array:23 [
  "pii" => "S1130147305703973"
  "issn" => "11301473"
  "doi" => "10.1016/S1130-1473(05)70397-3"
  "estado" => "S300"
  "fechaPublicacion" => "2005-01-01"
  "aid" => "70397"
  "copyright" => "Sociedad Española de Neurocirugía"
  "copyrightAnyo" => "2005"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Neurocirugia. 2005;16:323-31"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1719
    "formatos" => array:3 [
      "EPUB" => 18
      "HTML" => 963
      "PDF" => 738
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1130147305703985"
    "issn" => "11301473"
    "doi" => "10.1016/S1130-1473(05)70398-5"
    "estado" => "S300"
    "fechaPublicacion" => "2005-01-01"
    "aid" => "70398"
    "copyright" => "Sociedad Española de Neurocirugía"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Neurocirugia. 2005;16:331-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2246
      "formatos" => array:3 [
        "EPUB" => 17
        "HTML" => 1079
        "PDF" => 1150
      ]
    ]
    "es" => array:7 [
      "idiomaDefecto" => true
      "titulo" => "Comentario al trabajo&#58; <span class="elsevierStyleItalic">Existencia de hipoperfusi&#243;n oculta sist&#233;mica en el traumatismo craneoencef&#225;lico&#46; Estudio preliminar de</span> Murillo-Cabezas y cols"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "331"
          "paginaFinal" => "332"
        ]
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;A&#46; Poca"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Poca"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147305703985?idApp=UINPBA00004B"
    "url" => "/11301473/0000001600000004/v1_201305151241/S1130147305703985/v1_201305151241/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1130147305703961"
    "issn" => "11301473"
    "doi" => "10.1016/S1130-1473(05)70396-1"
    "estado" => "S300"
    "fechaPublicacion" => "2005-01-01"
    "aid" => "70396"
    "copyright" => "Sociedad Espa&#241;ola de Neurocirug&#237;a"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2005;16:301-22"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2280
      "formatos" => array:3 [
        "EPUB" => 20
        "HTML" => 1104
        "PDF" => 1156
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "M&#233;todos globales de monitorizaci&#243;n de la hemodin&#225;mica cerebral en el paciente neurocr&#237;tico&#58; fundamentos&#44; controversias y actualizaciones en las t&#233;cnicas de oximetr&#237;a yugular"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "301"
          "paginaFinal" => "322"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Global systems for monitoring cerebral hemodynamics in the neurocritical patient&#58; basic concepts&#44; controversies and recent advances in measuring jugular bulb oxygenation"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => "A&#46; Vilalta"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Vilalta"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => "M&#46;A&#46; Poca, J&#46; Sahuquillo, R&#46; Monforte"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Poca"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Sahuquillo"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Monforte"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147305703961?idApp=UINPBA00004B"
    "url" => "/11301473/0000001600000004/v1_201305151241/S1130147305703961/v1_201305151241/es/main.assets"
  ]
  "es" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Existencia de hipoperfusi&#243;n oculta sist&#233;mica en el traumatismo craneoencef&#225;lico&#46; Estudio preliminar"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "323"
        "paginaFinal" => "331"
      ]
    ]
    "autores" => array:2 [
      0 => array:4 [
        "autoresLista" => "F&#46; Murillo-Cabezas, R&#46; Amaya-Villar, M&#170;&#46;D&#46; Rinc&#243;n-Ferrari, J&#46;M&#46; Flores-Cordero, S&#46; Garc&#237;a-G&#243;mez, M&#170;&#46;A&#46; Mu&#241;oz-S&#225;nchez"
        "autores" => array:6 [
          0 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Murillo-Cabezas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "Amaya-Villar"
          ]
          2 => array:2 [
            "nombre" => "M&#170;&#46;D&#46;"
            "apellidos" => "Rinc&#243;n-Ferrari"
          ]
          3 => array:2 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Flores-Cordero"
          ]
          4 => array:2 [
            "nombre" => "S&#46;"
            "apellidos" => "Garc&#237;a-G&#243;mez"
          ]
          5 => array:2 [
            "nombre" => "M&#170;&#46;A&#46;"
            "apellidos" => "Mu&#241;oz-S&#225;nchez"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Servicio de Cuidados Cr&#237;ticos y Urgencias&#46; Hospitales Universitarios Virgen del Roc&#237;o&#46; Sevilla"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondencia postal&#58; Pablo Ruiz Picasso&#44; 4&#46; 41909 Salteras&#46; Sevilla&#46;"
          ]
        ]
      ]
      1 => array:3 [
        "autoresLista" => "J&#46; Valencia-Anguita"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Valencia-Anguita"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Servicio de Neurocirug&#237;a&#46; Hospitales Universitarios Virgen del Roc&#237;o&#46; Sevilla"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
