Point-of-care ultrasound in Spanish paediatric intensive care units

array:24 ["pii" => "S2341287917300844" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.06.007" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "2130" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:344-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1764 "formatos" => array:3 [ "EPUB" => 151 "HTML" => 1185 "PDF" => 428 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403316302193" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2016.06.009" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "2130" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:344-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4259 "formatos" => array:3 [ "EPUB" => 149 "HTML" => 3302 "PDF" => 808 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Ecografía en el punto de cuidado en las unidades de cuidados intensivos pediátricos españolas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Point-of-care ultrasound in Spanish paediatric intensive care units" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1231 "Ancho" => 1586 "Tamanyo" => 123904 ] ] "descripcion" => array:1 [ "es" => "Frecuencia de utilización de la ecografía para la canalización de los diferentes accesos vasculares." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael González Cortés, Luis Renter Valdovinos, Ana Coca Pérez, José Luis Vázquez Martínez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "González Cortés" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Renter Valdovinos" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Coca Pérez" ] 3 => array:2 [ "nombre" => "José Luis" "apellidos" => "Vázquez Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287917300844" "doi" => "10.1016/j.anpede.2016.06.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300844?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302193?idApp=UINPBA00005H" "url" => "/16954033/0000008600000006/v1_201705270026/S1695403316302193/v1_201705270026/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287917300856" "issn" => "23412879" "doi" => "10.1016/j.anpede.2016.08.007" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "2150" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2017;86:350-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1452 "formatos" => array:3 [ "EPUB" => 135 "HTML" => 961 "PDF" => 356 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Scientific Letter" "titulo" => "Improved lung function in cystic fibrosis using mechanical insufflation–exsufflation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "350" "paginaFinal" => "352" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mejora de la función pulmonar en fibrosis quística mediante insuflación-exuflación mecánica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1179 "Ancho" => 1524 "Tamanyo" => 58132 ] ] "descripcion" => array:1 [ "en" => "Changes in lung function (expressed as %FEV1) from baseline to the end of the intervention. FEV1, forced expiratory volume in the first second expressed as percentage. The values were expressed as the percentage of the theoretical value for individuals of the same age, weight and height based on the Spanish reference population." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Azahara Fuentes, Pilar Caro, Antonio Jose Garcia-Ruiz, Gregorio Muñoz Gómez, Elisa Martín-Montañez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Laura Azahara" "apellidos" => "Fuentes" ] 1 => array:2 [ "nombre" => "Pilar" "apellidos" => "Caro" ] 2 => array:2 [ "nombre" => "Antonio Jose" "apellidos" => "Garcia-Ruiz" ] 3 => array:2 [ "nombre" => "Gregorio" "apellidos" => "Muñoz Gómez" ] 4 => array:2 [ "nombre" => "Elisa" "apellidos" => "Martín-Montañez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403316302557" "doi" => "10.1016/j.anpedi.2016.08.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302557?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300856?idApp=UINPBA00005H" "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300856/v1_201705270049/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287917300790" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.12.007" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "2023" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2017;86:337-43" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1798 "formatos" => array:3 [ "EPUB" => 184 "HTML" => 1179 "PDF" => 435 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Epidemiology and risk factors in injuries due to fall in infants under one year-old" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "343" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epidemiología y factores de riesgo de las lesiones por caídas en niños menores de un año" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1284 "Ancho" => 1663 "Tamanyo" => 144887 ] ] "descripcion" => array:1 [ "en" => "Fall mechanisms by age group." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Jiménez de Domingo, Elena Rubio García, Rafael Marañon Pardillo, Vanessa Arias Constanti, Luis Alberto Frontado Haiek, Marta Soriano Arola, Francesc Ripoll Oliveras, Cristina Remón García, Gloria Estopiña Ferrer, Jorge Lorente Romero" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Jiménez de Domingo" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Rubio García" ] 2 => array:2 [ "nombre" => "Rafael" "apellidos" => "Marañon Pardillo" ] 3 => array:2 [ "nombre" => "Vanessa" "apellidos" => "Arias Constanti" ] 4 => array:2 [ "nombre" => "Luis Alberto" "apellidos" => "Frontado Haiek" ] 5 => array:2 [ "nombre" => "Marta" "apellidos" => "Soriano Arola" ] 6 => array:2 [ "nombre" => "Francesc" "apellidos" => "Ripoll Oliveras" ] 7 => array:2 [ "nombre" => "Cristina" "apellidos" => "Remón García" ] 8 => array:2 [ "nombre" => "Gloria" "apellidos" => "Estopiña Ferrer" ] 9 => array:2 [ "nombre" => "Jorge" "apellidos" => "Lorente Romero" ] 10 => array:1 [ "colaborador" => "Representing the Grupo de Trabajo de Lesiones no Intencionadas de la Sociedad Española de Urgencias de Pediatría" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315005603" "doi" => "10.1016/j.anpedi.2015.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315005603?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300790?idApp=UINPBA00005H" "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300790/v1_201705270049/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Point-of-care ultrasound in Spanish paediatric intensive care units" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "349" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rafael González Cortés, Luis Renter Valdovinos, Ana Coca Pérez, José Luis Vázquez Martínez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Rafael" "apellidos" => "González Cortés" "email" => array:1 [ 0 => "rafa_gonzalez_cortes@hotmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luis" "apellidos" => "Renter Valdovinos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "Coca Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "José Luis" "apellidos" => "Vázquez Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de investigación Sanitaria Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Red de Salud Materno Infantil y Desarrollo, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía en el punto de cuidado en las unidades de cuidados intensivos pediátricos españolas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1603 "Tamanyo" => 119171 ] ] "descripcion" => array:1 [ "en" => "Frequency of the use of ultrasonography to assist in the establishment of different vascular accesses." ] ] ] "textoCompleto" => "IntroductionPoint-of-care, bedside or clinical ultrasonography is defined as ultrasonography performed by the doctor in charge directly where the patient is for clinical assessment. It is used for addressing specific problems or questions immediately and in real time.<a class="elsevierStyleCrossRef" href="#bib0130">1</a> Compared to ultrasonography performed by radiologists, which can provide more comprehensive and accurate information, point-of-care ultrasound usually focuses on yes/no questions to facilitate diagnosis and especially on procedural guidance.<a class="elsevierStyleCrossRef" href="#bib0130">1</a> Furthermore, since it is easily repeatable, it can be used to assess changes in different clinical situations or conditions.The size of paediatric patients facilitates the access of ultrasound waves to different organs while obtaining high-quality images. This fact, along with the elimination of the risks associated with the use of ionising radiation techniques, is clearly stimulating an increase in the use of ultrasonography.