rev Recent Clin Trials." "fecha" => "2018" "volumen" => "13" "numero" => "1" "paginaInicial" => "15" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28901850" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Hypoxemia and Hypoxia”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Samuel" 1 => "C. Franklin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "J.A.Myers, K.W.Millikan, T.J.Saclarides" "titulo" => "Common Surgical Diseases" "paginaInicial" => "391" "paginaFinal" => "394" "serieFecha" => "2008" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound for the cardiologist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Picano" 1 => "M.C. Scali" 2 => "Q. Ciampi" 3 => "D. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JACC CardiovascImaging." 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"fecha" => "2015" "volumen" => "21" "numero" => "7" "paginaInicial" => "548" "paginaFinal" => "554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25725475" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioreactance: a new tool for cardiac output and thoracic fluid content monitoring during hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. Kossari" 1 => "G. Hufnagel" 2 => "P. Squara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1542-4758.2009.00386.x" "Revista" => array:7 [ "tituloSerie" => "Hemodial Int." "fecha" => "2009" "volumen" => "13" "numero" => "4" "paginaInicial" => "512" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19758300" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measurement of thoracic fluid content in heart failure: the role of impedance cardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Folan" 1 => "M. Funk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.AACN.0000310751.93287.42" "Revista" => array:7 [ "tituloSerie" => "AACN Adv Crit Care." "fecha" => "2008" "volumen" => "19" "numero" => "1" "paginaInicial" => "47" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18418105" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glicocálix: estructura, composición, funciones y factores que lo lesionan" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.R. Carrillo" 1 => "B.R.E. Melgar" 2 => "F.A.S. Jacinto" 3 => "M. Tapia Salazar" 4 => "A.N. Campa Mendoza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Fac Med UNAM" "fecha" => "2021" "volumen" => "64" "numero" => "6" "paginaInicial" => "45" "paginaFinal" => "54" "itemHostRev" => array:3 [ "pii" => "S014067362100516X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endothelial glycocalyx" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Jedlicka" 1 => "B.F. Becker" 2 => "D. Chappell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccc.2019.12.007" "Revista" => array:7 [ "tituloSerie" => "Crit Care Clin" "fecha" => "2020" "volumen" => "36" "numero" => "2" "paginaInicial" => "217" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32172810" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endothelial glycocalyx layer: a possible therapeutic target for acute lung injury during lung resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Wang" 1 => "A. Wu" 2 => "Y. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Biomed Res Int." "fecha" => "2017" "volumen" => "2017" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Performance of lung ultrasound in detecting peri-operative atelectasis after general anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Yu" 1 => "Z. Zhai" 2 => "Y. Zhao" 3 => "Z. Zhu" 4 => "J. Tong" 5 => "J. Yan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ultrasmedbio.2016.06.010" "Revista" => array:7 [ "tituloSerie" => "Ultrasound Med Biol." "fecha" => "2016" "volumen" => "42" "numero" => "12" "paginaInicial" => "2775" "paginaFinal" => "2784" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27639431" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound and transthoracic impedance for noninvasive evaluation of pulmonary congestion in heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Facchini" 1 => "G. Malfatto" 2 => "A. Giglio" 3 => "M. Facchini" 4 => "G. Parati" 5 => "G. Branzi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2459/JCM.0000000000000226" "Revista" => array:7 [ "tituloSerie" => "J Cardiovasc Med (Hagerstown)." "fecha" => "2016" "volumen" => "17" "numero" => "7" "paginaInicial" => "510" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25575275" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic fluid content: a novel parameter for detection of pulmonary edema in parturients with preeclampsia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Hammad" 1 => "A. Hasanin" 2 => "A. Elsakka" 3 => "A. Refaie" 4 => "D. Abdelfattah" 5 => "S.A. Rahman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10877-018-0176-6" "Revista" => array:7 [ "tituloSerie" => "J Clin Monit Comput." "fecha" => "2019" "volumen" => "33" "numero" => "3" "paginaInicial" => "413" "paginaFinal" => "418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29936563" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ecografía pulmonar básica. Parte 2. Patología parenquimatosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.B. De la Quintana Gordon" 1 => "B. Nacarino Alcorta" 2 => "M. Fajardo Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanimación." "fecha" => "2015" "volumen" => "62" "numero" => "6" "paginaInicial" => "337" "paginaFinal" => "349" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "“Pleura”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Reuss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "G.Mathis" "titulo" => "“Chest Sonography”" "paginaInicial" => "27" "paginaFinal" => "54" "edicion" => "3rd ed" "serieFecha" => "2011" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracic fluid content: a novel parameter for predicting failed weaning from mechanical ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Fathy" 1 => "A.M. Hasanin" 2 => "M. 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Use of thoracic fluid content for prediction of fluid balance and postoperative pulmonary complications after major abdominal surgery: an observational study

Uso del contenido de fluido torácico para la predicción del balance hídrico y las complicaciones pulmonares postoperatorias tras cirugía abdominal mayor

P. Martín-Serranoa,

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patrims_91@hotmail.com

Corresponding author.

