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Protocolo informático de manejo integral de la sepsis. Descripción de un sistema de identificación precoz
Computerised sepsis protocol management. Description of an early warning system
Begoña de Diosa,
Autor para correspondencia
begomarsella@hotmail.com

Autor para correspondencia.
, Marcio Borgesa, Timothy D. Smithb, Alberto del Castilloc, Antonia Sociasc, Leticia Gutiérrezc, Jordi Nicolásd, Bartolomé Lladóe, Jose A. Rochef, Maria P. Díazg, Yolanda Lladóa, Equipo de Sepsis
a Unidad Multidisciplinar de Sepsis, Hospital Son Llàtzer, Palma de Mallorca, España
b Servicio de Medicina Intensiva, Clínica Juaneda, Palma de Mallorca, España
c Servicio Medicina Intensiva, Hospital Son Llàtzer, Palma de Mallorca, España
d Servicio de Farmacia, Hospital Son Llàtzer, Palma de Mallorca, España
e Servicio de Medicina Interna, Hospital Son Llàtzer, Palma de Mallorca, España
f Servicio de Urgencias, Hospital Son Llàtzer, Palma de Mallorca, España
g Servicio de Microbiología, Hospital Son Llàtzer, Palma de Mallorca, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mecanismos de inclusi&#243;n de un paciente en el Protocolo Inform&#225;tico de Manejo Integral de la Sepsis &#40;PIMIS&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La sepsis contin&#250;a siendo una de las principales causas de muerte en pacientes hospitalizados&#46; En Espa&#241;a los &#250;ltimos estudios indican un aumento en la incidencia<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a>&#46; Por ello&#44; es preciso el desarrollo de mecanismos y herramientas que permitan su reconocimiento precoz para prevenir as&#237; el desarrollo de complicaciones&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A lo largo de los &#250;ltimos a&#241;os se han creado diversas estrategias para intentar mejorar el abordaje de la sepsis&#44; algunas originadas a partir del servicio de medicina intensiva o medicina interna<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Adem&#225;s&#44; se ha destacado el papel primordial que juega la enfermer&#237;a en el reconocimiento y seguimiento<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En un intento de mejorar la atenci&#243;n integral al paciente con sepsis&#44; en nuestro centro se cre&#243; en el a&#241;o 2006 la primera unidad multidisciplinar de sepsis &#40;UMS&#41; en nuestro pa&#237;s&#46; El equipo estaba compuesto por un m&#233;dico con formaci&#243;n espec&#237;fica en enfermedades infecciosas y una enfermera con dedicaci&#243;n exclusiva&#44; as&#237; como por un equipo multidisciplinar con dedicaci&#243;n parcial&#44; compuesto por especialistas de&#58; medicina intensiva&#44; urgencias&#44; neumolog&#237;a&#44; medicina interna&#44; farmacia&#44; microbiolog&#237;a y cirug&#237;a general&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La UMS tiene un triple objetivo&#46; En primer lugar&#44; promover el reconocimiento precoz de la sepsis grave&#46; Segundo&#44; conseguir la implementaci&#243;n de las medidas de abordaje y tratamiento de la sepsis seg&#250;n las gu&#237;as de la <span class="elsevierStyleItalic">Surviving Sepsis Campaing</span><a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a>&#46; El tercer objetivo va dirigido a la optimizaci&#243;n del tratamiento antibi&#243;tico&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La intervenci&#243;n de un especialista en enfermedades infecciosas se ha demostrado que mejora el pron&#243;stico de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; En algunos centros se est&#225;n implementando programas para la optimizaci&#243;n del tratamiento antibi&#243;tico por parte de equipos multidisciplinares que han logrado mejorar los resultados en la prescripci&#243;n y consumo de antibi&#243;ticos<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#44;10</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Para asegurar una intervenci&#243;n precoz&#44; la UMS cre&#243; una herramienta inform&#225;tica&#58; el Protocolo Inform&#225;tico de Manejo Integral de la Sepsis &#40;PIMIS&#41;&#46; Sus objetivos son&#58; permitir una identificaci&#243;n precoz de la sepsis y la implementaci&#243;n inmediata de un conjunto de medidas eficaces&#44; que puedan prevenir el desarrollo de complicaciones&#44; mejorando el pron&#243;stico del paciente&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El presente estudio describe el desarrollo e implantaci&#243;n del PIMIS&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis observacional&#44; descriptivo y retrospectivo entre el 1 de enero de 2011 y el 30 de junio de 2012&#44; en el que se recogieron las siguientes variables&#58; los diferentes mecanismos de inclusi&#243;n de un paciente en el PIMIS&#44; el servicio de procedencia&#44; los d&#237;as transcurridos desde el ingreso hasta la consulta &#40;DC&#41;&#44; el foco de infecci&#243;n&#44; el origen &#40;nosocomial&#41;&#44; el tipo de recomendaci&#243;n en el cambio del tratamiento antibi&#243;tico&#44; as&#237; como el grado de aceptaci&#243;n de los pacientes adultos incluidos en el PIMIS ingresados en el Hospital Son Ll&#224;tzer&#46; El hospital ofrece cobertura sanitaria a una poblaci&#243;n de unos 225&#46;000 habitantes y dispone de 400 camas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Un paciente puede ser incluido en el PIMIS a partir de 4 mecanismos&#58; 1&#41; mediante la activaci&#243;n inform&#225;tica directa por su m&#233;dico responsable&#59; 2&#41; por consulta telef&#243;nica directa a la UMS&#59; 3&#41; tras conocerse un aislamiento microbiol&#243;gico significativo&#44; y 4&#41; tras la alerta del Sistema Inform&#225;tico de Detecci&#243;n de Constantes Vitales &#40;SIDCV&#41;&#46; Consideramos que la consulta es directamente solicitada &#40;CDS&#41; cuando se realiza por la inclusi&#243;n del paciente por su m&#233;dico en el PIMIS o telef&#243;nicamente&#44; y no solicitada &#40;CNS&#41; cuando se incluye a partir de la informaci&#243;n de microbiolog&#237;a o del SIDCV &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Cuando un paciente tiene sospecha de sepsis grave&#44; al seleccionar la herramienta del PIMIS se despliegan en un <span class="elsevierStyleItalic">check-list</span> los criterios de respuesta inflamatoria sist&#233;mica &#40;SIRS&#41;&#44; disfunci&#243;n org&#225;nica y marcadores inflamatorios &#40;prote&#237;na C reactiva&#59; normal &#60;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>mg&#47;l y procalcitonina&#59; normal &#60;<span class="elsevierStyleHsp" style=""></span>0-05<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Cuando se cumplen al menos 2 criterios de SIRS y uno de disfunci&#243;n org&#225;nica&#44; o elevaci&#243;n de marcadores&#44; el paciente se identifica como sepsis grave y&#44; validando el <span class="elsevierStyleItalic">check-list</span>&#44; se genera la activaci&#243;n autom&#225;tica del protocolo&#46; Una vez incluido el paciente&#44; se genera un aviso autom&#225;tico a la UMS a trav&#233;s de la generaci&#243;n de un listado que identifica al paciente y sus criterios de inclusi&#243;n&#46; A partir de este momento el paciente es valorado por un miembro de la UMS que se encargar&#225; de realizar las recomendaciones correspondientes en cuanto al abordaje y tratamiento espec&#237;fico&#46; El PIMIS est&#225; disponible para su activaci&#243;n desde cualquier servicio del hospital&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Paralelamente a la generaci&#243;n de un listado de los pacientes incluidos&#44; se visualizan para su posible consulta una serie de recomendaciones sobre el abordaje terap&#233;utico en cuanto a&#58; reanimaci&#243;n inicial&#44; soporte hemodin&#225;mico&#44; y tratamientos asociados&#44; adaptadas y seg&#250;n las recomendaciones de la <span class="elsevierStyleItalic">Surviving Sepsis Campaing</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">11</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; as&#237; como una serie de peticiones&#58; extracci&#243;n de hemocultivos&#44; radiograf&#237;a de t&#243;rax&#44; y extracci&#243;n de an&#225;lisis para monitorizaci&#243;n de lactato y par&#225;metros de disfunci&#243;n org&#225;nica&#44; PCR y PCT a las 6 y 24<span class="elsevierStyleHsp" style=""></span>h siguientes a la inclusi&#243;n &#40;siempre&#41; y muestras microbiol&#243;gicas &#40;seg&#250;n proceda&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La activaci&#243;n de un paciente en el PIMIS a partir del aislamiento microbiol&#243;gico se realiza cuando&#44; tras la reuni&#243;n diaria con microbiolog&#237;a&#44; se facilitan los resultados de las muestras significativas&#46; Con el resultado se realiza una valoraci&#243;n cl&#237;nica del paciente&#44; y si cumple criterios de sepsis&#44; es introducido y activado a trav&#233;s del PIMIS&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La otra herramienta empleada para la detecci&#243;n de pacientes con sospecha de sepsis es el SIDCV&#46; Con los par&#225;metros hemodin&#225;micos introducidos en el sistema inform&#225;tico de enfermer&#237;a&#44; junto con valores predefinidos de laboratorio&#44; se genera una puntuaci&#243;n que clasifica al paciente como sospecha de sepsis si la puntuaci&#243;n es mayor de 6 puntos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; La puntuaci&#243;n obtenida siempre ser&#225; de las &#250;ltimas 24<span class="elsevierStyleHsp" style=""></span>h&#46; La UMS recibe una alerta con el listado de pacientes que superan esta puntuaci&#243;n cada 24<span class="elsevierStyleHsp" style=""></span>h a la UMS&#46; Este sistema estaba siendo