<a class="elsevierStyleCrossRefs" href="#bib0135">2,3</a> Decreasing costs, decreasing size and improvements in the specifications of ultrasonography systems in recent years have also been essential in the expansion of its use outside radiology units.It has multiple applications in the field of paediatrics, which are clearly expanding.<a class="elsevierStyleCrossRefs" href="#bib0145">4–6</a> This is demonstrated by the increasing availability of ultrasound units in the paediatric emergency departments of some countries, as well as its increasingly frequent inclusion in clinical practice guidelines and training curriculums of different specialties.<a class="elsevierStyleCrossRefs" href="#bib0160">7–9</a>Paediatric critical care and emergency care are probably the fields in which the use of bedside ultrasonography by the paediatrician in charge is becoming most widespread. This is probably due to several factors, such as the immediacy of its use, the possibility of performing serial assessments, and above all the increasing number of clinical applications. More specifically, in the field of intensive care, there is evidence that ultrasonography can be used by critical care physicians to guide the performance of other techniques, such as establishing vascular access<a class="elsevierStyleCrossRefs" href="#bib0175">10,11</a> or the drainage of effusions in different locations.<a class="elsevierStyleCrossRef" href="#bib0185">12</a> Furthermore, clinical ultrasonography can be used to answer specific questions regarding multiple organs and systems, and has demonstrated a high sensitivity and specificity in the diagnosis of various lung diseases.<a class="elsevierStyleCrossRef" href="#bib0190">13</a> It allows the assessment of different aspects to determine the haemodynamic status of a patient, such as myocardiac contractility or blood volume,<a class="elsevierStyleCrossRefs" href="#bib0195">14,15</a> detect the presence of intra-abdominal lesions<a class="elsevierStyleCrossRef" href="#bib0205">16</a> or assess changes in blood flow in different vital organs, such as the brain<a class="elsevierStyleCrossRef" href="#bib0210">17</a> or kidneys.<a class="elsevierStyleCrossRef" href="#bib0215">18</a>To date, although some studies have found clear evidence of its increasing use in adult intensive care units and paediatric emergency departments,<a class="elsevierStyleCrossRef" href="#bib0160">7</a> only one study conducted in the United States has described its availability and the characteristics of its use in paediatric intensive care units (PICUs).<a class="elsevierStyleCrossRef" href="#bib0220">19</a>The main objective of our study was to characterise the availability and use of point-of-care ultrasonography in Spanish PICUs. More specifically, we sought to identify the most widely used clinical applications. Our secondary objective was to determine the level of training on the use of ultrasonography in the care of critical paediatric patients of Spanish clinicians.Materials and methodsWe conducted a multicentric cross-sectional descriptive study. We developed an online survey using the Google Forms online platform that consisted of 45 questions organised into three sections. We gathered contact information for 51 PICUs in Spain. The survey was distributed by the Sociedad Española de Cuidados Intensivos Pediátricos (Spanish Society of Paediatric Critical Care) by electronic mail to the service chief or contact person of the different paediatric intensive care units. In a second phase, we attempted to contact the units that had not completed the questionnaire by electronic mail.The first section of the survey consisted of questions that explored the characteristics of the PICU and its activity and those of the hospital to which it belonged.The second section explored the availability of ultrasound machines, their location, exclusive or shared use, frequency of use and use for different applications. In the last section, the questionnaire asked about the training on ultrasonography of the PICU staff including physicians and nurses, the need for training and guidelines, and the usefulness of specific training in ultrasonography.We analysed the responses by means of the SPSS software for Mac OS X version 20.0.0 (IBM Corp, Armonk, New York, USA). We described categorical variables by the percentage of answers in each category, and continuous variables as median and interquartile range. We compared groups by means of nonparametric tests (Kruskal–Wallis, Fisher's exact and Mann–Whitney U), and defined statistical significance as a p-value of less than 0.05 in these tests.ResultsCharacteristics of participating paediatric intensive care unitsOf the 51 identified units, 33 (64.7%) responded to the survey. Of all the submitted surveys, 60.6% had been completed by the individual in charge of the unit (chief of service, department chief or coordinator) and the rest by attending physicians. Each unit submitted the survey only once.Of all participating units, 84.8% operated in public hospitals, 6.1% in privately managed public hospitals, and 9.1% in private hospitals; while 93.9% of all PICUs were in university hospitals.Most PICUs (72.7%) cared exclusively for paediatric patients, while 27.3% were mixed units offering both paediatric and neonatal care. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the type of patients routinely admitted to the PICUs.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>When it came to the size of the surveyed units, the median number of beds was eleven (IQR, 6.5). Of all units, 51.5% had more than ten beds, 39.4% between six and ten beds and 9.1% fewer than five. The median number of admissions per year was 368 (IQR, 290); five units (5.6%) had more than 600 admissions a year, 59.4% between 300 and 600 and 25% fewer than 300. The median number of physicians on staff was seven (IQR, 3.5); 27.3% of the units had more than eight physicians on staff, 57.6% between five and eight, and 15.2% fewer than five.Ultrasound machine availabilityOf all the PICUs, 53.1% had a dedicated ultrasound machine and the rest shared it with other units in the hospital (in 25%, the device was usually kept in the PICU and in 21.9% outside the PICU). Only two (6.1%) of the units that responded to our survey reported not having access to an ultrasound machine. We did not find an association between the availability of ultrasound systems and the number of beds, the number of physicians, the number of admissions per year or the type of patients routinely served in the unit. Of the PICUs with ultrasound machines, 43.8% had portable units, while 56.2% had large non-portable systems.Use of clinical ultrasonographyOnly one unit reported never having used clinical ultrasonography. A total of 35.5% of the units reported using clinical ultrasonography daily, 32.3% every two or three days, 19.4% weekly and 12.9% only occasionally. The daily use of ultrasonography was more frequent in PICUs where the ultrasound unit was kept in the PICU itself as opposed to PICUs where the machine was available but usually kept outside the PICU (52.9% versus 12.5%; P=.026). <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> compare the PICUs that used ultrasonography daily by their characteristics and type of patients served.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>In 29% of the PICUs, more than 75% of physicians used clinical ultrasonography regularly, in 25.8% of the units, this percentage of physicians ranged between 50% and 70%; in 29% of the units, it was used regularly by 25% to 50% of physicians, and in 16.1% of the units by fewer than 25% of physicians.<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> represents the frequency of the use of ultrasonography to establish different types of vascular access. In most ultrasound-guided procedures for establishing central access, cannulation was performed with real-time visualisation (insertion of 74.1% of jugular vein catheters; 85.7% of femoral vein catheters; 66.7% of subclavian or innominate vein catheters; and 75% of arterial catheters), and cannulation without direct visualisation after performance of ultrasonography was a much less frequent approach (insertion of 25.9% of jugular vein catheters, 14.3% of femoral vein catheters, 26.7% of subclavian or innominate vein catheters and 25% of arterial catheters).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the percentage of units that used ultrasonography to guide vascular cannulation for different purposes.