            "identificador" => "aff0010"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Evidence of occult systemic hypoperfussion in head injured patients&#46; Preliminary study"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2004-09-03"
    "fechaAceptado" => "2004-11-29"
    "PalabrasClave" => array:2 [
      "es" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec158957"
          "palabras" => array:4 [
            0 => "Traumatismo craneoencef&#225;lico"
            1 => "Acido l&#225;ctico"
            2 => "Hipoperfusi&#243;n oculta"
            3 => "Deuda de ox&#237;geno"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abreviaturas"
          "identificador" => "xpalclavsec158956"
          "palabras" => array:15 [
            0 => "AIS"
            1 => "AL"
            2 => "APACHE II"
            3 => "GCS"
            4 => "HO"
            5 => "ICU"
            6 => "ISS"
            7 => "LA"
            8 => "OH"
            9 => "RTS"
            10 => "SDRA"
            11 => "TAC"
            12 => "TCE"
            13 => "TSR"
            14 => "UCI"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec158958"
          "palabras" => array:4 [
            0 => "Head Injury"
            1 => "Lactic Acid&#46;"
            2 => "Occult hypoperfussion"
            3 => "Oxygen Debt"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Investigar en pacientes con traumatismo craneoencef&#225;lico grave y moderado &#40;TCE&#41;&#44; hemodin&#225;micamente estables&#44; la relaci&#243;n entre los valores arteriales de &#225;cido l&#225;ctico &#40;AL&#41; en las primeras 48 horas con la evoluci&#243;n y complicaciones del TCE&#44; y conocer qu&#233; factores de riesgo se relacionan con valores anormales de AL&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; pros-pectivo&#44; de cohorte&#44; de 210 pacientes adultos con TCE grave y moderado&#46; Conseguida la estabilizaci&#243;n hemodin&#225;mica del paciente&#44; se realiz&#243; una determinaci&#243;n basal de AL&#44; que se repiti&#243; cada 12 horas durante las primeras 48 horas y&#44; posteriormente&#44; cada 24 horas hasta la normalizaci&#243;n de los valores de AL&#46; Los pacientes se clasificaron en dos grupos&#58; Grupo 1 &#40;AL &#60; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; sin hipoperfusi&#243;n oculta &#40;HO&#41;&#44; y grupo 2 &#40;AL &#8805; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; con HO&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">115 pacientes &#40;57&#44;76&#37;&#41; se catalogaron como grupo 1&#44; y 95 pacientes &#40;45&#44;24&#37;&#41; como grupo 2&#46; En el an&#225;lisis univariante de los factores de riesgo para AL &#8805; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L mostraron significaci&#243;n estad&#237;stica todos los &#237;ndices generales de gravedad del TCE &#91;Glasgow Coma Scale &#40;GCS&#41;&#44; Injury Severity Score &#40;ISS&#41;&#44; Trauma Score Revisado &#40;TSR&#41; y Acute Physiology and Chronic Health Evaluation &#40;APACHE&#41; II&#93;&#44; la hipotensi&#243;n arterial&#44; hipoxemia&#44; anemia&#44; hiper-glucemia&#44; hipotermia y la mayor incidencia de administraci&#243;n de noradrenalina&#46; Asimismo&#44; en el grupo 1 se objetiv&#243; un mayor porcentaje en la TAC de ingreso de lesiones tipo II &#40;53&#44;91&#37; vs&#46; 38&#44;94&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; En el an&#225;lisis multivariante de regresi&#243;n log&#237;stica&#44; s&#243;lo dos factores se asociaron de forma independiente a valores elevados de AL&#58; APACHE II en las primeras 24 horas&#58; OR 1&#44;12 &#40;IC 95&#37; 1&#44;06&#8211;1&#44;196&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y volumen de l&#237;quidos total infundido en las primeras 48 horas&#58; OR 1&#44;09 &#40;IC 95&#37; 1&#44;02&#8211;1&#44;16&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; El grupo 2 se asoci&#243;&#44; con significaci&#243;n estad&#237;stica&#44; a una mayor tasa de infecciones &#40;63&#44;2&#37; vs 47&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#44; y al aumento de la estancia en UCI&#46; &#91;mediana &#40;percentil 25&#8211;75&#41;&#93; &#91;13&#44;29 &#40;7&#44;11&#8211;21&#44;22&#41; d&#237;as vs&#46; 8&#44;78 &#40;4&#44;40&#8211;16&#44;72&#41; d&#237;as&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#93;&#46; Aunque fue m&#225;s alto el porcentaje de hipertensi&#243;n intracraneal y mortalidad en el grupo 2&#44; no se constat&#243; significaci&#243;n estad&#237;stica&#46; El aumento de AL&#44; en el an&#225;lisis multivariante&#44; no se comport&#243; como factor independiente de riesgo para las complicaciones estudiadas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La existencia de HO en pacientes con TCE graves y moderados&#44; con valores de presi&#243;n arterial postreanimaci&#243;n seg&#250;n las recomendaciones actuales&#44; se asocia a una mayor gravedad del TCE manifestada por el APACHE II y por el volumen de l&#237;quidos administrado en las primeras 48 horas&#46; La HO en el TCE conlleva un aumento de la tasa de infecciones y de la estancia en UCI&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the correlation between blood lactic acid levels in the first48 hours and outcome&#44; in hemodynamically stable patients&#44; with moderate or severe