sometido a un ensayo piloto de validez interna durante los &#250;ltimos meses del estudio&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Los miembros de la UMS se distribuyen y valoran diariamente los pacientes incluidos en el PIMIS y&#47;o seleccionados por el SIDCV para asegurarse de que cumplen criterios cl&#237;nicos de sepsis&#44; en cuyo caso se contin&#250;a el seguimiento hasta el final del proceso&#46; En la primera consulta se establecen unas recomendaciones terap&#233;uticas que son comunicadas directamente al m&#233;dico responsable&#44; as&#237; como reflejadas en un informe de interconsulta&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Las recomendaciones de cambio en el tratamiento antibi&#243;tico pueden ser de 4 tipos&#58; a&#41; <span class="elsevierStyleItalic">desescalada</span>&#44; cuando el n&#250;mero o el espectro antibi&#243;tico se reduce de acuerdo con el patr&#243;n de resistencias&#59; b&#41; cambio por <span class="elsevierStyleItalic">mala evoluci&#243;n</span>&#44; cuando existen criterios cl&#237;nicos y&#47;o anal&#237;ticos de SIRS o disfunci&#243;n org&#225;nica que persisten m&#225;s all&#225; de las primeras 72<span class="elsevierStyleHsp" style=""></span>h&#59; c&#41; <span class="elsevierStyleItalic">ajuste de dosis o tratamiento inadecuado</span>&#44; cuando el antibi&#243;tico carece de actividad <span class="elsevierStyleItalic">in vitro</span> o es inadecuado para el foco de la infecci&#243;n&#44; o su administraci&#243;n puede conllevar efectos adversos que exceden a los beneficios esperados&#44; y d&#41; <span class="elsevierStyleItalic">terapia secuencial</span>&#44; cuando se pasa de la v&#237;a de administraci&#243;n intravenosa a la oral&#46; La optimizaci&#243;n del tratamiento antibi&#243;tico es supervisada por un farmac&#233;utico miembro de la UMS&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Una recomendaci&#243;n se considera aceptada cuando el cambio en el tratamiento antibi&#243;tico se ajusta a la recomendaci&#243;n realizada por la UMS&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas se expresan como frecuencias relativas y absolutas&#46; Las variables continuas se expresan como media y desviaci&#243;n est&#225;ndar &#40;DE&#41; y se comparan utilizando la t-Student o el test ANOVA para variables con distribuci&#243;n normal y el test U de Mann-Whitney para las de distribuci&#243;n no normal&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con SPSS 17&#46;0 &#40;Chicago&#44; IL&#44; EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41; y EPIDAT v&#46;3&#46;1&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0090" class="elsevierStylePara elsevierViewall">Durante el periodo de estudio se registraron 1&#46;581 nuevas consultas a la UMS correspondientes a 1&#46;340 pacientes&#44; lo que supone una media de 89 consultas nuevas por mes&#46; El 78&#44;5&#37; de los episodios fueron comunitarios&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El servicio de procedencia del paciente y el tipo de consulta realizada se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46; El servicio de urgencias &#40;22&#44;6&#37;&#41; y la UCI &#40;21&#37;&#41; fueron los servicios que realizaron un mayor n&#250;mero de consultas&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Mecanismos de activaci&#243;n del Protocolo Inform&#225;tico de Manejo Integral de la Sepsis &#40;PIMIS&#41;</span><p id="par0100" class="elsevierStylePara elsevierViewall">El principal mecanismo de consulta fue por activaci&#243;n directa del PIMIS por el m&#233;dico responsable &#40;54&#44;7&#37;&#41;&#46; Los pacientes proced&#237;an fundamentalmente de servicios m&#233;dicos &#40;91&#44;1&#37;&#41;&#58; urgencias &#40;29&#44;1&#37;&#41;&#44; seguido por la UCI &#40;27&#44;4&#37;&#41;&#44; medicina interna &#40;12&#44;4&#37;&#41; y neumolog&#237;a &#40;10&#44;3&#37;&#41;&#44; respectivamente&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El segundo mecanismo de inclusi&#243;n en el PIMIS fue tras la informaci&#243;n microbiol&#243;gica &#40;22&#44;8&#37;&#41;&#46; Existen servicios en los cuales m&#225;s de la mitad de los pacientes valorados eran incluidos a trav&#233;s de este mecanismo&#58; cardiolog&#237;a &#40;61&#44;9&#37;&#41;&#44; neurolog&#237;a &#40;58&#44;3&#37;&#41;&#44; ginecolog&#237;a y obstetricia &#40;53&#44;8&#37;&#41;&#44; y cirug&#237;a general &#40;51&#44;8&#37;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Por contacto telef&#243;nico directo se realizaron un 10&#44;4&#37; de las inclusiones en el PIMIS&#44; procedentes principalmente de oncolog&#237;a &#40;34&#44;7&#37;&#41;&#44; UCI &#40;20&#46;7&#37;&#41; y aparato digestivo &#40;10&#44;9&#37;&#41;&#46; El SIDCV identific&#243; tan solo 18 pacientes con sepsis&#44; correspondiendo solamente al 1&#44;1&#37; del total de consultas&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Consultas directamente solicitadas &#40;CDS&#41; vs&#46; consultas no solicitadas &#40;CNS&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las consultas fueron CDS &#40;65&#44;1&#37;&#41;&#46; De ellas&#44; el 84&#44;1&#37; fueron por activaci&#243;n del PIMIS por el m&#233;dico responsable y el 15&#44;9&#37; por contacto telef&#243;nico directo&#46; La proporci&#243;n fue significativamente mayor en los servicios m&#233;dicos que en los quir&#250;rgicos &#40;73&#44;0&#37; vs&#46; 39&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; As&#237; mismo&#44; las CDS se realizaron significativamente de forma m&#225;s precoz &#40;5&#44;63<span class="elsevierStyleHsp" style=""></span>d&#237;as vs&#46; 8&#44;47<span class="elsevierStyleHsp" style=""></span>d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Entre las CNS&#44; el 95&#44;2&#37; proced&#237;an de microbiolog&#237;a y el 4&#44;8&#37; del SIDCV&#46; El tiempo transcurrido entre la admisi&#243;n del paciente en el hospital y la consulta con la UMS se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> &#40;d&#237;as hasta consulta &#91;DC&#93;&#41;&#46; Las CDS por activaci&#243;n directa del PIMIS se realizaron antes que las que se hicieron por contacto telef&#243;nico directo &#40;4&#44;93<span class="elsevierStyleHsp" style=""></span>d&#237;as vs&#46; 9&#44;33<span class="elsevierStyleHsp" style=""></span>d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Foco de infecci&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En la primera consulta la infecci&#243;n m&#225;s frecuente fue de origen respiratorio &#40;34&#44;4&#37;&#41;&#44; seguida de la de origen abdominal &#40;22&#44;4&#37;&#41; y urinaria &#40;18&#44;2&#37;&#41;&#46; En un 23&#44;9&#37; de los casos no fue posible identificar el foco de la infecci&#243;n&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Recomendaci&#243;n de cambio de antibi&#243;tico</span><p id="par0125" class="elsevierStylePara elsevierViewall">Se recomend&#243; un cambio en 506 &#40;32&#37;&#41; de las primeras consultas y fue aceptado en 398 casos &#40;78&#44;1&#37;&#41;&#46; La frecuencia de aceptaci&#243;n fue muy variable entre las especialidades&#46; El porcentaje de aceptaci&#243;n fue significativamente mayor en las CDS &#40;80&#44;6&#37; vs&#46; 72&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Tipos de recomendaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">La principal causa de recomendaci&#243;n de cambio de antibi&#243;tico fue por mala evoluci&#243;n &#40;38&#44;5&#37;&#41;&#44; seguido por tratamiento inadecuado &#40;33&#44;9&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Los servicios donde se realiz&#243; el cambio por mala evoluci&#243;n fueron principalmente anestesia y reanimaci&#243;n &#40;78&#44;6&#37;&#41;&#44; aparato digestivo &#40;63&#44;2&#37;&#41;&#44; urgencias &#40;52&#44;9&#37;&#41; y UCI &#40;48&#44;6&#37;&#41;&#46; El ajuste de dosis fue la intervenci&#243;n m&#225;s frecuente en los servicios quir&#250;rgicos &#40;cirug&#237;a general&#44; ginecolog&#237;a y obstetricia&#44; urolog&#237;a&#44; traumatolog&#237;a&#41;&#44; as&#237; como en cardiolog&#237;a y neurolog&#237;a&#46; La desescalada fue la principal intervenci&#243;n en medicina interna &#40;45&#44;8&#37;&#41; y la terapia secuencial lo fue en neumolog&#237;a &#40;25&#44;6&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">El ajuste de dosis de antibi&#243;tico fue la intervenci&#243;n m&#225;s frecuente en algunas infecciones como en la infecci&#243;n del tracto urinario &#40;ITU&#41;&#44; infecci&#243;n asociada a cat&#233;ter&#44; o de piel y partes blandas &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; La ITU fue la infecci&#243;n en que se realiz&#243; desescalada antibi&#243;tica en un mayor n&#250;mero de ocasiones&#46; Por el contrario&#44; la infecci&#243;n abdominal y la respiratoria fueron las localizaciones donde mayormente se realiz&#243; cambio de antibi&#243;tico por mala evoluci&#243;n&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0140" class="elsevierStylePara elsevierViewall">Hay 2 aspectos importantes que diferencian el abordaje de la sepsis en nuestro centro&#46; Por un lado&#44; la existencia de una UMS&#44; compuesta por especialistas m&#233;dicos y quir&#250;rgicos&#46; Por otro lado&#44; la existencia de una herramienta inform&#225;tica que permite la identificaci&#243;n&#44; evaluaci&#243;n y registro de pacientes potencialmente afectos de sepsis grave&#58; el PIMIS&#44; pionero en Espa&#241;a&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se han desarrollado sistemas de alerta inform&#225;ticos para promover la identificaci&#243;n e implementaci&#243;n de medidas de abordaje de la sepsis en unidades