, E. Alday-Muñozb, A. Planas-Rocab, E. Martín-Pérezc

a Anestesiología y Reanimación, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas, Las Palmas de Gran Canaria, Spain

b Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain

c Cirugía General y Digestivo, Hospital de La Princesa, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The harmful effects of excess fluids frequently manifest in the lungs&#46; So much so that postoperative pulmonary complications are the most common non-surgical complications&#46; In major abdominal surgery they can affect 5&#37;&#8211;40&#37; of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Among them&#44; postoperative atelectasis can complicate the evolution of patients after major abdominal surgery&#46; They are found in 20&#37;&#8211;70&#37; of cases of severe postoperative hypoxemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Variation in perioperative fluid administration within the range of usual clinical practice can be associated with its appearance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Bioreactance is a non-invasive tool to monitor changes in electrical impedance of the chest&#46; Thoracic fluid content &#40;TFC&#41; is a variable provided by the STARLING&#8482; Bioreactance Cardiac Output Monitor&#46; It is the inverse of the transthoracic electrical impedance &#40;Z0&#41; and represents the total volume of fluid in the chest&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The main objective of the study was to analyse the association of TFCd0&#37; &#40;percentage of change in thoracic fluid content with respect to its baseline value&#44; acquired in the first five readings&#44; considering that the monitor automatically measures its parameters every 8&#8239;seconds&#41;&#44; measured 24&#8239;h after surgery&#44; with the fluid balance of the patients&#46; The secondary objective was to analyse the relationship between TFC and the appearance of postoperative atelectasis measured by lung ultrasound&#44; as well as pulmonary congestion&#46; The relationship between TFC during the surgical procedure with intraoperative fluid balance and surgical stress was analysed&#44; measured through the Estimation of Physiologic Ability and Surgical Stress &#40;E-PASS&#41; scale&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A prospective and analytical observational study was carried out&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients scheduled for major abdominal surgery at a tertiary university hospital between August 9&#44; 2018 and November 25&#44; 2019 were included&#46; The study was previously approved by the CEIm of the La Princesa University Hospital &#40;07&#47;26&#47;2018&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; patients undergoing scheduled major abdominal surgery for whom monitoring was performed with the STARLING&#8482; non-invasive hemodynamic monitor and with a scheduled stay in Resuscitation of at least 18&#8722;24&#8239;hours&#46; Patients who did not give their consent to participate&#44; who were admitted to the resuscitation unit undergoing mechanical ventilation or with a contraindication for bioreactance monitoring &#40;aortic disease&#44; complex congenital heart disease or previous lung resection&#41; were excluded&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study protocol</span><p id="par0040" class="elsevierStylePara elsevierViewall">After obtaining informed consent and prior to anaesthetic induction&#44; the two pairs of sensors of the STARLING&#8482; non-invasive hemodynamic monitor were placed on the patient&#39;s back&#46; The baseline values obtained were recorded and the TFC at that time was recorded as the baseline value&#44; from which the TFCd0&#37; would be calculated at different times from then on&#46; This bioreactance technology &#40;patented and exclusive to this monitor&#41; is a non-invasive tool to monitor changes in electrical impedance of the chest&#46; It is based on the analysis of the phase change that occurs in the electrical frequency wave that is emitted to the thorax due to changes in blood volume&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is considered a diagnostic technique to measure the electrical properties of biological tissues in the chest&#46; The principle of this technique consists of applying a current of known frequency between the external pairs of sensors and subsequently a signal is recorded between the internal pairs of sensors&#46; When the heart dilates and contracts&#44; the bloodstream creates a delay&#44; or phase shift&#44; in the flow&#46; The monitor uses this phase change as a starting point for measuring systolic volume&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Monitoring was maintained throughout the intraoperative period and the first 24&#8239;h postoperatively&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Management was carried out according to the anaesthetic criteria of the anaesthetist in charge of the operating room&#46; Mechanical ventilation was performed with a protective and open lung ventilation strategy according to the protocol published in the iPROVE<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> study&#46; Alveolar recruitment manoeuvres were performed in those patients in whom the appearance of atelectasis was suspected due to unexplained loss of pulmonary compliance coupled with a positive AirTest&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Intraoperative maintenance fluid therapy was performed with balanced crystalloid solutions at 1&#8722;3&#8239;ml&#47;kg&#47;hour in laparoscopic surgery and 4&#8722;7&#8239;ml&#47;kg&#47;hour in open surgery&#46; Bleeding was replaced with colloids in a 1&#58;1 ratio&#46; When the administration of blood products was necessary&#44; they were transfused according to the transfusion guidelines of the National Institute for Health Care and Excellence &#40;NICE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Given the suspicion of hypovolemia based on haemodynamic monitoring data&#44; tests were performed with 250&#8239;cc crystalloid boluses guided by the haemodynamic response of the STARLING&#8482; monitor&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">After surgery&#44; the patients were extubated to the resuscitation unit&#44; where after 15&#8239;min they would undergo an AirTest<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and a first lung ultrasound&#44; following the modified protocol described by Volpicelli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> &#40;excluding the bilateral anteroinferior areas&#41;&#46; Patterns that could indicate pathology were looked for&#58; presence of &#8239;B lines&#44; pleural effusion and consolidations suggestive of atelectasis&#46; Image captures were made of each of the explored fields and stored to measure the area of atelectasis with the ImageJ software&#46; A new lung ultrasound was performed 24&#8239;h later by the same researcher&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">All Resuscitation care was carried out in accordance with usual practice&#46; In no case were fluids administered or restricted taking into account the value of TFC or TFCd0&#37;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The fluid balance balance of the first 24&#8239;h was also counted in the usual way by adding inputs and subtracting diuresis&#44; vomiting&#44; drainage outputs&#44; including blood and insensible losses&#46; Insensible losses were counted as &#46;5&#8239;ml&#47;kg&#47;hour&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Collection of variables</span><p id="par0075" class="elsevierStylePara elsevierViewall">The anthropometric characteristics of the patients &#40;age&#44; weight and height&#41;&#44; the risk classification of complications &#40;ASA&#44; ARISCAT&#44; rCRI&#41;&#44; the characteristics of the anaesthetic management &#40;use of epidural anaesthesia&#44; administered fluid therapy&#8230;&#41; and surgical management &#40;type of intervention&#44; open or laparoscopic approach&#44; time in surgery&#41; were collected&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> The level of surgical stress was estimated according to the scale for estimating physiological capacity and surgical stress &#40;E-PASS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The lung ultrasound and AirTest were performed 15&#8239;min after arrival at the Resuscitation Unit and were repeated the next morning after surgery&#46; The presence of &#8239;B lines and their score according to the Simplified Ultrasound Comet Tail Grading Scoring&#44; the appearance and size of consolidations&#44; and the presence or absence of pleural effusion were recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">TFC