head injury &#40;HI&#41;&#44; and to investigate the risk factors associated with abnormal lactate levels&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective observational study&#44; in 210 adults patients with moderate or severe head injury&#46; When the patients were hemodynamically stable&#44; blood lactate concentrations were measured once on admission&#44; twice daily during the first 2 days and once daily until lactate levels were normalized&#46; The whole group 210 patients were divided into 2 groups&#46; Group 1&#58; &#40;LA &#60; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; patients without occult hypoperfussion &#40;OH&#41;&#44; and group 2&#58; &#40;LA &#8805; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#41; patients with OH&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">One hundred and fifteen patients &#40;57&#44;76&#37;&#41; were categorized as group 1&#44; and 95 patients &#40;45&#44;24&#37;&#41; as group 2&#46; In the univariate analysis of risk factors for blood lactate &#8805; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L the following variables showed statistical significance&#58; severity of the head injury measured by several scales &#91;Glasgow Coma Scale &#40;GCS&#41;&#44; Injury Severity Score &#40;ISS&#41;&#44; Revised Trauma Score &#40;RTS&#41; and Acute Physiology and Chronic Health Evaluation &#40;APACHE&#41; II&#93;&#44; arterial hypotension&#44; hypoxemia&#44; anaemia&#44; hyperglucemia&#44; hypothermia&#44; a greater incidence of norepinephrine infusion&#44; and the higher percentage of type II lesions in the head computerized tomography at admission showed in the group 1 &#40;53&#44;91&#37; vs&#46; 38&#44;94&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41;&#46; In the multiple logistic regression analysis only two variables were risk independently associated with elevated blood lactate concentration&#58; APACHE II in the first 24 hours&#58; OR 1&#44;12 &#40;95&#37; IC 1&#44;06&#8211;1&#44;196&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; and the first 48-hours total fluid infusion volumes&#58; OR 1&#44;09 &#40;95&#37; IC 1&#44;021&#44;16&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; The infection rate &#40;63&#44;2&#37; vs 47&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#44; and length of ICU stay &#91;mediana &#40;percentil 25&#8211;75&#41;&#93; &#91;13&#44;29 &#40;7&#44;11&#8211;21&#44;22&#41; days vs&#46; 8&#44;78 &#40;4&#44;40&#8211;16&#44;72&#41; days&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#93; were significantly higher in patients with blood lactate &#8805; 2&#44;2<span class="elsevierStyleHsp" style=""></span>mmol&#47;L &#40;group 2&#41;&#46; Although&#44; the percentage of intracranial hypertension and mortality was higher in the group 2&#44; there was no significant difference&#46; In the multivariate analysis&#44; the increase of blood lactate concentration&#44; was not independently associated as a risk factor with studied complications&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The presence of OH in patients with moderate or severe head injury&#44; with postres uscitation arterial pressure&#44; according to present recommendations&#44; is associated with a more severe head injury&#44; showed by APACHE II and the total fluid infusion volumes in the first 48 hours&#46; OH in head injury increases the infection rate and length of ICU stay&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Murillo-Cabezas&#44; F&#46;&#59; Amaya-Villar&#44;R&#46;&#59; Rinc&#243;n-Ferrari&#44; M&#170;&#46;D&#46;&#59; Flores-Cordero&#44; J&#46;M&#46;&#59; Valencia-Anguita&#44; J&#46;&#59; Garc&#237;a-G&#243;mez&#44; S&#46;&#59; Mu&#241;oz-S&#225;nchez&#44; M&#170;&#46;A&#46;&#58; Existencia de hipoperfusi&#243;n oculta sist&#233;mica en el traumatismo craneoencef&#225;lico&#46; Estudio Preliminar&#46; Neurocirug&#237;a 2005&#59; 16&#58; 323&#8211;332&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "The Brain Trauma Foundation&#46; The American Association of Neurological Surgeons"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/neu.2000.17.471"
                      "Revista" => array:7 [
                        "titulo" => "The Joint Section on Neurotrauma and Critical Care&#46; Resuscitation of blood pressure and oxygenation"
                        "tituloSerie" => "J Neurotrauma"
                        "fecha" => "2000"
                        "volumen" => "17"
                        "paginaInicial" => "471"
                        "paginaFinal" => "478"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10937889"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Injury Severity Score&#58; a method for describing patients with multiple injuries and evaluating emergency care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;P&#46; Baker"
                            1 => "B&#46; O&#8217;Neill"
                            2 => "W&#46; Haddon"
                            3 => "W&#46;B&#46; Long"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1974"
                        "volumen" => "14"
                        "paginaInicial" => "187"