distintas de la UCI<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;5&#44;12&#44;13</span></a>&#46; La idea que comparten todos ellos es permitir la identificaci&#243;n precoz y facilitar un abordaje integral e intensivo de patolog&#237;as potencialmente cr&#237;ticas&#46; A diferencia de la herramienta inform&#225;tica desarrollada por Ferreras et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a>&#44; con implantaci&#243;n en el servicio de urgencias&#44; nuestro protocolo permite la activaci&#243;n desde cualquier servicio del hospital&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Nuestro an&#225;lisis refleja la actividad pormenorizada por servicio&#44; mientras que estudios previos se limitan a comparar las diferencias entre los servicios m&#233;dicos y los quir&#250;rgicos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a>&#46; Esto nos permite reconocer aquellos servicios con los que necesitamos mejorar nuestra asistencia&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las consultas realizadas a la UMS se llevaron a cabo mediante la activaci&#243;n directa del PIMIS&#44; lo que demuestra su aceptaci&#243;n y reconocimiento&#46; As&#237; mismo&#44; es probable que la generaci&#243;n autom&#225;tica de un paquete de recomendaciones sea percibida como una ayuda &#250;til para el abordaje del paciente&#46; Sin embargo&#44; algunos profesionales prefieren recurrir a la consulta telef&#243;nica directa&#46; Esto podr&#237;a deberse a diversas causas&#44; como mayor confianza en la comunicaci&#243;n verbal directa&#44; desconocimiento o falta de informaci&#243;n acerca de la existencia del PIMIS o desconfianza en la tecnolog&#237;a&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En conjunto&#44; las CDS constituyen el principal mecanismo de consulta&#44; lo que demuestra que las recomendaciones sobre el abordaje de la sepsis por parte de la UMS son consideradas y aceptadas&#46; Uno de los principales retos a los que se enfrentan los profesionales de estas unidades es que su labor sea aceptada y reconocida por los especialistas de sus propios centros&#46; Esto es un requisito que permite asegurar la cooperaci&#243;n con las distintas especialidades y la eficacia de estos programas&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes valorados mediante CNS fueron aquellos procedentes de los aislamientos microbiol&#243;gicos&#46; Esto podr&#237;a implicar un retraso en el reconocimiento de la sepsis y la prescripci&#243;n de antibi&#243;tico adecuado&#44; dado que la valoraci&#243;n se hace al menos en las 24<span class="elsevierStyleHsp" style=""></span>h posteriores al env&#237;o de la muestra&#44; sin haberse consultado acerca del abordaje precoz o del tratamiento emp&#237;rico&#46; De hecho&#44; existe en estos casos una diferencia significativa en los d&#237;as que transcurren desde el ingreso del paciente hasta la valoraci&#243;n por la UMS&#46; En el futuro&#44; pensamos que los esfuerzos deber&#225;n ser dirigidos a la promoci&#243;n del reconocimiento precoz y a hacer m&#225;s accesible el PIMIS&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Actualmente se han desarrollado estrategias institucionales para promover la implementaci&#243;n de programas que optimicen la prescripci&#243;n antibi&#243;tica<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16-18</span></a>&#44; ya que se ha demostrado que en ocasiones hasta un 50&#37; de las prescripciones antibi&#243;ticas eran inapropiadas<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a>&#46; En nuestro estudio el 32&#37; de las prescripciones iniciales se consideraron inapropiadas&#46; G&#243;mez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">3</span></a> demostraron que la consulta con un especialista en enfermedades infecciosas aumentaba la proporci&#243;n de tratamientos apropiados en las prescripciones iniciales&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En comparaci&#243;n con estudios previos&#44; la frecuencia de modificaci&#243;n de la prescripci&#243;n antibi&#243;tica fue mayor<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">20-22</span></a>&#46; Los resultados son especialmente relevantes en los servicios quir&#250;rgicos<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19&#44;23&#44;24</span></a>&#46; Uno de los motivos que podr&#237;a explicar estos resultados podr&#237;a ser la integraci&#243;n de miembros de los servicios quir&#250;rgicos en la UMS&#46; Adem&#225;s&#44; el hecho de que las recomendaciones sean comunicadas directamente al m&#233;dico responsable&#44; en lugar de ser simplemente reflejadas en la historia cl&#237;nica&#44; podr&#237;a haber favorecido el grado de aceptaci&#243;n&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Es destacable la elevada proporci&#243;n de cambios aceptados en la UCI de acuerdo con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25&#44;26</span></a>&#46; Este hecho se deber&#237;a a que la UMS fue creada en el servicio de medicina intensiva y una elevada proporci&#243;n de sus miembros pertenecen a este servicio&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En cuanto al tipo de recomendaci&#243;n de cambio&#44; el hecho de que el m&#225;s frecuente sea por mala evoluci&#243;n podr&#237;a sugerir que se solicita ayuda en un segundo tiempo&#44; cuando el abordaje terap&#233;utico puede ser m&#225;s complejo&#44; y se estima necesaria la intervenci&#243;n de un especialista en enfermedades infecciosas&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Es posible que nuestra intervenci&#243;n&#44; adem&#225;s de conseguir optimizar el tratamiento antibi&#243;tico&#44; disminuya su consumo al promover la desescalada y la terapia secuencial precoz&#44; pero necesitamos confirmarlo con un estudio econ&#243;mico&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Aunque nuestro estudio refleja la experiencia de un solo centro&#44; creemos que la exhaustiva descripci&#243;n del funcionamiento de nuestra intervenci&#243;n puede alentar a otros grupos a definir y organizar estrategias en otros centros&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Recientemente&#44; en el &#250;ltimo documento de consenso acerca de las definiciones de la sepsis<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a>&#44; se cuestiona el uso de los criterios de SIRS en su diagn&#243;stico&#44; sugiriendo como nueva herramienta de valoraci&#243;n cl&#237;nica el qSOFA<span class="elsevierStyleItalic">&#46;</span> En el periodo de nuestro estudio todav&#237;a estaban vigentes las recomendaciones previas que inclu&#237;an los criterios de SIRS&#44; sin embargo&#44; creemos que puede ser una escala que facilite la valoraci&#243;n e identificaci&#243;n de gravedad en los pacientes con sepsis&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Una de las limitaciones de nuestro estudio es que no hemos recogido el n&#250;mero de episodios de sepsis que no fueron consultados a nuestra unidad&#46; A pesar de que no podemos conocer ni comparar el pron&#243;stico de ambos grupos&#44; el objetivo de nuestro estudio se centraba en se&#241;alar la importancia de organizar un abordaje coordinado con la implementaci&#243;n simult&#225;nea de unas medidas desde una perspectiva multidisciplinar&#46; Esperamos poder examinar variables cl&#237;nicas en pr&#243;ximos estudios&#46; Por otra parte&#44; las consultas realizadas para valoraci&#243;n diagn&#243;stica u otra causa distinta a la prescripci&#243;n antibi&#243;tica no han sido recogidas&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En resumen&#44; este estudio revela que una herramienta inform&#225;tica como el PIMIS puede ser una estrategia v&#225;lida para el reconocimiento de la sepsis&#46; Adem&#225;s&#44; la elevada proporci&#243;n de aceptaci&#243;n de las recomendaciones realizadas implica que la actividad de la UMS es aceptada y valorada positivamente&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicto de intereses</span><p id="par0215" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Introduction"
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              "titulo" => "Mecanismos de activaci&#243;n del Protocolo Inform&#225;tico de Manejo Integral de la Sepsis &#40;PIMIS&#41;"
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              "identificador" => "sec0030"
              "titulo" => "Consultas directamente solicitadas &#40;CDS&#41; vs&#46; consultas no solicitadas &#40;CNS&#41;"
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              "titulo" => "Foco de infecci&#243;n"
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              "titulo" => "Recomendaci&#243;n de cambio de antibi&#243;tico"
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                  "titulo" => "Tipos de recomendaci&#243;n"
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    "fechaAceptado" => "2016-11-10"
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            1 => "Protocolo Inform&#225;tico de Manejo Integral de la Sepsis"