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Training in ultrasonographyOnly a small percentage of the PICUs (18.2%) reported that all of their physicians had been specifically trained on the use of ultrasonography in the care of critical patients; 33.3% of the units reported that more than 50% had this training, 45.5% of the units reported that fewer than 50% had this training, and 3% not having trained any of the physicians. Physicians had received specific training on critical care ultrasonography in intensive care units, emergency departments or paediatric resuscitation units (68.8%) or through specific courses on the subject (18.8%). Training in adult units or radiology departments was less frequent (3.1% and 6.3%, respectively).The presence of more than 50% of physicians with training on ultrasonography for critical patient care was not associated with any of the characteristics under study; however, it was significantly associated with greater daily use of ultrasonography (P=.033) and the use of ultrasonography for the assessment of cardiac function (P=.033), blood volume (P=.004) and free intraperitoneal fluid (P=.021).In 36.4% of the PICUs, the nursing staff had training in ultrasonography, and 87.9% of respondents answered that they thought this training was necessary. Ninety-seven percent believed that if there were more training, point-of-care ultrasound would be used more frequently. All respondents considered that the availability of guidelines and educational materials on ultrasonography in critically ill paediatric patients in the SECIP website was helpful. They also considered that skills in ultrasonography for the care of paediatric critical patients should be part of the training of paediatricians that work in PICUs.DiscussionPoint-of-care ultrasound is a tool used increasingly in the care of critical patients and has a clear impact on the diagnostic and therapeutic approach.<a class="elsevierStyleCrossRefs" href="#bib0135">2,20</a> Our study describes the extent to which clinical ultrasonography is used in Spanish PICUs. The results of our survey are a good reflection of the current status quo, as the response rate was high, greater than the one reported by Lambert et al. in the United States,<a class="elsevierStyleCrossRef" href="#bib0220">19</a> and it included PICUs of very different sizes and with different types of patients.One salient finding was that the availability of ultrasound machines was not associated with the size or level of care of the PICUs, which may be due to many different factors (the attitude of professionals, the resources of each hospital, etc.). However, a more frequent use of this technique was associated with the number of admissions per year and the type of patients usually served in the PICU, as well as with the existence of a transplant programme or the availability of ECMO. Units that had more beds used point-of-care ultrasound more frequently, but this difference was not statistically significant. A study published by Lambert et al., however, did find a clear association between the use of this technique and the number of beds in the unit, the number of admissions and the existence of paediatric intensive care training programmes.<a class="elsevierStyleCrossRef" href="#bib0220">19</a>We ought to note that when it came to the specific applications of point-of-care ultrasound, we found that this technique has ceased to be solely used to guide other procedures and has become just another tool that contributes to the assessment of multiple organs and systems. The ability to quickly and directly address specific questions concerning the patient's haemodynamic, respiratory or neurologic status, among others, helps clinical decision-making in the daily practise of paediatric intensivists. In our study, we found a high proportion of PICUs that used point-of-care ultrasound for purposes other than cannulation (more than 70% for many uses). This percentage exceeded the 50% reported in the study Lambert et al.<a class="elsevierStyleCrossRef" href="#bib0220">19</a>The use of ultrasonography can reduce the risk of complications in certain procedures, such as vascular cannulation or the assessment of effusion (mainly pleural and pericardial). We found it surprising that while the percentage of units that reported using ultrasonography to guide these procedures in our study was high, its use is not yet widespread, despite the mounting scientific evidence and international recommendations that support it.<a class="elsevierStyleCrossRefs" href="#bib0230">21,22</a> More specifically, when it came to the use of ultrasound for guiding vascular cannulation, a high percentage of the PICUs (between 30% and 50%, depending on the type of vascular access) reported ultrasound was only used sometimes. Likewise, the frequent use of ultrasound to guide vascular cannulation only reached approximately 60% when it came to placement of jugular vein catheters. Thus, the use of ultrasound for guiding these procedures needs to be promoted.As one would expect, we found that ultrasonography was used more frequently in PICUs with staff trained in its use. Given the high availability of ultrasound machines, we think that the development of a structured training programme in ultrasonography is essential.Several studies have analysed the status quo of specialised training in point-of-care ultrasound in intensive and emergency care units in the United States.<a class="elsevierStyleCrossRefs" href="#bib0160">7–9,23,24</a> In the United States, training on point-of-care ultrasound is part of the educational curriculum of paediatric intensive care and paediatric emergency care subspecialties. In Spain, these subspecialties are not officially recognised in paediatrics, although most subspecialties have established educational curricula. We believe that basic competencies in the use of point-of-care ultrasound should be included in the learning objectives of paediatricians that will be working in paediatric intensive care settings, as is the case of other techniques such as incubation care or vascular cannulation. This has already been done in other countries, such as Canada, through consensus meetings.<a class="elsevierStyleCrossRef" href="#bib0250">25</a>Our study shows that there is large proportion of physicians in the surveyed PICUs that had training on point-of-care ultrasonography (in up to one third of the PICUs, up to 50% of the medical staff had training in ultrasonography). This proportion was higher than the one found by the study by Lambert et al.<a class="elsevierStyleCrossRef" href="#bib0220">19</a> from 2011, in which the percentage of institutions with formal training did not reach 30%. Most respondents in our study considered that the availability of online educational resources on clinical ultrasonography in paediatric patients is useful, and that paediatricians that care for critical paediatric patients should be trained on this technique. We believe that specific training in point-of-care ultrasound is essential to standardise its use and reduce errors in its interpretation.LimitationsThe main limitation of our study, which applies to all voluntary surveys, is that it does not reflect reality directly, but rather the views of those surveyed. Despite the high response rate (64.7% of the identified units), we cannot rule out the possibility that the PICUs that responded to the survey were those that use ultrasonography more frequently.On the other hand, when it came to training on point-of-care ultrasound, there were no established criteria to assess the quality and homogeneity of the training received, so it may have varied widely between units.ConclusionsPoint-of-care ultrasound is a frequently used technique in Spanish PICUs. Ultrasound units are available at a high percentage of the PICUs independently of their level of care. Point-of-care ultrasound was used not only to guide vascular cannulation or drainage placement, but also for the assessment of different organs and systems to complement physical examination and monitoring. Specific training is irregular and should be an essential strategy to promote its use.