                        "paginaFinal" => "196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4814394"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between supranormal circulatory values&#44; time delays&#44; and outcome in severely traumatized patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;H&#46; Bishop"
                            1 => "W&#46;C&#46; Shoemaker"
                            2 => "P&#46;L&#46; Appel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1993"
                        "volumen" => "21"
                        "paginaInicial" => "56"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8420731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The golden our and the silver day&#58; detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Blow"
                            1 => "L&#46; Magliore"
                            2 => "J&#46; Claridge"
                            3 => "K&#46; Butler"
                            4 => "S&#46; Jeffrey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1999"
                        "volumen" => "47"
                        "paginaInicial" => "964"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10568731"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factores pron&#243;sticos en el traumatismo craneoencef&#225;lico grave"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;R&#46; Boto"
                            1 => "P&#46;A&#46; G&#243;mez"
                            2 => "J&#46; De la Cruz"
                            3 => "R&#46; Diez Lobato"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurocirug&#237;a"
                        "fecha" => "2004"
                        "volumen" => "15"
                        "paginaInicial" => "233"
                        "paginaFinal" => "247"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15239010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between injury severity and lactate levels in severely injured patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "O&#46; Cerovi"
                            1 => "V&#46; Golubovi"
                            2 => "A&#46; pec-Marn"
                            3 => "B&#46; Krem"
                            4 => "G&#46; Vidmar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-1753-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "1300"
                        "paginaFinal" => "1305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12904861"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A revision of the Trauma Score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;R&#46; Champion"
                            1 => "W&#46;J&#46; Sacco"
                            2 => "W&#46;S&#46; Copes"
                            3 => "D&#46;S&#46; Gann"
                            4 => "T&#46;A&#46; Gennarelli"
                            5 => "M&#46;E&#46; Flanagan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1989"
                        "volumen" => "29"
                        "paginaInicial" => "623"
                        "paginaFinal" => "629"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2657085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of secondary brain injury in determining outcome from severe head injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;M&#46; Chesnut"
                            1 => "L&#46;F&#46; Marshall"
                            2 => "M&#46;R&#46; Klauber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1993"
                        "volumen" => "34"
                        "paginaInicial" => "216"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8459458"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Detection of early ischemia in severe head injury by means of arteriovenous lactate differences and jugular bulb oxygen saturation&#46; Relationship with CPP&#44; severity indexes and outcome&#44; Preliminary analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Chieregato"
                            1 => "M&#46; Marchi"
                            2 => "R&#46; Zoppellari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Neurochir"
                        "fecha" => "2002"
                        "volumen" => "81"
                        "numero" => "Suppl"
                        "paginaInicial" => "289"
                        "paginaFinal" => "293"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Cladrige"
                            1 => "T&#46;D&#46; Crabtree"
                            2 => "S&#46;J&#46; Pelletier"
                            3 => "K&#46; Butler"
                            4 => "R&#46;G&#46; Sowyer"
                            5 => "J&#46;S&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2000"
                        "volumen" => "48"
                        "paginaInicial" => "8"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10647559"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occult hypoperfusion is associated with increased morbidity in patients undergoing early femur fracture fixation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46;C&#46; Crowl"
                            1 => "J&#46;S&#46; Young"
                            2 => "S&#46; Jeffrey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2000"
                        "volumen" => "48"