and TFCd0&#37; values were collected at different times&#58; baseline &#40;prior to the induction of general anaesthesia&#41;&#44; at the beginning of intraoperative mechanical ventilation&#44; at the end of surgery prior to awakening&#44; after extubation 15&#8239;min after arrival at Resuscitation and the day after surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">During the first 15&#8239;min after extubation and the next day after surgery&#44; the following were recorded&#58; the presence of B-lines&#44; pleural effusion and atelectasis on postoperative ultrasound&#44; as well as hypoxemia or the need for invasive or non-invasive mechanical ventilation&#46; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Atelectasis was diagnosed as an image of pulmonary consolidation with static air bronchogram ultrasound&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Pleural effusion was defined as a homogeneous hypoechoic or anechoic collection in the dependent part of the thoracic cavity&#44; above the line of the diaphragm&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">B lines were defined as vertical&#44; hyperechoic artifacts originating from the pleural line and extending to the bottom of the screen moving synchronously with respiration&#46; They were considered pathological if three or more vertical &#8239;B lines appeared with loss of the &#8239;A lines between two ribs&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Hypoxemia was defined as arterial oxygen pressure &#40;PaO2&#41; &#60;80&#8239;mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">The AirTest was considered positive with values of 96&#37; or less&#44; and negative if it was greater than 96&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall">Like Gustafsson et al&#46;&#44; the variable &#8220;pulmonary congestion&#8221; was defined taking into account findings suggestive of pulmonary congestion &#40;B lines and&#47;or pleural effusion&#41; as an indirect measure to quantify lung fluid and changes in fluids in the pleural space or the lung parenchyma&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">The sample size calculation was carried out with the GRANMO programme version 7&#46;12&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">For the descriptive statistics of the variables&#44; the mean&#44; standard deviation&#44; median and the 25th and 75th percentiles were calculated for the quantitative variables&#46; Frequency and percentage were calculated in the qualitative variables&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The Shapiro&#8211;Wilk test was used to check the normality of the data&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Logistic regression was used to predict dichotomous variables and the area under the ROC curve was used to test goodness of fit&#46; The variance inflation factor &#40;VIF&#41; statistic was used to check the multicollinearity of the variables&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A logistic regression was performed to predict the appearance of atelectasis and pulmonary congestion at 24&#8239;h&#44; where the TFC and TFCd0&#37; values at different times were included&#46; The optimal model was obtained&#44; composed of three variables that measured the evolution of thoracic fluid content at different moments in time&#58; baseline TFC&#44; TFCd0&#37; before extubation and TFC at 24&#8239;h&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The Pearson correlation coefficient was calculated to check the association between numerical variables&#46; A means comparison test was used to analyse quantitative variables that followed a normal distribution &#40;Student&#39;s t&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Values of p&#8239;&#8804;&#8239;&#46;05 were considered statistically significant in drawing up the conclusions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0160" class="elsevierStylePara elsevierViewall">A total of 54 patients were included&#44; of which 4 abandoned the study due to loss of bioreactance monitoring &#40;7&#46;41&#37;&#41;&#44; leaving a total of 50 patients&#46; The characteristics of the patients and the surgical procedures&#44; as well as the distribution of the TFC at different times&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The findings of the ultrasounds performed and other respiratory complications in the first 24&#8239;h postoperatively&#44; starting from admission to Resuscitation&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">The r-Pearson correlation for postoperative balance with TFCd0&#37; measured on the morning of the first postoperative day had r&#8239;&#61;&#8239;&#46;44 &#40;p&#8239;&#61;&#8239;&#46;002&#59; 95&#37; CI&#58; &#46;17&#8211;&#46;65&#41;&#44; as seen in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; TFCd0&#37; before extubation did not correlate with intraoperative fluid balance&#44; with the r-Pearson being &#46;104&#44; with p&#8239;&#61;&#8239;&#46;474&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">There was a relationship between the duration of the intervention and the TFC before extubation &#40;r&#8239;&#61;&#8239;&#46;466&#59; p&#8239;&#61;&#8239;&#46;001&#41;&#46; There was a slight correlation &#40;r&#8239;&#61;&#8239;&#46;285&#59; p&#8239;&#61;&#8239;&#46;45&#41; between the TFCd0&#37; before extubation and the Comprehensive risk score&#44; and a moderate correlation &#40;r&#8239;&#61;&#8239;&#46;308&#59; p&#8239;&#61;&#8239;&#46;029&#41; with the Surgical stress score&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Once the multivariate analysis was carried out with the optimal model &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; it was observed that the TFC at 24&#8239;h was a risk factor for the appearance of atelectasis at 24&#8239;h&#44; with an odds ratio &#40;OR&#41; of 1&#46;24 &#40;95&#37; CI&#58; 1&#46;06&#8211;1&#46;53&#59; p&#8239;&#61;&#8239;&#46;021&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">We observed that an increase in TFC at 24&#8239;h &#40;TFCd0&#37; at 24&#8239;h&#41; increased the risk of developing pulmonary congestion&#44; with an OR of 1&#46;3 &#40;95&#37; CI&#58; 1&#46;06&#8211;2&#46;77&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">The TFCd0&#37; at 24&#8239;h was also higher in patients who presented B-lines defined as pathological &#40;three or more vertical B-lines with loss of A-lines between two ribs&#41; with a value of 34&#46;25&#8239;&#177;&#8239;16&#46;79&#37;&#44; compared to 26&#46;01&#8239;&#177;&#8239;13&#46;33&#37; in those patients without&#8239;B lines or with less than three &#40;p&#8239;&#61;&#8239;&#46;065&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Use of variation in thoracic fluid content to predict postoperative fluid balance</span><p id="par0195" class="elsevierStylePara elsevierViewall">The TFC increased throughout the perioperative process&#46; The variation in thoracic fluid content measured 24&#8239;h after surgery and considering the TFC obtained before anesthetic induction as the baseline value &#40;45&#8239;k&#937;<span class="elsevierStyleSup">&#8211;1</span>&#41;&#44; was related to the postoperative fluid balance of the patients&#44; calculated at that same moment&#44; with r&#8239;&#61;&#8239;&#46;44&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The bioreactance monitoring system has shown that there is a relationship between TFC and fluid balance during a heamodialysis session&#46; Specifically&#44; in 2009&#44; Kossari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> found a strong correlation of TFC with the amount of fluid extracted &#40;r&#8239;&#61;&#8239;&#46;8&#59; p&#8239;&#60;&#8239;&#46;0001&#41;&#44; studying 25 patients with chronic renal failure who underwent routine haemodialysis sessions&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">It is likely that this difference in the strength of the correlation was due to the heterogeneity of the surgical population and its interventions&#44; as well as the variability in the response to stress&#44; which could imply this lower correlation&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The study population by Kossari et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> was fairly uniform&#58; 25 patients with stable chronic renal failure without overt heart failure undergoing routine haemodialysis sessions&#58; a process with relatively stable physiological stress&#46; Considering that thoracic fluid content provides only a relative measure of changes in thoracic fluid &#40;water&#44; fat&#44; bone&#44; lung tissue and muscles&#41;&#44; the difference in result could be partially justified by changes in the distribution of our