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres843841" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec838961" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres843840" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec838962" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Characteristics of participating paediatric intensive care units" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Ultrasound machine availability" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Use of clinical ultrasonography" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Training in ultrasonography" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-18" "fechaAceptado" => "2016-06-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec838961" "palabras" => array:4 [ 0 => "Ultrasound" 1 => "Intensive care" 2 => "Children" 3 => "Training" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec838962" "palabras" => array:4 [ 0 => "Ecografía" 1 => "Cuidados intensivos" 2 => "Niños" 3 => "Educación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionPoint-of-care (bedside) ultrasound is being increasingly used by paediatricians who treat critically ill children. The aim of this study is to describe its availability, use, and specific training in Paediatric Intensive Care Units in Spain. Material and methodsA descriptive, cross-sectional, multicentre study was performed using an online survey. ResultsOf a total of 51 PICUs identified in our country, 64.7% responded to the survey. Just over half (53.1%) have their own ultrasound machine, 25% share it, with other units with the usual location in the PICU, and 21.9% share it, but it is usually located outside the PICU. Ultrasound machine availability was not related to size, care complexity, or number PICU admissions. The ultrasound was used daily in 35% of the units, and was associated with the location of the machine in the PICU (P=.026), the existence of a transplant program (P=.009), availability of ECMO (P=.006), and number of admissions (P=.015). 45.5% of PICUs have less than 50% of the medical staff specifically trained in bedside ultrasound, and 18.2% have all their medical staff trained. The presence of more than 50% of medical staff trained was associated with a higher rate of daily use (P=.033), and with specific use to evaluate cardiac function (P=.033), intravascular volume estimation (P=.004), or the presence of intra-abdominal collections (P=.021). ConclusionsBedside ultrasound is frequently available in Spanish PICUs. Specific training is still variable, but it should serve to enhance its implementation." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa ecografía a pie de cama es cada vez más utilizada por los pediatras que tratan a niños críticos. El objetivo del estudio es describir la disponibilidad, el uso y la formación específica existente para esta técnica en las UCIP de nuestro entorno. Material y métodosSe realizó un estudio descriptivo transversal multicéntrico mediante una encuesta en línea. ResultadosSe identificaron 51 UCIP en nuestro país, el 64,7% respondió a la encuesta. El 53,1% dispone de ecógrafo propio, el 25% lo comparte con otras unidades ubicándose en la unidad y el 21,9% dispone de él pero está ubicado en otra unidad. La disponibilidad de ecógrafo no se relacionó con el tamaño, la complejidad asistencial o el número de ingresos anuales. El 35% emplea la ecografía diariamente; esto se relacionó con la ubicación del ecógrafo en la unidad (p=0,026), con la realización de trasplantes (p=0,009), la disponibilidad de ECMO (p=0,006) y con el número de ingresos anuales (p=0,015). El 45,5% tiene menos del 50% de sus médicos con formación específica; el 18,2% ha formado a todos sus médicos. La presencia de más del 50% de médicos formados se asoció con mayor utilización a diario (p=0,033) y con su uso para evaluar la función cardiaca (p=0,033), la volemia (p=0,004) o la presencia de líquido intraabdominal (p=0,021). ConclusionesLa ecografía a pie de cama es una técnica frecuentemente disponible en las UCIP españolas. La formación específica para su uso es hasta el momento heterogénea pero debe servir para potenciar su implantación." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González Cortés R, Renter Valdovinos L, Coca Pérez A, Vázquez Martínez JL. Ecografía en el punto de cuidado en las unidades de cuidados intensivos pediátricos españolas. An Pediatr (Barc). 2017;86:344–349." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1248 "Ancho" => 1603 "Tamanyo" => 119171 ] ] "descripcion" => array:1 [ "en" => "Frequency of the use of ultrasonography to assist in the establishment of different vascular accesses." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Health care services \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">Number of units (% of total) \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">Neurosurgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (97) \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">Polytrauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (90.9) \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">Oncology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (87.9) \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">Heart surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (42.4) \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">Transplants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (39.4) \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">ECMO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (30.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425283.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Type of patients routinely admitted to participating units." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Statistically significant results are presented in boldface." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit characteristics \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">Yes (%) \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">No (%) \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">P \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">Paediatrics-only ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.212 \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">Availability of ultrasound machine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \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">Neurosurgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \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">Polytrauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \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">Oncology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.276 \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">Cardiac surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.136 \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">Transplants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.009 \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">ECMO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425284.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Percentage of PICUs that used ultrasonography daily by unit characteristics." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Statistically significant results are presented in boldface." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Yes</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No</th><th class="td" title="table-head " align="left" valign="top" scope="col">P \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median \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">IQR \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">Median \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">IQR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></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">Number of beds in PICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.067 \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">Number of admissions/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">462.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.015 \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">Number of physicians on staff \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.233 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425285.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of units that used ultrasonography daily and units that did not." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Purpose \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">% of units that used ultrasound \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">Assessment of free intraperitoneal fluid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.2 \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">Diagnosis and drainage of pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Assessment of cardiac function \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.7 \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">Diagnosis and drainage of pericardial effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.4 \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">Head ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.4 \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">Assessment of increased intracranial pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diagnosis of pneumothorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \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">Diagnosis of other lung diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.7 \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">Assessment of blood volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.7 \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">Renal ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Management of cardiorespiratory arrest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.7 \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">Assessment of optic nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transcranial Doppler \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 \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">Basic echocardiography \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 \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">Assessment of airway \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425286.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Percentage of units that used ultrasonography to guide vascular cannulation for different purposes." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0130" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.L. Moore" 1 => "J.A. Copel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra0909487" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "364" "paginaInicial" => "749" "paginaFinal" => "757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21345104" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915014002226" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0135" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of point-of-care ultrasonography on imaging studies in the medical ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Oks" 1 => "K.L. Cleven" 2 => "J. Cardenas-Garcia" 3 => "J.A. Schaub" 4 => "S. Koenig" 5 => "R.I. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.14-0728" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2014" "volumen" => "146" "paginaInicial" => "1574" "paginaFinal" => "1577" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25144593" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0140" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasound in pediatric clinical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.J. McLario" 1 => "A.B. Sivitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamapediatrics.2015.22" "Revista" => array:6 [ "tituloSerie" => "JAMA Pediatr" "fecha" => "2015" "volumen" => "169" "paginaInicial" => "594" "paginaFinal" => "600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25893571" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0145" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound in pediatric emergency medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Levy" 1 => "V.E. Noble" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2007-1816" "Revista" => array:7 [ "tituloSerie" => "Pediatrics" "fecha" => "2008" "volumen" => "121" "paginaInicial" => "e1404" "paginaFinal" => "e1412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18450883" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915014016499" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0150" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound in pediatric practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.L. Vieira" 1 => "R. Bachur" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2013-0750" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2014" "volumen" => "133" "paginaInicial" => "1" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24344106" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0155" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasonography by pediatric emergency medicine physicians" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "American Academy of Pediatrics Committee on Pediatric Emergency Medicine, Society for Academic Emergency Medicine Academy of Emergency Ultrasound, American College of Emergency Physicians Pediatric Emergency Medicine Committee, World Interactive Network Focused on Critical Ultrasound" "etal" => false "autores" => array:2 [ 0 => "J.R. Marin" 1 => "R.E. Lewiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2015-0343" "Revista" => array:7 [ "tituloSerie" => "Pediatrics" "fecha" => "2015" "volumen" => "135" "paginaInicial" => "e1113" "paginaFinal" => "e1122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25825532" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915013007375" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0160" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilization of emergency ultrasound in pediatric emergency departments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.C. Chamberlain" 1 => "S.R. Reid" 2 => "M. Madhok" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0b013e3182259908" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "628" "paginaFinal" => "632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21712744" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0165" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound education in pediatric emergency medicine fellowship programs in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.S. Cohen" 1 => "S.J. Teach" 2 => "J.I. Chapman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0b013e318267a771" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2012" "volumen" => "28" "paginaInicial" => "845" "paginaFinal" => "850" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22929139" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0170" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of emergency ultrasound in United States pediatric emergency medicine fellowship programs in 2011" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.R. Marin" 1 => "N.S. Zuckerbraun" 2 => "J.M. Kahn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "1357" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922615" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0175" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of ultrasound-guided radial artery cannulation in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Ganesh" 1 => "R. Kaye" 2 => "A.M. Cahill" 3 => "W. Stern" 4 => "R. Pachikara" 5 => "P.R. Gallagher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PCC.0b013e31819368ca" "Revista" => array:6 [ "tituloSerie" => "Pediatr Crit Care Med" "fecha" => "2009" "volumen" => "10" "paginaInicial" => "45" "paginaFinal" => "48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057451" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0180" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Lamperti" 1 => "A.R. Bodenham" 2 => "M. Pittiruti" 3 => "M. Blaivas" 4 => "J.G. Augoustides" 5 => "M. Elbarbary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2597-x" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "1105" "paginaFinal" => "1117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0185" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided thoracentesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Feller-Kopman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.129.6.1709" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2006" "volumen" => "129" "paginaInicial" => "1709" "paginaFinal" => "1714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16778292" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0190" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in critically ill patients: comparison with bedside chest radiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Xirouchaki" 1 => "E. Magkanas" 2 => "K. Vaporidi" 3 => "E. Kondili" 4 => "M. Plataki" 5 => "A. Patrianakos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-011-2317-y" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "1488" "paginaFinal" => "1493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21809107" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915015301854" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0195" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care echocardiography by pediatric emergency physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Longjohn" 1 => "J. Wan" 2 => "V. Joshi" 3 => "J. Pershad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0b013e318226c7c7" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2011" "volumen" => "27" "paginaInicial" => "693" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21811201" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0200" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Point-of-care ultrasound for pediatric shock" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.B. Park" 1 => "B.C. Presley" 2 => "T. Cook" 3 => "G.E. Hayden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0000000000000519" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2015" "volumen" => "31" "paginaInicial" => "591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26241714" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915015013088" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0205" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinician-performed abdominal sonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Dickman" 1 => "M.O. Tessaro" 2 => "A.C. Arroyo" 3 => "L.E. Haines" 4 => "J.P. Marshall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00068-015-0508-x" "Revista" => array:6 [ "tituloSerie" => "Eur J Trauma Emerg Surg" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "481" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26038027" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0210" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of transcranial Doppler in neurocritical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Saqqur" 1 => "D. Zygun" 2 => "A. Demchuk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000260633.66384.FB" "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "S216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17446782" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0215" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal ultrasonography in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Barozzi" 1 => "M. Valentino" 2 => "A. Santoro" 3 => "E. Mancini" 4 => "P. Pavlica" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000260631.62219.B9" "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "S198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17446779" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0220" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National survey of bedside ultrasound use in pediatric critical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.L. Lambert" 1 => "J.R. Boker" 2 => "F.A. Maffei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PCC.0b013e3182266a51" "Revista" => array:6 [ "tituloSerie" => "Pediatr Crit Care Med" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "655" "paginaFinal" => "659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21725274" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0225" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[Epub ahead of print]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnostic and therapeutic impact of point-of-care ultrasonography in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Bernier-Jean" 1 => "M. Albert" 2 => "A.L. Shiloh" 3 => "L.A. Eisen" 4 => "D. Williamson" 5 => "Y. Beaulieu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0885066615606682" "Revista" => array:2 [ "tituloSerie" => "J Intensive Care Med" "fecha" => "2015" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0230" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute for Health Care and Excellence (NICE). Guidance on the use of ultrasound locating devices for placing central venous catheters. NICE technology appraisal guidance. 2002 [accessed 04.03.16]. Available from: <a href="https://www.nice.org.uk/guidance/ta49">https://www.nice.org.uk/guidance/ta49</a>" ] ] ] 21 => array:3 [ "identificador" => "bib0235" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.D. Froehlich" 1 => "M.R. Rigby" 2 => "E.S. Rosenberg" 3 => "R. Li" 4 => "P-L.J. Roerig" 5 => "K.A. Easley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e31819b570e" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "1090" "paginaFinal" => "1096" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19237922" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0240" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric emergency medicine fellow training in ultrasound: Consensus educational guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.L. Vieira" 1 => "D. Hsu" 2 => "J. Nagler" 3 => "L. Chen" 4 => "R. Gallagher" 5 => "J.A. Levy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/acem.12087" "Revista" => array:6 [ "tituloSerie" => "Acad Emerg Med" "fecha" => "2013" "volumen" => "20" "paginaInicial" => "300" "paginaFinal" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23517263" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0245" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Establishing intensivist-driven ultrasound at the PICU bedside—It's about time" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Su" 1 => "A. Pustavoitau" 2 => "E.L. Hirshberg" 3 => "A. Nishisaki" 4 => "T. Conlon" 5 => "D.B. Kantor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PCC.0000000000000168" "Revista" => array:6 [ "tituloSerie" => "Pediatr Crit Care Med" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "649" "paginaFinal" => "652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24977438" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0250" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining competencies for ultrasound-guided bedside procedures: consensus opinions from Canadian physicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G.M. Brown" 1 => "M. Otremba" 2 => "L.A. Devine" 3 => "C. Gray" 4 => "S.J. Millington" 5 => "I.W.Y. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.15.01063" "Revista" => array:7 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "129" "paginaFinal" => "141" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26657751" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0021915015001112" "estado" => "S300" "issn" => "00219150" ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgments" "texto" => "We thank the representatives of every participating unit for collaborating in the collection of data through the online survey, which we proceed to list alphabetically: Amalia Martínez Antón (Hospital Universitario Fundación Jiménez Díaz), Antonio Bonillo Perales (Complejo Hospitalario Torrecárdenas), Antonio Jiménez Bravo de Laguna (Complejo Hospitalario Universitario Insular Maternoinfantil de Canarias), Antonio Rodríguez Núñez (Complexo Hospitalario Universitario de Santiago), Asunción Pino Vázquez (Hospital Clínico Universitario de Valladolid), Begoña Arias Novas (Hospital Universitario Sanitas La Zarzuela), Carlos Solís Reyes (Hospital Universitario Nuestras Señora de la Candelaria), Concha Goñi Orayen (Complejo Hospitalario de Navarra), Corsino Rey Galán (Hospital Universitario Central de Asturias), Roberto Reig Sáenz (Hospital General Universitario de Alicante), Eduard Carreras González (Hospital de la Santa Creu i Sant Pau), Ender Oñate Vergara (Hospital Universitario Donostia), Francisco José Cambra Lassaloa (Hospital Sant Joan de Déu), Gerardo Romera Modamio (Hospital Universitario HM Madrid-Montepríncipe), Guillermo Milano Manso (Hospital Regional Universitario de Málaga), Irene Centelles Sales (Hospital General Universitario de Castellón), Javier Pilar Orive (Hospital Universitario de Cruces), Jesús de la Cruz Moreno (Complejo Hospitalario de Jaén), Joan Ballcels Ramírez (Hospital Vall d’Hebron), José Luis Vázquez Martínez (Hospital Universitario Ramón y Cajal), Juan Carlos de Carlos (Hospital Universitario Son Espases), Luis Moreno Fernández (Hospital San Rafael), Luis Renter Valdovinos (Hospital Universitario Parc Tauli), Manuel Ortiz Pallarés (Hospital Xeral de Vigo), Mario Sánchez Fernández (Hospital Universitari Dr. Josep Trueta), Montserrat Nieto Moro (Hospital Infantil Universitario Niño Jesús), Paula Madurga Revilla (Hospital Universitario Miguel Servet), Rafael González Cortés (Hospital General Universitario Gregorio Marañón), Susana Jaraba Caballero (Hospital Universitario Reina Sofía de Córdoba), Susana Reyes Domínguez (Hospital Clínico Universitario Virgen de la Arrixaca) and Sylvia Belda-Hofheinz (Hospital Universitario Doce de Octubre)." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300844/v1_201705270049/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008600000006/v1_201705270049/S2341287917300844/v1_201705270049/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300844?idApp=UINPBA00005H"]