                        "paginaInicial" => "260"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10697084"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lactate production by the lungs in acute lung injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; De Backer"
                            1 => "J&#46; Creteur"
                            2 => "H&#46; Zhang"
                            3 => "M&#46; Norrenberg"
                            4 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.156.4.9701048"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1997"
                        "volumen" => "156"
                        "paginaInicial" => "1099"
                        "paginaFinal" => "1104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9351608"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lactic acidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; De Backer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-003-1746-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2003"
                        "volumen" => "29"
                        "paginaInicial" => "699"
                        "paginaFinal" => "702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12682722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CDC definitions for nosocomial infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;S&#46; Garner"
                            1 => "W&#46;R&#46; Jarvis"
                            2 => "T&#46;G&#46; Emori"
                            3 => "T&#46;C&#46; Horan"
                            4 => "J&#46;M&#46; Hughes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Infect Control"
                        "fecha" => "1988"
                        "volumen" => "16"
                        "paginaInicial" => "128"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2841893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lactic acidosis during sepsis is related to increase pyruvate production&#44; no deficits in tissue oxygen availability"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;C&#46; Gore"
                            1 => "F&#46; Jahoor"
                            2 => "J&#46;M&#46; Hibbert"
                            3 => "E&#46;J&#46; DeMaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1996"
                        "volumen" => "224"
                        "paginaInicial" => "97"
                        "paginaFinal" => "102"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8678625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "APACHE II&#46; A severity of disease classification system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;A&#46; Knaus"
                            1 => "D&#46;P&#46; Wagner"
                            2 => "E&#46;A&#46; Draper"
                            3 => "J&#46;E&#46; Zimmerman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1985"
                        "volumen" => "13"
                        "paginaInicial" => "818"
                        "paginaFinal" => "829"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3928249"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of ICP instability and hypotension on outcome in patients with severe head trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Marmarou"
                            1 => "R&#46;L&#46; Anderson"
                            2 => "J&#46;D&#46; Ward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1991"
                        "volumen" => "75"
                        "numero" => "Suppl"
                        "paginaInicial" => "S28"
                        "paginaFinal" => "S36"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new classification of head injury based on computerized tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;F&#46; Marshall"
                            1 => "S&#46;B&#46; Marshall"
                            2 => "M&#46;R&#46; Klauber"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1991"
                        "volumen" => "75"
                        "numero" => "Suppl"
                        "paginaInicial" => "S59"
                        "paginaFinal" => "S66"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-injury multiple organ failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;A&#46; Moore"
                            1 => "E&#46;E&#46; Moore"
                            2 => "J&#46;B&#46; Haenel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Trauma"
                        "paginaInicial" => "1205"
                        "paginaFinal" => "1218"
                        "edicion" => "3&#170;"
                        "serieFecha" => "1996"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilidad del doppler transcraneal en la fase precoz del traumatismo craneoencef&#225;lico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Murillo Cabezas"
                            1 => "D&#46; Arteta Arteta"
                            2 => "J&#46;M&#46; Flores Cordero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurocirug&#237;a"
                        "fecha" => "2002"
                        "volumen" => "13"
                        "paginaInicial" => "196"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12148164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early biochemical changes and severity of injury on man"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;L&#46; Oppenheim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1980"