population&#44; with a lower average age&#44; typical of the surgical population &#40;65&#46;82&#8239;&#177;&#8239;12&#46;85&#8239;years compared to almost 12&#8239;years more for patients undergoing haemodialysis&#41;&#44; and also an inversion of the male&#58; female ratio&#44; this being 1&#58;1&#46;6&#44; typical of the representative population in our environment&#44; and invested in our baseline study &#40;1&#46;5&#58;1&#41;&#46; There were also subtle differences in weight and height&#46; All of this would invariably change the thoracic configuration and the TFC results&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Important changes were also found that justified the heterogeneity of the study in the great variety of procedures that our patients underwent&#46; These were very varied major abdominal surgery processes&#44; 46&#37; being laparoscopic compared to 54&#37; open&#44; and including among them colorectal&#44; hepatobiliary&#44; pancreatic&#44; intestinal surgeries&#44; etc&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">This heterogeneity found is typical of a surgical population&#44; and the correlation of r&#8239;&#61;&#8239;&#46;44 in our study has moderate strength to predict the fluid balance of patients in an effective&#44; quantifiable&#44; monitorable&#44; observer-independent&#44; and economical and non-invasive manner&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Nowadays&#44; thoracic fluid content can be measured either by subjective and imprecise indirect measurements &#40;such as lung auscultation&#44; degree of dyspnoea&#44; interpretation of chest x-ray or even fluid balance itself&#41;&#44; or by objective measurements but more invasive and with greater financial expense&#44; such as the use of Swan-Ganz catheters to measure pulmonary capillary wedge pressure or the right atrium&#44; or through serial determination of pro-B type natriuretic peptide &#40;proBNP&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Alternatively&#44; bioreactance devices could be used in a non-invasive and reliable manner&#44; not only to perform goal-directed fluid therapy&#44; avoiding excessively liberal fluid administration&#44; but to continuously monitor and predict postoperative fluid balance and initiate early treatment for possible effects derived from overload or lack of fluids&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Just as we used the variation in thoracic fluid content to predict postoperative fluid balance in our patients&#44; we wanted to check if this same correlation was true intraoperatively&#46; However&#44; TFCd0&#37; before extubation &#40;mean 21&#46;27&#8239;&#177;&#8239;14&#46;40&#37;&#41; did not correlate with intraoperative fluid balance&#44; with a median of 175&#46;5&#8239;ml &#40;IQR&#58; &#8722;427&#46;25&#8211;698&#46;12&#41;&#44; where practically 75&#37; of the patients obtained a neutral balance &#40;between &#8722;500&#8239;ml and &#43;500&#8239;ml&#41;&#44; as dictated by the protocol&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">In our study&#44; fluid balance during surgery and TFC were not correlated&#59; However&#44; there was a relationship between the duration of the intervention and the TFC before extubation &#40;r&#8239;&#61;&#8239;&#46;466&#59; p&#8239;&#61;&#8239;&#46;001&#41;&#44; with 243&#46;92&#8239;&#177;&#8239;95&#46;23&#8239;min&#59; This relationship was probably due to the greater endothelial damage produced in the context of the surgical trauma of long-term surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Surgical stress was highly variable depending on the type of surgery&#44; with a median in the E-PASS classification&#44; Comprehensive risk score&#44; of &#46;29&#44; but with a very wide range from &#8722;&#46;22 to &#43;1&#46;08 and there was a slight correlation &#40;r&#8239;&#61;&#8239;&#46;285&#59; p&#8239;&#61;&#8239;&#46;45&#41; between the TFCd0&#37; before extubation and the comprehensive risk score&#44; and a moderate one &#40;r&#8239;&#61;&#8239;&#46;308&#59; p&#8239;&#61;&#8239;&#46;029&#41; with the surgical stress score&#46; Similarly to surgical time &#40;which is included in this equation&#41;&#44; greater stress or surgical aggression can produce greater detachment of the endothelial glycocalyx and&#44; thus&#44; increase its dysfunction and increase TFC&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Use of postoperative thoracic fluid content variation to determine the incidence of postoperative pulmonary complications</span><p id="par0245" class="elsevierStylePara elsevierViewall">Postoperative pulmonary complications are the most common nonsurgical complications and increase postoperative length of stay&#44; mortality&#44; and costs&#46; This figure is variable in the literature&#44; usually approximately 6&#46;8&#37; in major abdominal surgery&#44; but since the criteria used to define respiratory complications are very inconsistent&#44; some authors estimate them as high as 40&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">The increase in TFC at 24&#8239;h was a risk factor for the appearance of atelectasis at 24&#8239;h&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">A ROC curve was created with an area under the curve of &#46;78 &#40;95&#37; CI&#58; &#46;62&#8211;&#46;94&#41; with the predictive probabilities obtained in this model&#44; obtaining a high sensitivity of 94&#46;1&#37;&#46; In other words&#44; with a high possibility that the patient with atelectasis had a high TFC&#44; but a low specificity&#44; of 60&#37;&#44; so there could be a rate of up to 40&#37; of patients with high TFC who did not present atelectasis&#44; i&#46;e&#44; false positives&#46; Therefore&#44; as a screening test it could be acceptable&#44; but&#44; given its low specificity&#44; the diagnosis would have to be confirmed with a second test&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">In our study&#44; this test was lung ultrasound&#46; There are multiple publications aimed at evaluating the performance of lung ultrasound in the detection of postoperative atelectasis after general anaesthesia&#46; The accuracy of ultrasound is usually evaluated in comparison with chest CT as the gold standard&#46; Lung ultrasound is an excellent tool for the diagnosis of postoperative atelectasis&#44; with a sensitivity of 87&#46;7&#37;&#44; a specificity of 92&#46;1&#37; and a diagnostic accuracy of 90&#46;8&#37;&#46; Therefore&#44; it provides a rapid&#44; reliable&#44; and radiation-free method to identify perioperative atelectasis in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> 20&#37; of the patients presented mild pleural effusion in the lung ultrasound performed 15&#8239;min after arrival at Resuscitation&#44; doubling this figure &#40;42&#37;&#41; at 24&#8239;h&#46; Up to 90&#37; of patients presented some&#8239;B line in the first ultrasound&#44; and 82&#37; in the one performed 24&#8239;h postoperatively&#41;&#46; Since the diagnosis of alveolointerstitial syndrome is given if three or more vertical&#8239;B lines appear with loss of A lines between two ribs&#44; this would correspond to 28 and 59&#46;2&#37; of patients&#44; respectively&#46; In our case&#44; furthermore&#44; the TFCd0&#37; at 24&#8239;h was considerably higher in this group of patients who presented pathological B lines compared to those that can be considered physiological&#46; In those who presented&#8239;B lines&#44; the mean Simplified Ultrasound Comet Tail Grading Scoring scores were 3&#46;68&#8239;&#177;&#8239;2&#46;54&#47;18 at 15&#8239;min and 4&#46;67&#8239;&#177;&#8239;3&#46;13&#47;18 at 24&#8239;h&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">These other two postoperative pulmonary complications were collected in the study together as the variable&#58; &#34;pulmonary congestion&#46;&#34; In 2015&#44; Gustafsson al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> reported that the finding of any sign of pulmonary congestion &#40;B lines&#44; pleural effusion&#41; increased the rate of hospitalisation or death in patients with chronic heart failure&#44; compared to those who did not present any of these signs&#46; To see if the TFC was capable of predicting the appearance of these signs of pulmonary congestion&#44; a logistic regression similar to that used to predict the appearance of atelectasis was performed&#46; According to this analysis&#44; we observed that an increase in TFC at 24&#8239;h &#40;TFCd0&#37; at 24&#8239;h&#44; with a median of 27&#46;1&#37; &#91;IQR&#58; 20&#46;3&#8211;37&#46;5&#93;&#41; increased the risk of appearance of pulmonary congestion &#40;OR&#58; 1&#46;3&#59; 95&#37; CI&#58; 1&#46;06&#8211;2&#46;77&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The TFC had