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            1 => "Computer-assisted sepsis management protocol"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Es preciso desarrollar nuevas estrategias que permitan una identificaci&#243;n precoz y una inmediata instauraci&#243;n de medidas efectivas en el abordaje de la sepsis&#46; La unidad multidisciplinar de sepsis &#40;UMS&#41; desarroll&#243; una herramienta&#58; el Protocolo Inform&#225;tico de Manejo Integral de la Sepsis &#40;PIMIS&#41;&#46; El objetivo de este estudio es evaluar la intervenci&#243;n de la UMS y la utilidad del PIMIS&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las intervenciones seg&#250;n fueran realizadas por consulta directamente solicitada &#40;activaci&#243;n de PIMIS o consulta telef&#243;nica&#41; o no solicitada &#40;aislamientos microbiol&#243;gicos y el Sistema Inform&#225;tico de Detecci&#243;n de Constantes Vitales &#91;SIDCV&#93;&#41;&#44; los servicios&#44; el tipo de infecci&#243;n&#44; la recomendaci&#243;n de cambio de antibi&#243;tico y el grado de aceptaci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De las 1&#46;581 consultas&#44; el 65&#44;1&#37; se solicitaron directamente&#58; un 84&#44;1&#37; por activaci&#243;n del PIMIS por el m&#233;dico responsable y un 15&#44;9&#37; por contacto telef&#243;nico directo&#46; Entre las consultas no solicitadas&#44; el 95&#44;2&#37; proced&#237;an de microbiolog&#237;a y el 4&#44;8&#37; del SIDCV&#46; Las consultas directamente solicitadas se realizaron m&#225;s precozmente que las no solicitadas &#40;5&#44;63<span class="elsevierStyleHsp" style=""></span>d&#237;as vs&#46; 8&#44;47<span class="elsevierStyleHsp" style=""></span>d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y la frecuencia fue mayor en los servicios m&#233;dicos frente a los quir&#250;rgicos &#40;73&#44;0&#37; vs&#46; 39&#44;1&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Se recomend&#243; un cambio de antibi&#243;tico en el 32&#37; de las primeras consultas y se acept&#243; en el 78&#44;1&#37; de los casos&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La elevada proporci&#243;n de consultas directamente solicitadas y aceptaci&#243;n de las recomendaciones demuestra que la intervenci&#243;n de la UMS es valorada y respetada&#46; El PIMIS es el principal mecanismo de consulta&#44; lo que lo convierte en una herramienta &#250;til y conveniente para la identificaci&#243;n precoz y el abordaje de la sepsis&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
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            "titulo" => "M&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">New strategies need to be developed for the early recognition and rapid response for the management of sepsis&#46; To achieve this purpose&#44; the Multidisciplinary Sepsis Team &#40;MST&#41; developed the Computerised Sepsis Protocol Management &#40;PIMIS&#41;&#46; The aim of this study was to evaluate the convenience of using PIMIS&#44; as well as the activity of the MST&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An analysis was performed on the data collected from solicited MST consultations &#40;direct activation of PIMIS by attending physician or telephone request&#41; and unsolicited ones &#40;by referral from the microbiology laboratory or an automatic referral via the hospital vital signs recording software &#91;SIDCV&#93;&#41;&#44; as well as the hospital department&#44; source of infection&#44; treatment recommendation&#44; and acceptance of this&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 1&#44;581 first consultations&#44; 65&#46;1&#37; were solicited consultations &#40;84&#46;1&#37; activation of PIMIS and 15&#46;9&#37; by telephone&#41;&#46; The majority of unsolicited consultations were generated by the microbiology laboratory &#40;95&#46;2&#37;&#41;&#44; and 4&#46;8&#37; from the SIDCV&#46; Referral from solicited consultations were generated sooner &#40;5&#46;63days vs 8&#46;47days&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and came from clinical specialties rather than from the surgical ward &#40;73&#46;0&#37; vs 39&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; A recommendation was made for antimicrobial prescription change in 32&#37; of first consultations&#46; The treating physician accepted 78&#46;1&#37; of recommendations&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The high rate of solicited consultations and acceptance of recommended prescription changes suggest that a MST is seen as a helpful resource&#44; and that PIMIS software is perceived to be useful and convenient to use&#44; as it is the main source of referral&#46;</p></span>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#59; INR&#58; cociente internacional normalizado&#59; PAM&#58; presi&#243;n arterial media&#59; PaO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno&#59; PAS&#58; presi&#243;n arterial sist&#243;lica&#59; PCO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial carb&#243;nico&#59; SIRS&#58; s&#237;ndrome inflamatorio de respuesta sist&#233;mica&#59; TTPA&#58; tiempo de tromboplastina parcial activado&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">S&#237;ndrome de respuesta inflamatoria sist&#233;mica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Temperatura 38<span class="elsevierStyleHsp" style=""></span>&#176;C o &#60;<span class="elsevierStyleHsp" style=""></span>36<span class="elsevierStyleHsp" style=""></span>&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frecuencia cardiaca &#62;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>lpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frecuencia respiratoria &#62;<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>rpm o PCO<span class="elsevierStyleInf">2</span> &#60;<span class="elsevierStyleHsp" style=""></span>32<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leucocitosis &#62;<span class="elsevierStyleHsp" style=""></span>12&#46;000&#47;&#956;l o &#60;<span class="elsevierStyleHsp" style=""></span>4&#46;000&#47;&#956;l o 10&#37;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>formas inmaduras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Disfunci&#243;n org&#225;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alteraci&#243;n del nivel de conciencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PAS &#60;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg o PAM &#60;<span class="elsevierStyleHsp" style=""></span>70<span class="elsevierStyleHsp" style=""></span>mmHg o disminuci&#243;n de PAS &#62;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mmHg o inferior a 2 DE en adultos de la misma edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hipoxemia arterial &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>300&#41; o saturaci&#243;n O<span class="elsevierStyleInf">2</span> &#60;<span class="elsevierStyleHsp" style=""></span>90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oliguria &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h&#41; en las &#250;ltimas 2<span class="elsevierStyleHsp" style=""></span>h a pesar de adecuada reanimaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Incremento de creatinina &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl o &#62;<span class="elsevierStyleHsp" style=""></span>2 veces su valor normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coagulopat&#237;a&#58; INR &#62;<span class="elsevierStyleHsp" style=""></span>1&#44;5 o TTPA &#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>s o trombocitopenia &#60;<span class="elsevierStyleHsp" style=""></span>100&#46;000&#47;&#956;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oliguria &#40;&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h&#41; en las &#250;ltimas 2<span class="elsevierStyleHsp" style=""></span>h a pesar de adecuada reanimaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hiperbilirrubinemia &#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hiperlactacidemia &#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prote&#237;na C reactiva &#62;<span class="elsevierStyleHsp" style=""></span>2 veces su valor normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Procalcitonina &#62;<span class="elsevierStyleHsp" style=""></span>2 veces su valor normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Criterios de activaci&#243;n del Protocolo de manejo integral de la sepsis</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CVC&#58; cat&#233;ter venoso central&#59; DVA&#58; drogas vasoactivas&#59; FR&#58; frecuencia respiratoria&#59; IBP&#58; inhibidores de la bomba de protones&#59; i&#46;v&#46;&#58; intravenoso&#59; PAM&#58; presi&#243;n arterial media&#59; PCO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial carb&#243;nico&#59; PO<span class="elsevierStyleInf">2</span>&#58; presi&#243;n parcial de ox&#237;geno&#59; PVC&#58; presi&#243;n venosa central&#59; s&#46;c&#46;&#58; subcut&#225;nea&#59; SatO<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n ox&#237;geno&#59; SatO<span class="elsevierStyleInf">2</span>V&#58; saturaci&#243;n venosa de ox&#237;geno central&#59; SatVM&#58; saturaci&#243;n venosa mixta&#59; SG&#58; sepsis grave&#59; SS&#58; shock s&#233;ptico&#59; UCI&#58; unidad de cuidados intensivos&#59; VMK&#58; ventimask&#59; v&#46;o&#46;&#58; v&#237;a oral&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reanimaci&#243;n inicial &#40;grado 1C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Durante las 6 primeras horas<br>Asegurar diuresis horaria 0&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;kg&#47;h y PAM 65<span class="elsevierStyleHsp" style=""></span>mmHg<br>Colocaci&#243;n CVC&#58; PVC 8-12<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O&#59; SatO<span class="elsevierStyleInf">2</span>V &#8805;<span class="elsevierStyleHsp" style=""></span>70&#37; o SatVM &#8805;<span class="elsevierStyleHsp" style=""></span>65&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fluidoterapia &#40;grado 1C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000<span class="elsevierStyleHsp" style=""></span>ml cristaloides o 300-500<span class="elsevierStyleHsp" style=""></span>ml coloides en 