                        "volumen" => "20"
                        "paginaInicial" => "135"
                        "paginaFinal" => "140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7354495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Rinc&#243;n-Ferrari&#44; M&#46;D&#46;&#44; Flores-Cordero&#44; J&#46;M&#46;&#44; Leal-Noval&#44; S&#46;R&#46;&#44; et al&#46;&#58; Impact of ventilator-associated pneumoma in patients with severe head injury&#46; J Trauma &#40;in press&#41;&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early goal-directed therapy in the treatment of severe sepsis and septic shock"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "E&#46; Rivers"
                            1 => "B&#46; Nguyen"
                            2 => "S&#46; Havstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa010307"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2001"
                        "volumen" => "345"
                        "paginaInicial" => "1368"
                        "paginaFinal" => "1377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11794169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic correlates of oxygen debt predict posttrauma early acute respiratory distress syndrome and the related cytokine response"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Rixen"
                            1 => "J&#46;H&#46; Siegel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2000"
                        "volumen" => "49"
                        "paginaInicial" => "392"
                        "paginaFinal" => "403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11003314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Robertson"
                            1 => "R&#46;G&#46; Grossman"
                            2 => "J&#46;C&#46; Goodman"
                            3 => "R&#46;K&#46; Narayan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1987.67.3.0361"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1987"
                        "volumen" => "67"
                        "paginaInicial" => "361"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3612268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of coma and impaired consciousness&#58; A practical Scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Teasdale"
                            1 => "B&#46; Jennnet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1974"
                        "volumen" => "2"
                        "paginaInicial" => "81"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2567876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of blood lactate monitoring in clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Updated in lntensive Care and Emergency Medicine"
                        "paginaInicial" => "260"
                        "paginaFinal" => "272"
                        "serieFecha" => "1991"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/11301473/0000001600000004/v1_201305151241/S1130147305703973/v1_201305151241/es/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/11301473/0000001600000004/v1_201305151241/S1130147305703973/v1_201305151241/es/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147305703973?idApp=UINPBA00004B"
]
Compartir
Información de la revista
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Existencia de hipoperfusión oculta sistémica en el traumatismo craneoencefálico. Estudio preliminar
Evidence of occult systemic hypoperfussion in head injured patients. Preliminary study
F. Murillo-Cabezas
, R. Amaya-Villar, Mª.D. Rincón-Ferrari, J.M. Flores-Cordero, S. García-Gómez, Mª.A. Muñoz-Sánchez
Servicio de Cuidados Críticos y Urgencias. Hospitales Universitarios Virgen del Rocío. Sevilla
J. Valencia-Anguita*
* Servicio de Neurocirugía. Hospitales Universitarios Virgen del Rocío. Sevilla

Comprar documento

Para la compra de este documento es necesario que rellene el siguiente formulario:

Afganistan
Albania
Alemania
Andorra
Angola
Anguilla
Antartica
Antigua and barbuda
Antillas holandesas
Arabia saudita
Argelia
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgica
Belice
Benin
Bermudas/antillas britanicas
Bhutan
Bolivia
Bosnia y herzegowina
Botswana
Brasil
Brunei darussalam
Bulgaria
Burkina faso
Burundi
Cabo verde
Camboya
Camerun
Canada
Chad
Chile
China
Chipre
Colombia
Comoros
Corea
Costa rica
Cote d´ivoire
Croacia
Cuba
Dinamarca
Djibouti
Dominica
East timor
Ecuador
Egipto
El salvador
Emiratos arabes unidos
Eritrea
Escocia
Eslovaquia
Eslovenia
España
Estados federados de micronesia
Estados unidos
Estonia
Etiopia
Fiji
Filipinas
Finlandia
Francia
Gabon
Gambia
Georgia
Ghana
Gibraltar
Grecia
Grenada
Groenlandia
Guadalupe
Guam
Guatemala
Guayana britanica
Guinea
Guinea ecuatorial
Guinea francesa
Guinea-bissau
Haiti
Holanda
Honduras
Hong kong
Hungria
India
Indonesia
Irak
Iran
Irlanda
Isla bouvet
Isla cocos (keeling)
Isla cook
Isla mauricio
Isla navidad
Isla norfolk
Islandia
Islas caiman
Islas falkland (malvinas)
Islas faroe
Islas georgia del sur y sandwich
Islas heard and mc donald
Islas marshall
Islas northern mariana
Islas salomon
Islas svalbard and jan mayen
Islas turks and caicos
Islas united states minor outlyi
Islas virgenes (britanicas)
Islas virgenes (u.s.a.)