already been used successfully before&#44; with similar objectives&#44; to detect pulmonary oedema&#46; In 2016&#44; Facchini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> detected a correlation between the TFC value and the number of B lines presented by their patients with heart failure&#44; and both indices had very good sensitivity and specificity for detecting pulmonary oedema&#44; which increased even further if they were taken into consideration at the same time&#46; In this same study&#44; pro-BNP levels and TFC values were mutually related and correctly identified pulmonary congestion even when clinical signs were not evident&#46; Furthermore&#44; they changed in the same direction and by a similar amount when patients improved after diuretic treatment&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Another example in the literature is a work carried out in 2019 by Hammad et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> in women in labour with preeclampsia&#46; In this case&#44; the presence of pulmonary oedema was evaluated by both ultrasound and CFT&#44; and both methods showed an excellent ability to detect pulmonary oedema &#40;ROC AUC&#58; &#46;961&#59; 95&#37; CI&#58; &#46;887&#8211;&#46;994&#59; and ROC AUC&#58; &#46;941&#59; 95&#37; CI&#58; &#46;849&#8211;&#46;986&#44; respectively&#41;&#44; also showing very good correlation between both parameters &#40;Spearman correlation coefficient r&#8239;&#61;&#8239;&#46;816&#59; 95&#37; CI&#58; &#46;709&#8211;&#46;886&#41;&#46; When comparing patients with or without pulmonary oedema&#44; those with pulmonary oedema had a higher TFC&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">This strong correlation that Hammad and Facchini found between TFC and ultrasound is a point to take into account&#44; since the presence of &#8239;B lines in lung ultrasound for the diagnosis of alveolointerstitial syndrome has a sensitivity of 93&#46;4&#37; and a specificity of 93&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> For pleural effusion&#44; sensitivity is 100&#37; and specificity is 99&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">With these data it is difficult to justify the superiority of TFC over ultrasound&#44; but as suggested in Facchini&#39;s article&#44; it can be used in conjunction with other methods to monitor these postoperative pulmonary complications&#46; First&#44; to suspect its diagnosis in the event of an increase in TFCd0&#37;&#44; and second&#44; to carry out continuous and quantitative monitoring of this value&#44; in response to the treatment established&#46; Also of consideration is that this monitor does not require the learning curve required by lung ultrasound expertise&#44; it has no interoperator variability and allows minute-by-minute values&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">An interesting addition to the use of TFC for the prediction of postoperative pulmonary complications would be that suggested by Hammad himself in his study on preeclampsia&#44; where he proposes a cut-off point of 40&#8239;K&#937;<span class="elsevierStyleSup">&#8722;1</span>&#44; with a sensitivity of 100&#37; and a specificity of 85&#46;2&#37; to detect pulmonary oedema &#40;median 29&#8239;K&#937;<span class="elsevierStyleSup">&#8722;1</span>&#59; IQR&#58; 27&#8211;40&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Something similar is proposed by Fathy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> to predict failure to wean from mechanical ventilation&#44; establishing a cut-off point of 50&#8239;K&#937;<span class="elsevierStyleSup">&#8211;1</span>&#44; with a sensitivity of 65&#46;2&#37; and a specificity of 75&#46;6&#37;&#46; Due to the design of our study&#44; created to see the correspondence between the TFC and the fluid balance&#44; we did not indicate a cut-off point in our sample&#44; but these authors create an interesting precedent and make us consider what the cut-off point of a surgical population from which postoperative pulmonary complications will begin to develop&#46; Finding that point would make the TFC a much more useful tool as it is easily interpretable&#44; both quantitatively and continuously&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0295" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1</span><p id="par0300" class="elsevierStylePara elsevierViewall">FCd0&#37; measured 24&#8239;h after surgery presents a moderate correlation &#40;r&#8239;&#61;&#8239;&#46;44&#41; with postoperative fluid balance&#46; However&#44; TFCd0&#37; before extubation did not correlate with intraoperative fluid balance&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2</span><p id="par0305" class="elsevierStylePara elsevierViewall">The increase in TFC at 24&#8239;h is a risk factor for the appearance of atelectasis at 24&#8239;h&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3</span><p id="par0310" class="elsevierStylePara elsevierViewall">An increase in TFC at 24&#8239;h increases the odds ratio of the appearance of pulmonary congestion&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0315" class="elsevierStylePara elsevierViewall">The authors declare no funding was received for the study design and development&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0320" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The harmful effects of excess fluids frequently manifest in the lungs&#46; Thoracic fluid content &#40;TFC&#41; is a variable provided by the STARLINGTM bioreactance monitor&#44; which represents the total volume of fluid in the chest&#46; The objective is to analyse the association between the variation in TFC values &#40;TFCd0&#37;&#41; at 24&#8239;h postoperatively&#44; postoperative fluid balance&#44; and postoperative pulmonary complications&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prospective and analytical observational study&#46; Patients scheduled for major abdominal surgery at a tertiary teaching hospital were included&#46; They were monitored during the intervention and the first 24 postoperative hours with the monitor&#46; STARLINGTM&#44; measuring TFC and its variation in different stages of the perioperative period&#46; Serial lung ultrasounds were performed and postoperative pulmonary complications were recorded&#46; Logistic regression was performed to predict the occurrence of atelectasis and pulmonary congestion&#46; The Pearson correlation coefficient was calculated to verify the association between TFC and fluid balance&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">50 patients were analyzed&#46; TFCd0&#37; measured on the morning of the first postoperative day increased by a median of 27&#46;1&#37; &#91;IQR&#58; 20&#46;3&#8211;37&#46;5&#93; and was correlated at r&#8239;&#61;&#8239;0&#46;44 with the postoperative balance of 677&#8239;ml &#91;IQR&#58; 125&#46;5&#8722;1&#44;412&#93;&#46; Increased TFC was related to a higher risk of atelectasis &#40;OR&#8239;&#61;&#8239;1&#46;24&#41; and pulmonary congestion &#40;OR&#8239;&#61;&#8239;1&#46;3&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">TFCd0&#37; measured 24&#8239;h after surgery presents a moderate correlation with postoperative fluid balance&#46; Its increase is a risk factor for the appearance of postoperative pulmonary complications&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Los efectos nocivos del exceso de l&#237;quidos se manifiestan frecuentemente en los pulmones&#46; El TFC &#40;Thoracic Fluid Content&#41; es una variable que proporciona el monitor por biorreactancia STARLING&#8482;&#44; que representa el volumen total de l&#237;quido en el t&#243;rax&#46;&#8239;El objetivo es analizar la asociaci&#243;n entre la variaci&#243;n de los valores del TFC &#40;TFCd0&#37;&#41; a las 24&#8239;horas postoperatorias&#44; el balance h&#237;drico postoperatorio y las complicaciones pulmonares postoperatorias &#40;CPP&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo y anal&#237;tico&#46; Se incluyeron pacientes programados para cirug&#237;a abdominal mayor en un hospital universitario de tercer nivel&#46; Fueron monitorizados durante la intervenci&#243;n y las 24 primeras horas postoperatorias con el monitor STARLING&#8482;&#44; midiendo el TFC y su variaci&#243;n en distintas etapas del perioperatorio&#46; Se realizaron ecograf&#237;as pulmonares seriadas y se recogieron las CPP&#46; Se realiz&#243; una regresi&#243;n log&#237;stica para predecir la aparici&#243;n de atelectasias y congesti&#243;n pulmonar&#46; Se calcul&#243; el coeficiente de correlaci&#243;n de Pearson para comprobar la asociaci&#243;n entre TFC y balance h&#237;drico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 50 pacientes&#46; El TFCd0&#37; medido en la ma&#241;ana del primer d&#237;a postoperatorio aument&#243; una mediana de un 27&#44;1&#37; &#91;IQR&#58;20&#44;3&#8211;37&#44;5&#93; y se correlacion&#243; con una r&#8239;&#61;&#8239;0&#44;44 con el balance postoperatorio de 677&#8239;ml &#91;IQR&#58; 125&#44;5&#8211;1412&#93;&#46; El aumento del TFC se relacion&#243; con un mayor riesgo de sufrir atelectasias &#40;OR&#8239;&#61;&#8239;1&#44;24&#41; y congesti&#243;n pulmonar &#40;OR&#8239;&#61;&#8239;1&#44;3&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El TFCd0&#37; medido a las 24&#8239;horas de la cirug&#237;a presenta una correlaci&#243;n moderada con el balance h&#237;drico postoperatorio&#46; Su incremento es un factor de riesgo para la aparici&#243;n de complicaciones pulmonares postoperatorias&#46;</p></span>"