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Antibioterapia &#40;grado 1B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Precoz&#58; en la primera hora de reconocimiento SG<br>Elecci&#243;n seg&#250;n origen &#40;comunitario&#47;nosocomial&#41; y epidemiolog&#237;a local<br>Amplio espectro y buena penetraci&#243;n<br>Asociaci&#243;n en&#58; SS&#44; sospecha <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; neutrop&#233;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Control del foco &#40;grado C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Valorar intervenci&#243;n quir&#250;rgica precoz<br>Drenaje&#44; desbridamiento<br>Retirada de dispositivos intravasculares&#44; pr&#243;tesis&#44; cuerpo extra&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vasopresores &#40;grados A-D&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">En sepsis grave con hipotensi&#243;n o lactato &#62;<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mmol&#47;l<br>Noradrenalina y dopamina &#40;1C&#41;<br>Dopamina&#58; evitar uso dosis bajas &#40;1A&#41;<br>Colocar v&#237;a arterial &#40;1D&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inotr&#243;picos &#40;grado 1C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">En SS y bajo gasto considerar dobutamina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Esteroides &#40;grado B-C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">En SS con hipotensi&#243;n pese DVA<br>Hidrocortisona 200-300<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7 d&#237;as &#40;2B&#41;<br>Valorar a&#241;adir fludrocortisona 50<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h v&#46;o&#46; &#40;2C&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prote&#237;na C activada recombinante &#40;grado 2B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indicada en shock s&#233;ptico con fracaso de 2 &#243;rganos y&#47;o APACHE II<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25<br>Xigris<span class="elsevierStyleSup">&#174;</span> 24<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>96<span class="elsevierStyleHsp" style=""></span>h<br>Ver contraindicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Administraci&#243;n productos hematol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Objetivo hemoglobina 7-9<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;1B&#41;<br>Transfusi&#243;n de plaquetas si &#60;<span class="elsevierStyleHsp" style=""></span>5&#46;000&#47;&#956;l o 5&#46;000-30&#46;000&#47;&#956;l si riesgo de sangrado &#40;2D&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Insuficiencia respiratoria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Considerar soporte ventilatorio si&#58; FR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30-35<span class="elsevierStyleHsp" style=""></span>rpm o SatO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>90&#37; o VMK<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#37; PO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mmHg o PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>200 o pH<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#44;35&#47;PCO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sedaci&#243;n&#44; analgesia&#44; relajaci&#243;n &#40;grado B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Seg&#250;n protocolo de UCI y reanimaci&#243;n<br>Evitar relajaci&#243;n prolongada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Control gluc&#233;mico &#40;grados B-C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pauta correctora de insulina i&#46;v&#46; y s&#46;c&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Remplazamiento renal &#40;grado 2B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uso hemodi&#225;lisis intermitente y hemofiltraci&#243;n veno-venosa continua indistintamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bicarbonato &#40;grado C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No utilizar si pH &#8805;<span class="elsevierStyleHsp" style=""></span>7&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Profilaxis trombosis venosa profunda &#40;grado A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Considerar medias de compresi&#243;n<br>Heparina bajo peso molecular&#46; Enoxaparina 40<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h s&#46;c&#46;&#59; &#62;<span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>kg &#40;sin recomendaci&#243;n clara&#58; 60<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;<br>Heparina s&#243;dica 5&#46;000<span class="elsevierStyleHsp" style=""></span>UI&#47;24<span class="elsevierStyleHsp" style=""></span>h i&#46;v&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Profilaxis &#250;lcera estr&#233;s &#40;grados A-B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uso anti-H2 &#40;1A&#41;<br>Uso IBP &#40;1B&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Soporte nutricional &#40;grado E&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dextrosa i&#46;v&#46; hasta inicio de nutrici&#243;n enteral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">FiO<span class="elsevierStyleInf">2</span>&#58; fracci&#243;n inspirada de ox&#237;geno&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Puntuaci&#243;n asignada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actividad protrombina &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bicarbonato &#40;mmol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18-21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15-17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilirrubina total &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7-11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinina &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;2-1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;51-2&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FiO<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24-31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35-49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Frecuencia cardiaca &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100-125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactato plasm&#225;tico &#40;mmol&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3-3&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leucocitos &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11-14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15-19&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plaquetas &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20-49&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Procalcitonina &#40;ng&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5-1&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2-9&#44;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prote&#237;na C reactiva &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50-99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100-200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Saturaci&#243;n ox&#237;geno &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temperatura &#40;&#176;C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38-38&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>39&#47;&#8804;<span class="elsevierStyleHsp" style=""></span>35&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Presi&#243;n arterial media &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60-65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Criterios de puntuaci&#243;n en el Sistema Inform&#225;tico de Detecci&#243;n de Constantes Vitales &#40;SIDCV&#41;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Acept&#46;&#58; cambio de antibi&#243;tico aceptado&#59; Anest&#46; y rea&#46;&#58; anestesia y reanimaci&#243;n&#59; CATBS&#58; cambio de antibi&#243;tico sugerido&#59; CS&#58; consulta solicitada&#59; CTD&#58; contacto telef&#243;nico directo&#59; DC&#58; d&#237;as hasta consulta&#59; Gin&#46; y obstr&#46;&#58; ginecolog&#237;a y obstetricia&#59; Microb&#46;&#58; aislamiento microbiol&#243;gico&#59; N-S&#58; consulta no solicitada&#59; Nosoc&#46;&#58; nosocomial&#59; PMISG&#58; protocolo de manejo integral de la sepsis grave&#59; SIDCV&#58; Sistema Inform&#225;tico de Detecci&#243;n de Constantes Vitales&#59; Solic&#46;&#58; consulta solicitada&#59; Trauma&#46; y ortop&#46;&#58; traumatolog&#237;a y ortopedia&#59; UCI&#58; unidad de cuidados intensivos&#59; UG&#58; urgencias generales&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Servicio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;581&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PMISG<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CTD<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SIDCV<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microb&#46;<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Otro<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Nosoc&#46;<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>340&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DC<br>&#40;m&#44; DE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CS<br>&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N-S<br>&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CATBS<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>506&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Acept&#46;<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>395&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">252 &#40;70&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;16&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;3 