Statistics

Original Article

Point-of-care ultrasound in Spanish paediatric intensive care units

Ecografía en el punto de cuidado en las unidades de cuidados intensivos pediátricos españolas

Rafael González Cortésa,b,c,

Corresponding author

rafa_gonzalez_cortes@hotmail.com

Corresponding author.

, Luis Renter Valdovinosd, Ana Coca Péreze, José Luis Vázquez Martíneze

a Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain

b Instituto de investigación Sanitaria Gregorio Marañón, Madrid, Spain

c Red de Salud Materno Infantil y Desarrollo, Madrid, Spain

d Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain

e Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, Spain

Read

5900

Times
was read the article

2213

Total PDF

3687

Total HTML

Share statistics

 array:24 [
  "pii" => "S2341287917300844"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2016.06.007"
  "estado" => "S300"
  "fechaPublicacion" => "2017-06-01"
  "aid" => "2130"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2017;86:344-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1764
    "formatos" => array:3 [
      "EPUB" => 151
      "HTML" => 1185
      "PDF" => 428
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403316302193"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2016.06.009"
      "estado" => "S300"
      "fechaPublicacion" => "2017-06-01"
      "aid" => "2130"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "An Pediatr &#40;Barc&#41;. 2017;86:344-9"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 4259
        "formatos" => array:3 [
          "EPUB" => 149
          "HTML" => 3302
          "PDF" => 808
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Ecograf&#237;a en el punto de cuidado en las unidades de cuidados intensivos pedi&#225;tricos espa&#241;olas"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "344"
            "paginaFinal" => "349"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Point-of-care ultrasound in Spanish paediatric intensive care units"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1231
                "Ancho" => 1586
                "Tamanyo" => 123904
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frecuencia de utilizaci&#243;n de la ecograf&#237;a para la canalizaci&#243;n de los diferentes accesos vasculares&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Rafael Gonz&#225;lez Cort&#233;s, Luis Renter Valdovinos, Ana Coca P&#233;rez, Jos&#233; Luis V&#225;zquez Mart&#237;nez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "Gonz&#225;lez Cort&#233;s"
              ]
              1 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Renter Valdovinos"
              ]
              2 => array:2 [
                "nombre" => "Ana"
                "apellidos" => "Coca P&#233;rez"
              ]
              3 => array:2 [
                "nombre" => "Jos&#233; Luis"
                "apellidos" => "V&#225;zquez Mart&#237;nez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287917300844"
          "doi" => "10.1016/j.anpede.2016.06.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300844?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302193?idApp=UINPBA00005H"
      "url" => "/16954033/0000008600000006/v1_201705270026/S1695403316302193/v1_201705270026/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287917300856"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2016.08.007"
    "estado" => "S300"
    "fechaPublicacion" => "2017-06-01"
    "aid" => "2150"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "An Pediatr &#40;Barc&#41;. 2017;86:350-2"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1452
      "formatos" => array:3 [
        "EPUB" => 135
        "HTML" => 961
        "PDF" => 356
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Improved lung function in cystic fibrosis using mechanical insufflation&#8211;exsufflation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "350"
          "paginaFinal" => "352"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Mejora de la funci&#243;n pulmonar en fibrosis qu&#237;stica mediante insuflaci&#243;n-exuflaci&#243;n mec&#225;nica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1179
              "Ancho" => 1524
              "Tamanyo" => 58132
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Changes in lung function &#40;expressed as &#37;FEV1&#41; from baseline to the end of the intervention&#46; FEV1&#44; forced expiratory volume in the first second expressed as percentage&#46; The values were expressed as the percentage of the theoretical value for individuals of the same age&#44; weight and height based on the Spanish reference population&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Laura Azahara Fuentes, Pilar Caro, Antonio Jose Garcia-Ruiz, Gregorio Mu&#241;oz G&#243;mez, Elisa Mart&#237;n-Monta&#241;ez"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Laura Azahara"
              "apellidos" => "Fuentes"
            ]
            1 => array:2 [
              "nombre" => "Pilar"
              "apellidos" => "Caro"
            ]
            2 => array:2 [
              "nombre" => "Antonio Jose"
              "apellidos" => "Garcia-Ruiz"
            ]
            3 => array:2 [
              "nombre" => "Gregorio"
              "apellidos" => "Mu&#241;oz G&#243;mez"
            ]
            4 => array:2 [
              "nombre" => "Elisa"
              "apellidos" => "Mart&#237;n-Monta&#241;ez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403316302557"
        "doi" => "10.1016/j.anpedi.2016.08.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316302557?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300856?idApp=UINPBA00005H"
    "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300856/v1_201705270049/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341287917300790"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.12.007"
    "estado" => "S300"
    "fechaPublicacion" => "2017-06-01"
    "aid" => "2023"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2017;86:337-43"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1798
      "formatos" => array:3 [
        "EPUB" => 184
        "HTML" => 1179
        "PDF" => 435
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Epidemiology and risk factors in injuries due to fall in infants under one year-old"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "337"
          "paginaFinal" => "343"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Epidemiolog&#237;a y factores de riesgo de las lesiones por ca&#237;das en ni&#241;os menores de un a&#241;o"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1284
              "Ancho" => 1663
              "Tamanyo" => 144887
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fall mechanisms by age group&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Jim&#233;nez de Domingo, Elena Rubio Garc&#237;a, Rafael Mara&#241;on Pardillo, Vanessa Arias Constanti, Luis Alberto Frontado Haiek, Marta Soriano Arola, Francesc Ripoll Oliveras, Cristina Rem&#243;n Garc&#237;a, Gloria Estopi&#241;a Ferrer, Jorge Lorente Romero"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Jim&#233;nez de Domingo"
            ]
            1 => array:2 [
              "nombre" => "Elena"
              "apellidos" => "Rubio Garc&#237;a"
            ]
            2 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Mara&#241;on Pardillo"
            ]
            3 => array:2 [
              "nombre" => "Vanessa"
              "apellidos" => "Arias Constanti"
            ]
            4 => array:2 [
              "nombre" => "Luis Alberto"
              "apellidos" => "Frontado Haiek"
            ]
            5 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Soriano Arola"
            ]
            6 => array:2 [
              "nombre" => "Francesc"
              "apellidos" => "Ripoll Oliveras"
            ]
            7 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Rem&#243;n Garc&#237;a"
            ]
            8 => array:2 [
              "nombre" => "Gloria"
              "apellidos" => "Estopi&#241;a Ferrer"
            ]
            9 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Lorente Romero"
            ]
            10 => array:1 [
              "colaborador" => "Representing the Grupo de Trabajo de Lesiones no Intencionadas de la Sociedad Espa&#241;ola de Urgencias de Pediatr&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315005603"
        "doi" => "10.1016/j.anpedi.2015.12.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315005603?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300790?idApp=UINPBA00005H"
    "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300790/v1_201705270049/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Point-of-care ultrasound in Spanish paediatric intensive care units"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "344"
        "paginaFinal" => "349"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Rafael Gonz&#225;lez Cort&#233;s, Luis Renter Valdovinos, Ana Coca P&#233;rez, Jos&#233; Luis V&#225;zquez Mart&#237;nez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Rafael"
            "apellidos" => "Gonz&#225;lez Cort&#233;s"
            "email" => array:1 [