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivos"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">TFC value throughout perioperative period&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">TFCd0&#37; correlation at 24&#8239;h and fluid balance&#46;</p>"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 1983
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ROC curve of the optimum model for predicting atelectasias at 24&#8239;h according to TFC&#46;</p>"
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        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ROC curve of the optimal model to predict pulmonary congestion at 24&#8239;h according to TFC&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; Body Mass Index&#59; IQR&#58; Interquartile Range&#59; n&#58; cases&#59; SD&#58; Standard Deviation&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26&#46;68 &#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
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                  \t\t\t\t">1 &#40;2&#41;&#47;25 &#40;50&#47;24 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lee index&#58; I &#47; II &#47; III &#47; IV&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;12&#41;&#47;35 &#40;70&#41;&#47;6 &#40;12&#41;&#47;3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ARISCAT&#58; low risk &#40;&#60; 26 points&#41; &#47; intermediate risk &#40;26&#8722;44 points&#41; &#47; high risk &#40;&#62; 45 points&#41;&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&#47;34 &#40;68&#41;&#47;16 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Use of epidural&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34 &#40;68&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Duration of surgery &#40;min&#41;&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">243&#46;92 &#40;95&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Approach&#58; laparoscopic&#47;open&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colorrectal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;50&#46;0&#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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intestinal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;8&#46;0&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#46;0&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;26&#46;0&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;12&#46;0&#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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;2&#46;0&#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
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                  \t\t\t\t"><span class="elsevierStyleItalic">E-PASS</span><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Preoperative Risk Score</span> &#40;PRS&#41;&#44; median &#91;IQR&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;47 &#91;0&#44;42 to 0&#44;58&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgical Stress Score</span> &#40;SSS&#41;&#44; median &#91;IQR&#93;&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
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                  \t\t\t\t">&#46;13 &#91;&#8211;0&#44;18 to 0&#44;22&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Comprehensive Risk Score</span> &#40;CRS&#41;&#44; median &#91;IQR&#93;&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">&#46;29 &#91;&#8211;0&#44;04 to 0&#44;39&#93;&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 " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fluid balance</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraoperative &#40;ml&#41;&#44; median &#91;IQR&#93;&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">175&#46;5&#8239;ml &#91;&#8722;427&#44;25 to &#43;698&#44;12&#93;&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"><span class="elsevierStyleHsp" style=""></span>Postoperative at 24&#8239;h &#40;ml&#41;&#44; median &#91;IQR&#93;&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">677&#8239;ml &#91;&#43;125&#44;5 to &#43;1&#44;412&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resuscitation at 15 min&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resuscitation at 24&#8239;h&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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atelectasis &#40;LUS&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#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">24 &#40;48&#46;0&#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">35 &#40;70&#46;0&#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"><span class="elsevierStyleHsp" style=""></span>Size &#40;cm&#41;&#44; mean &#40;SD&#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">13&#46;65 &#40;10&#46;09&#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">12&#46;82 &#40;9&#46;02&#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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pleural effusion &#40;LUS&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#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">10 &#40;20&#46;0&#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">21 &#40;42&#46;0&#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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B lines <span class="elsevierStyleItalic">&#40;LUS&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#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 &#40;90&#46;0&#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">41 &#40;82&#46;0&#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"><span class="elsevierStyleHsp" style=""></span>Ultrasounds with pathological B lines&#44; n &#40;&#37;&#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">14 &#40;28&#46;0&#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">29 &#40;59&#46;2&#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"><span class="elsevierStyleHsp" style=""></span>Simplified Ultrasound Comet Tail Grading Scoring&#44; mean &#40;SD&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&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;68 &#40;2&#46;54&#41;&#47;18&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">4&#46;67 &#40;3&#46;13&#41;&#47;18&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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CPulmonary congestion &#40;LUS&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&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">46 &#40;92&#46;0&#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 &#40;90&#46;0&#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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hypoxemia</span><a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span> &#60;&#8239;80 with ambient air&#44; n &#40;&#37;&#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">25 &#40;54&#46;35&#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">23 &#40;50&#46;0&#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"><span class="elsevierStyleHsp" style=""></span>PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; mean &#40;SD&#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">387&#46;58 &#40;119&#46;46&#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">394&#46;56 &#40;108&#46;10&#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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Positive air test</span>&#44; n &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&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">35 &#40;70&#46;0&#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">41 &#40;82&#46;0&#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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-invasive mechanical ventilation</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#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">&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 &#40;0&#46;0&#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 " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Invasive mechanical ventilation &#40;re-intubation&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Of the total&#44; n &#40;&#37;&#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">&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">1 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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      "titulo" => "References"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative respiratory failure&#58; pathogenesis&#44; prediction&#44; and prevention"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Canet"