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;53&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">237 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;10&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#44;2 &#40;16&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;41&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128 &#40;92&#44;1&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a general&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;51&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;13&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;5 &#40;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;37&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;75&#44;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medicina interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;66&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;1 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;82&#44;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oncolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;29&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;45&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;15&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;5 &#40;10&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;81&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neumolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;01 &#40;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;70&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">A&#46; digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;26&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;23&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;42&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;8&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;7 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;68&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;36&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;15&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;9 &#40;9&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;37&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;85&#44;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anest&#46; y rea&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;62&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;9 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;37&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;69&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gin&#46; y obstr&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;53&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;15&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;4 &#40;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;46&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;83&#44;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;19&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;61&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;7 &#40;9&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;38&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;62&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nefrolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;38&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;90&#44;9&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hematolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;9 &#40;12&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;66&#44;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;58&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;2 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;41&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;80&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trauma&#46; y ortop&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;3 &#40;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;33&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;100&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Otras esp&#46; m&#233;d&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;60&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;5 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;15&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Mecanismo de consulta y modificaci&#243;n de tratamiento por servicio</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">AD&#58; ajuste de dosis&#59; Anest&#46; y rea&#46;&#58; anestesia y reanimaci&#243;n&#59; DE&#58; desescalada&#59; Gin&#46; y obstr&#46;&#58; ginecolog&#237;a y obstetricia&#59; ME&#58; mala evoluci&#243;n&#59; Trauma&#46; y ortop&#46;&#58; traumatolog&#237;a y ortopedia&#59; TS&#58; terapia secuencial&#59; UCI&#58; unidad de cuidados intensivos&#59; UG&#58; urgencias generales&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Servicio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>121 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ME<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>205<br>&#40;38&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AD<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>181<br>&#40;33&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TS<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26<br>&#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">UG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;14&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;52&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;19&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">UCI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;48&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;23&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146 &#40;44&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cirug&#237;a general&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;29&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;26&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;42&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;35&#44;8&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medicina interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;45&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;30&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oncolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;46&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;35&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;5&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;44&#44;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neumolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;27&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;37&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;25&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;41&#44;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">A&#46; digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;63&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;24&#44;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;57&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;37&#44;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anest&#46; y rea&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;78&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;40&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gin&#46; y obst&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;69&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;15&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;50&#44;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;20&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;23&#44;8&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nefrolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;40&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;55&#44;6&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hematolog&#237;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;37&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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          "identificador" => "bibs0005"
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                    0 => array:2 [
                      "titulo" => "Epidemiology and recent trends of severe sepsis in Spain&#58; A nationwide population-based analysis &#40;2006-2011&#41;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Bouza"
                            1 => "T&#46; L&#243;pez-Cuadrado"
                            2 => "Z&#46; Saz-Parkinson"
                            3 => "J&#46;M&#46; Amate-Blanco"
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                    0 => array:2 [
                      "doi" => "10.1186/s12879-014-0717-7"
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                        "tituloSerie" => "BMC Infect Dis&#46;"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "3863"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25528662"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0145"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surviving sepsis campaign&#58; International guidelines for management of severe sepsis and septic shock&#44; 2012"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Dellinger"
                            1 => "M&#46;M&#46; Levy"
                            2 => "A&#46; Rhodes"
                            3 => "D&#46; Annane"
                            4 => "H&#46; Gerlach"
                            5 => "S&#46;M&#46; Opal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2769-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "165"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23361625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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            ]