Islas wallis and futuna
Israel
Italia
Jamaica
Japon
Jordania
Kazakhstan
Kenia
Kiribati
Kuwait
Kyrgyzstan
Lesoto
Letonia
Libano
Liberia
Libia arab jamahiriya
Liechtenstein
Lituania
Luxemburgo
Macao
Macedonia
Madagascar
Malasia
Malawi
Maldives
Mali
Malta
Marruecos
Martinica
Mauritania
Mayotte
Mexico
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Niger
Nigeria
Niue
Noruega
Nueva caledonia
Nueva zelanda
Oman
Pakistan
Palau
Panama
Papua new guinea
Paraguay
Peru
Pitcairn
Polinesia francesa
Polonia
Portugal
Posesiones gran bretaña
Posesiones u.s.a.
Puerto rico
Qatar
Reino unido
Republica checa
Republica de africa central
Republica de cabo verde
Republica de congo
Republica de corea
Republica de moldova
Republica democratica de laos
Republica democratica del congo
Republica dominicana
Reunion
Ruanda
Rumania
Rusia
Sahara occidental
Saint kitts and nevis
Samoa
Samoa americana
San marino
San tomas y principe
San vincent and the grenadines
Santa lucia
Senegal
Serbia
Seychelles
Sierra leona
Singapur
Siria
Somalia
Sri lanka
St. helena
St. pierre and miquelon
Sudafrica
Sudan
Suecia
Suiza
Surinam
Swaziland
Tailandia
Taiwan republica de china
Tajikistan
Tanzania
Territorio de indias britanicas
Togo
Tokelau
Tonga
Trinidad and tobago
Tunisia
Turkmenistan
Turquia
Tuvalu
Ucrania
Uganda
Uruguay
Uzbekistan
Vanuatu
Vaticano
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbawe
Lebanon
Paises bajos
A coruña
Alava
Albacete
Alicante
Almeria
Asturias
Avila
Badajoz
Balears
Barcelona
Bizkaia
Burgos
Caceres
Cadiz
Cantabria
Castellon
Ceuta
Ciudad real
Cordoba
Cuenca
Girona
Granada
Guadalajara
Guipuzcoa
Huelva
Huesca
Jaen
La rioja
Las palmas
Leon
Lleida
Lugo
Madrid
Malaga
Melilla
Murcia
Navarra
Ourense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Tarragona
Tenerife
Teruel
Toledo
Valencia
Valladolid
Zamora
Zaragoza
-- No procede --
Deseo recibir información sobre productos y promociones especiales de Elsevier por correo electrónico
Deseo recibir información sobre productos y promociones especiales de los partners de Elsevier por correo electrónico
* Campos obligatorios
Además del acceso temporal al documento, este le será enviado por correo electrónico.
Atención al cliente
Teléfono
Llamadas desde España
932 415 960
Llamadas desde el extranjero
+34 932 415 960
Horario de 9 a 18h. excepto los meses de julio y agosto que será de 9 a 15h.
Idiomas
Neurocirugía
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?