                            1 => "L&#46; Gallart"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1097/MCC.0000000000000045"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2014"
                        "volumen" => "20"
                        "paginaInicial" => "56"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24240985"
                            "web" => "Medline"
                          ]
                        ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postoperative pulmonary complications following major elective abdominal surgery&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "A&#46; Ali"
                            3 => "G&#46; Broadley"
                            4 => "K&#46; Evans"
                            5 => "C&#46; Horder"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27222707"
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                      "titulo" => "Complications of general anesthesia"
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                            0 => "M&#46; Harris"
                            1 => "F&#46; Chung"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Clin Plastic Surg&#46;"
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                        "numero" => "4"
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                        "paginaFinal" => "513"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Respiratory complications after major surgery"
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                            0 => "G&#46; Ferreyra"
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                        "paginaInicial" => "342"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19542885"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Effects of neuromuscular block reversal with sugammadex versus neostigmine on postoperative respiratory outcomes after major abdominal surgery&#58; a randomized-controlled trial"
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                          "etal" => false
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                            2 => "A&#46; Planas"
                            3 => "E&#46; Mata"
                            4 => "C&#46; Alvarez"
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                        "tituloSerie" => "Can J Anaesth&#46;"
                        "fecha" => "2019"
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                        "numero" => "11"
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                        "paginaFinal" => "1337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31165457"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Impedance cardiography&#58; recent applications and developments"
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                        0 => array:2 [
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                            2 => "S&#46; Chanchoub"
                            3 => "R&#46; Ben Salah"
                          ]
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                        "paginaFinal" => "3552"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Estimation of physiologic ability and surgical stress &#40;E-PASS&#41; for a surgical audit in elective digestive surgery"
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                            0 => "Y&#46; Haga"
                            1 => "Y&#46; Wada"
                            2 => "H&#46; Takeuchi"
                            3 => "O&#46; Kimura"
                            4 => "T&#46; Furuya"
                            5 => "H&#46; Sameshima"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Surgery&#46;"
                        "fecha" => "2004"
                        "volumen" => "135"
                        "numero" => "6"
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                        "paginaFinal" => "594"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15179364"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
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                        0 => array:2 [
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                            1 => "J&#46; Mill&#225;n Soria"
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                            3 => "P&#46; Garc&#237;a Bermejo"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29094841"
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                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction &#40;iPROVE-O2&#41; and its effects on surgical site infection&#58; study protocol for a randomised controlled trial"
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                      ]
                    ]
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                  "host" => array:1 [
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                      "Revista" => array:3 [
                        "tituloSerie" => "BMJ Open"
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The accuracy of postoperative&#44; non-invasive Air-Test to diagnose atelectasis in healthy patients after surgery&#58; a prospective&#44; diagnostic pilot study"
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                        0 => array:2 [
                          "etal" => true
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                            1 => "C&#46; Romero"
                            2 => "G&#46; Tusman"
                            3 => "F&#46; Suarez-Sipmann"
                            4 => "J&#46; Canet"
                            5 => "R&#46; Dosd&#225;"
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              "identificador" => "bib0055"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
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                      "WWW" => array:1 [
                        "link" => "www&#46;nice&#46;org&#46;uk&#47;guidance&#47;NG24"
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                      "titulo" => "Bedside lung ultrasound in the assessment of alveolar-interstitial s&#237;ndrome"
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                          "etal" => true
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                            4 => "G&#46; Casoli"
                            5 => "F&#46; Perotto"
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Emerg Med&#46;"
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                        "paginaInicial" => "689"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16984837"
                            "web" => "Medline"
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                ]
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              "identificador" => "bib0065"
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                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:1 [
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                      "Libro" => array:1 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Prediction of postoperative pulmonary complications in a population-based surgical cohort"
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                            4 => "J&#46; Vall&#232;s"
                            5 => "J&#46; Castillo"
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                    0 => array:2 [
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                        "paginaFinal" => "1350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045639"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Systematic review&#58; prediction of perioperative cardiac complications and mortality by the revised cardiac risk index"
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                    0 => array:2 [
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                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2010"
                        "volumen" => "152"