            2 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The influence of the opinion of an infectious disease consultant on the appropriateness of antibiotic treatment in a general hospital"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Gomez"
                            1 => "S&#46;J&#46; Conde Cavero"
                            2 => "J&#46;L&#46; Hernandez Cardona"
                            3 => "M&#46;L&#46; Nu&#241;ez"
                            4 => "J&#46; Ruiz Gomez"
                            5 => "M&#46; Cantera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Antimicrob Chemoth&#46;"
                        "fecha" => "1996"
                        "volumen" => "38"
                        "paginaInicial" => "309"
                        "paginaFinal" => "314"
                      ]
                    ]
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            3 => array:3 [
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              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of infectious diseases specialists&#58; Non-patient care activities"
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                          "autores" => array:6 [
                            0 => "D&#46;P&#46; McQuillen"
                            1 => "R&#46;M&#46; Petrak"
                            2 => "R&#46;B&#46; Wasserman"
                            3 => "R&#46;G&#46; Nahass"
                            4 => "J&#46;A&#46; Scull"
                            5 => "L&#46;P&#46; Martinelli"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/592067"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis&#46;"
                        "fecha" => "2008"
                        "volumen" => "47"
                        "paginaInicial" => "1051"
                        "paginaFinal" => "1063"
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                      "titulo" => "Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy&#44; the infectious disease division&#44; and the microbiology laboratory"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Schentag"
                            1 => "C&#46;H&#46; Ballow"
                            2 => "A&#46;L&#46; Fritz"
                            3 => "J&#46;A&#46; Paladino"
                            4 => "J&#46;D&#46; Williams"
                            5 => "T&#46;J&#46; Cumbo"
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                        "tituloSerie" => "Diagn Microbiol Infect Dis&#46;"
                        "fecha" => "1993"
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                        "paginaInicial" => "255"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8477582"
                            "web" => "Medline"
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              "identificador" => "bib0165"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years"
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                          "autores" => array:5 [
                            0 => "P&#46; Carling"
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                            2 => "A&#46; Killion"
                            3 => "N&#46; Terrin"
                            4 => "M&#46; Barza"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/502278"
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                        "tituloSerie" => "Infect Control Hosp Epidemiol&#46;"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "699"
                        "paginaFinal" => "706"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14510254"
                            "web" => "Medline"
                          ]
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                ]
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              "identificador" => "bib0170"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Implementation and outcomes of the Multiple Urgent Sepsis Therapies &#40;MUST&#41; protocol"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46;D&#46; Howell"
                            2 => "D&#46; Talmor"
                            3 => "D&#46; Lahey"
                            4 => "L&#46; Ngo"
                            5 => "J&#46; Buras"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Crit Care Med&#46;"
                        "fecha" => "2006"
                        "volumen" => "34"
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                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Septic shock&#58; A multidisciplinary response team and weekly feedback to physicians improve the process of care and mortality"
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                          "etal" => false
                          "autores" => array:5 [
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                            1 => "R&#46; Kashyap"
                            2 => "J&#46;J&#46; Mullon"
                            3 => "O&#46; Gajic"
                            4 => "B&#46; Afessa"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181ffde08"
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                        "tituloSerie" => "Crit Care Med&#46;"
                        "fecha" => "2011"
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                        "paginaInicial" => "252"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21057312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0180"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and implementation of a multidisciplinary sepsis protocol"
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                        0 => array:2 [
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                          "autores" => array:4 [
                            0 => "K&#46;M&#46; Picard"
                            1 => "S&#46;C&#46; O&#8217;Donoghue"
                            2 => "D&#46;A&#46; Young-Kershaw"
                            3 => "K&#46;J&#46; Russell"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Nurse&#46;"
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                        "paginaInicial" => "43"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16717386"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib0185"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Developing an early sepsis alert program"
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                            0 => "K&#46;M&#46; Buck"
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                        "tituloSerie" => "J Nurs Care Qual&#46;"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "124"
                        "paginaFinal" => "132"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24048073"
                            "web" => "Medline"
                          ]
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                    0 => array:2 [
                      "titulo" => "Surviving Sepsis Campaign&#58; international guidelines for management of severe sepsis and septic shock&#58; 2008"
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                        0 => array:3 [
                          "colaboracion" => "International Surviving Sepsis Campaign Guidelines Committee"
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                            2 => "J&#46;M&#46; Carlet"
                            3 => "J&#46; Bion"
                            4 => "M&#46;M&#46; Parker"
                            5 => "R&#46; Jaeschke"
                          ]
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                    ]
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                    0 => array:2 [
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                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158437"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Impact of protocol watch on compliance with the surviving sepsis campaign"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;K&#46; Giuliano"
                            1 => "M&#46; Lecardo"
                            2 => "L&#46; Staul"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4037/ajcc2011421"
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                        "tituloSerie" => "Am J Crit Care&#46;"
                        "fecha" => "2011"
                        "volumen" => "20"
                        "paginaInicial" => "313"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21724635"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Implementation of a real-time computerized sepsis alert in non-intensive care unit patients"
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                            1 => "E&#46;N&#46; Deal"
                            2 => "A&#46;J&#46; Labelle"
                            3 => "C&#46; Witt"
                            4 => "S&#46;W&#46; Thiel"
                            5 => "K&#46; Heard"
                          ]
                        ]
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                    0 => array:2 [
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                        "paginaFinal" => "473"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21169824"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
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                      "titulo" => "Implementaci&#243;n de un sistema de alarmas autom&#225;tico para la detecci&#243;n precoz de los pacientes con sepsis grave"