                        "paginaInicial" => "26"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20048269"
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A simplified ultrasound comet tail grading scoring to assess pulmonary congestion in patients with heart failure"
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                            4 => "X&#46;G&#46; Ye"
                            5 => "Q&#46;Z&#46; Cai"
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                    0 => array:1 [
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                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Point-of-care lung ultrasound in critically ill patients"
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                    ]
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                    0 => array:2 [
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28901850"
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                        "paginaFinal" => "394"
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                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung ultrasound for the cardiologist"
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                0 => array:2 [
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                      ]
                    ]
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                    0 => array:2 [
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                        "paginaFinal" => "554"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25725475"
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                ]
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              "identificador" => "bib0110"
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                    0 => array:2 [
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                        "tituloSerie" => "AACN Adv Crit Care&#46;"
                        "fecha" => "2008"
                        "volumen" => "19"
                        "numero" => "1"
                        "paginaInicial" => "47"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18418105"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Glicoc&#225;lix&#58; estructura&#44; composici&#243;n&#44; funciones y factores que lo lesionan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46;R&#46; Carrillo"
                            1 => "B&#46;R&#46;E&#46; Melgar"
                            2 => "F&#46;A&#46;S&#46; Jacinto"
                            3 => "M&#46; Tapia Salazar"
                            4 => "A&#46;N&#46; Campa Mendoza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Rev Fac Med UNAM"
                        "fecha" => "2021"
                        "volumen" => "64"
                        "numero" => "6"
                        "paginaInicial" => "45"
                        "paginaFinal" => "54"
                        "itemHostRev" => array:3 [
                          "pii" => "S014067362100516X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endothelial glycocalyx"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Jedlicka"
                            1 => "B&#46;F&#46; Becker"
                            2 => "D&#46; Chappell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccc.2019.12.007"
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Clin"
                        "fecha" => "2020"
                        "volumen" => "36"
                        "numero" => "2"
                        "paginaInicial" => "217"
                        "paginaFinal" => "232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32172810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endothelial glycocalyx layer&#58; a possible therapeutic target for acute lung injury during lung resection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Wang"
                            1 => "A&#46; Wu"
                            2 => "Y&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Biomed Res Int&#46;"
                        "fecha" => "2017"
                        "volumen" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Performance of lung ultrasound in detecting peri-operative atelectasis after general anesthesia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Yu"
                            1 => "Z&#46; Zhai"
                            2 => "Y&#46; Zhao"
                            3 => "Z&#46; Zhu"
                            4 => "J&#46; Tong"
                            5 => "J&#46; Yan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ultrasmedbio.2016.06.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ultrasound Med Biol&#46;"
                        "fecha" => "2016"
                        "volumen" => "42"
                        "numero" => "12"
                        "paginaInicial" => "2775"
                        "paginaFinal" => "2784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27639431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung ultrasound and transthoracic impedance for noninvasive evaluation of pulmonary congestion in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Facchini"
                            1 => "G&#46; Malfatto"
                            2 => "A&#46; Giglio"
                            3 => "M&#46; Facchini"
                            4 => "G&#46; Parati"
                            5 => "G&#46; Branzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2459/JCM.0000000000000226"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Cardiovasc Med &#40;Hagerstown&#41;&#46;"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "numero" => "7"
                        "paginaInicial" => "510"
                        "paginaFinal" => "517"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25575275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thoracic fluid content&#58; a novel parameter for detection of pulmonary edema in parturients with preeclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Hammad"
                            1 => "A&#46; Hasanin"
                            2 => "A&#46; Elsakka"
                            3 => "A&#46; Refaie"
                            4 => "D&#46; Abdelfattah"
                            5 => "S&#46;A&#46; Rahman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10877-018-0176-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Monit Comput&#46;"
                        "fecha" => "2019"
                        "volumen" => "33"
                        "numero" => "3"
                        "paginaInicial" => "413"
                        "paginaFinal" => "418"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29936563"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ecograf&#237;a pulmonar b&#225;sica&#46; Parte 2&#46; Patolog&#237;a parenquimatosa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;B&#46; De la Quintana Gordon"
                            1 => "B&#46; Nacarino Alcorta"
                            2 => "M&#46; Fajardo P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Anestesiol Reanimaci&#243;n&#46;"
                        "fecha" => "2015"
                        "volumen" => "62"
                        "numero" => "6"
                        "paginaInicial" => "337"
                        "paginaFinal" => "349"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#8220;Pleura&#8221;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Reuss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "G&#46;Mathis"
                        "titulo" => "&#8220;Chest Sonography&#8221;"
                        "paginaInicial" => "27"
                        "paginaFinal" => "54"
                        "edicion" => "3rd ed"
                        "serieFecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thoracic fluid content&#58; a novel parameter for predicting failed weaning from mechanical ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Fathy"
                            1 => "A&#46;M&#46; Hasanin"
                            2 => "M&#46; Raafat"
                            3 => "M&#46;M&#46;A&#46; Mostafa"
                            4 => "A&#46;M&#46; Fetouh"
                            5 => "M&#46; Elsayed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40560-017-0216-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Intensive Care&#46;"
                        "fecha" => "2020"
                        "volumen" => "5"
                        "numero" => "8"
                        "paginaInicial" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28250933"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2024.03.005

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