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                            3 => "C&#46; Aspiroz"
                            4 => "R&#46; Mart&#237;nez-&#193;lvarez"
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                        "tituloSerie" => "Enferm Infecc Microbiol Clin&#46;"
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                        "volumen" => "33"
                        "paginaInicial" => "508"
                        "paginaFinal" => "515"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25701057"
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                    0 => array:2 [
                      "titulo" => "Impact of a non-compulsory antibiotic control program &#40;PACTA&#41;&#58; Cost reductions and decreases in some nosocomial infection"
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                            4 => "C&#46; Lumbreras"
                            5 => "M&#46; Lizasoain"
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Enferm Infecc Microbiol Clin"
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                        "paginaInicial" => "186"
                        "paginaFinal" => "190"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15826540"
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Evaluation of an advisory program in antibiotic therapy"
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                            5 => "S&#46; Moreno Guill&#233;n"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp&#46;"
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                        "paginaInicial" => "78"
                        "paginaFinal" => "83"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11996759"
                            "web" => "Medline"
                          ]
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                ]
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                    0 => array:2 [
                      "titulo" => "Why don&#8217;t they listen&#63; Adherence to recommendations of infectious disease consultations"
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                            4 => "M&#46; Phillips"
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Clin Infect Dis&#46;"
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                        "paginaInicial" => "1212"
                        "paginaFinal" => "1218"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15127330"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0225"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Compliance with an infectious disease specialist&#39;s advisory consultations on targeted antibiotic usage"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;N&#46; Kim"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "J Infect Chemother&#46;"
                        "fecha" => "2005"
                        "volumen" => "11"
                        "paginaInicial" => "84"
                        "paginaFinal" => "88"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15856376"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
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              "identificador" => "bib0230"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of the infectious diseases specialist consultant on the appropriateness of antimicrobial therapy prescription in an intensive care unit"
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                          "etal" => false
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                            3 => "A&#46; Acquarolo"
                            4 => "A&#46; Candiani"
                            5 => "L&#46; Crema"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Am J Infect Control&#46;"
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                        "paginaInicial" => "283"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18455049"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0235"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship"
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                        0 => array:3 [
                          "colaboracion" => "Infectious Diseases Society of America&#59; Society for Healthcare Epidemiology of America"
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                            5 => "J&#46;P&#46; Burke"
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                  "host" => array:1 [
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                        "paginaInicial" => "159"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17173212"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0240"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Unsolicited post-prescription antibiotic review in surgical and medical wards&#58; Factors associated with counselling and physicians&#8217; compliance"
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                        0 => array:2 [
                          "etal" => false
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Eur J Clin Microbiol Infect Dis"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "227"
                        "paginaFinal" => "235"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22918515"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0245"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Improving antimicrobial stewardship&#58; The evolution of programmatic strategies and barriers"
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                      "titulo" => "Antimicrobial stewardship &#8212; the state of the art in 2011&#58; Focus on outcome and methods"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                    ]
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                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22418627"
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                      ]
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                  ]
                ]
              ]
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              "etiqueta" => "24"
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                    0 => array:2 [
                      "titulo" => "Programs for optimizing the use of antibiotics &#40;PROA&#41; in Spanish hospitals&#58; GEIH-SEIMC&#44; SEFH and SEMPSPH consensus document"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            3 => "A&#46; Asensio"
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                        "volumen" => "30"
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                        "paginaFinal" => "22&#46;e23"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22541340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "25"
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                    0 => array:2 [
                      "titulo" => "Factors associated with adherence to infectious diseases advice in two intensive care units"
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                          "autores" => array:6 [
                            0 => "C&#46; Pulcini"
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                            4 => "G&#46; Bernardin"
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                        "volumen" => "57"
                        "paginaInicial" => "546"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16449306"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program&#58; a pilot study"
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                        0 => array:3 [
                          "colaboracion" => "Sopravvivere alla Sepsis Group of the Modena-University Hospital"
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                          "autores" => array:6 [
                            0 => "M&#46; Girardis"
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                            2 => "L&#46; Donno"
                            3 => "M&#46; Marietta"
                            4 => "M&#46; Codeluppi"
                            5 => "P&#46; Marchegiano"
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                        ]
                      ]
                    ]
                  ]
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                        "volumen" => "13"
                        "paginaInicial" => "R143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19728879"
                            "web" => "Medline"
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                  ]
                ]
              ]
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              "etiqueta" => "27"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The third international consensus definitions for sepsis and septic shock &#40;Sepsis-3&#41;"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Singer"
                            1 => "C&#46;S&#46; Deutschman"
                            2 => "C&#46;W&#46; Seymour"
                            3 => "M&#46; Shankar-Hari"
                            4 => "D&#46; Annane"
                            5 => "M&#46; Bauer"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "volumen" => "315"
                        "paginaInicial" => "801"
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Información del artículo
ISSN: 0213005X
Idioma original: Español
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