              0 => "rafa&#95;gonzalez&#95;cortes&#64;hotmail&#46;com"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Luis"
            "apellidos" => "Renter Valdovinos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Coca P&#233;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jos&#233; Luis"
            "apellidos" => "V&#225;zquez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Servicio de Cuidados Intensivos Pedi&#225;tricos&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de investigaci&#243;n Sanitaria Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Red de Salud Materno Infantil y Desarrollo&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Unidad de Cuidados Intensivos Pedi&#225;tricos&#44; Hospital Universitario Parc Taul&#237;&#44; Sabadell&#44; Barcelona&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Unidad de Cuidados Intensivos Pedi&#225;tricos&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Ecograf&#237;a en el punto de cuidado en las unidades de cuidados intensivos pedi&#225;tricos espa&#241;olas"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1248
            "Ancho" => 1603
            "Tamanyo" => 119171
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequency of the use of ultrasonography to assist in the establishment of different vascular accesses&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Point-of-care&#44; bedside or clinical ultrasonography is defined as ultrasonography performed by the doctor in charge directly where the patient is for clinical assessment&#46; It is used for addressing specific problems or questions immediately and in real time&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Compared to ultrasonography performed by radiologists&#44; which can provide more comprehensive and accurate information&#44; point-of-care ultrasound usually focuses on yes&#47;no questions to facilitate diagnosis and especially on procedural guidance&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Furthermore&#44; since it is easily repeatable&#44; it can be used to assess changes in different clinical situations or conditions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The size of paediatric patients facilitates the access of ultrasound waves to different organs while obtaining high-quality images&#46; This fact&#44; along with the elimination of the risks associated with the use of ionising radiation techniques&#44; is clearly stimulating an increase in the use of ultrasonography&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;3</span></a> Decreasing costs&#44; decreasing size and improvements in the specifications of ultrasonography systems in recent years have also been essential in the expansion of its use outside radiology units&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It has multiple applications in the field of paediatrics&#44; which are clearly expanding&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a> This is demonstrated by the increasing availability of ultrasound units in the paediatric emergency departments of some countries&#44; as well as its increasingly frequent inclusion in clinical practice guidelines and training curriculums of different specialties&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Paediatric critical care and emergency care are probably the fields in which the use of bedside ultrasonography by the paediatrician in charge is becoming most widespread&#46; This is probably due to several factors&#44; such as the immediacy of its use&#44; the possibility of performing serial assessments&#44; and above all the increasing number of clinical applications&#46; More specifically&#44; in the field of intensive care&#44; there is evidence that ultrasonography can be used by critical care physicians to guide the performance of other techniques&#44; such as establishing vascular access<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">10&#44;11</span></a> or the drainage of effusions in different locations&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> Furthermore&#44; clinical ultrasonography can be used to answer specific questions regarding multiple organs and systems&#44; and has demonstrated a high sensitivity and specificity in the diagnosis of various lung diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> It allows the assessment of different aspects to determine the haemodynamic status of a patient&#44; such as myocardiac contractility or blood volume&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">14&#44;15</span></a> detect the presence of intra-abdominal lesions<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> or assess changes in blood flow in different vital organs&#44; such as the brain<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> or kidneys&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; although some studies have found clear evidence of its increasing use in adult intensive care units and paediatric emergency departments&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> only one study conducted in the United States has described its availability and the characteristics of its use in paediatric intensive care units &#40;PICUs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main objective of our study was to characterise the availability and use of point-of-care ultrasonography in Spanish PICUs&#46; More specifically&#44; we sought to identify the most widely used clinical applications&#46; Our secondary objective was to determine the level of training on the use of ultrasonography in the care of critical paediatric patients of Spanish clinicians&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We conducted a multicentric cross-sectional descriptive study&#46; We developed an online survey using the Google Forms online platform that consisted of 45 questions organised into three sections&#46; We gathered contact information for 51 PICUs in Spain&#46; The survey was distributed by the Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos &#40;Spanish Society of Paediatric Critical Care&#41; by electronic mail to the service chief or contact person of the different paediatric intensive care units&#46; In a second phase&#44; we attempted to contact the units that had not completed the questionnaire by electronic mail&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The first section of the survey consisted of questions that explored the characteristics of the PICU and its activity and those of the hospital to which it belonged&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The second section explored the availability of ultrasound machines&#44; their location&#44; exclusive or shared use&#44; frequency of use and use for different applications&#46; In the last section&#44; the questionnaire asked about the training on ultrasonography of the PICU staff including physicians and nurses&#44; the need for training and guidelines&#44; and the usefulness of specific training in ultrasonography&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We analysed the responses by means of the SPSS software for Mac OS X version 20&#46;0&#46;0 &#40;IBM Corp&#44; Armonk&#44; New York&#44; USA&#41;&#46; We described categorical variables by the percentage of answers in each category&#44; and continuous variables as median and interquartile range&#46; We compared groups by means of nonparametric tests &#40;Kruskal&#8211;Wallis&#44; Fisher&#39;s exact and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>&#41;&#44; and defined statistical significance as a <span class="elsevierStyleItalic">p</span>-value of less than 0&#46;05 in these tests&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Characteristics of participating paediatric intensive care units</span><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 51 identified units&#44; 33 &#40;64&#46;7&#37;&#41; responded to the survey&#46; Of all the submitted surveys&#44; 60&#46;6&#37; had been completed by the individual in charge of the unit &#40;chief of service&#44; department chief or coordinator&#41; and the rest by attending physicians&#46; Each unit submitted the survey only once&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Of all participating units&#44; 84&#46;8&#37; operated in public hospitals&#44; 6&#46;1&#37; in privately managed public hospitals&#44; and 9&#46;1&#37; in private hospitals&#59; while 93&#46;9&#37; of all PICUs were in university hospitals&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Most PICUs &#40;72&#46;7&#37;&#41; cared exclusively for paediatric patients&#44; while 27&#46;3&#37; were mixed units offering both paediatric and neonatal care&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the type of patients routinely admitted to the PICUs&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">When it came to the size of the surveyed units&#44; the median number of beds was eleven &#40;IQR&#44; 6&#46;5&#41;&#46; Of all units&#44; 51&#46;5&#37; had more than ten beds&#44; 39&#46;4&#37; between six and ten beds and 9&#46;1&#37; fewer than five&#46; The median number of admissions per year was 368 &#40;IQR&#44; 290&#41;&#59; five units &#40;5&#46;6&#37;&#41; had more than 600 admissions a year&#44; 59&#46;4&#37; between 300 and 600 and 25&#37; fewer than 300&#46; The median number of physicians on staff was seven &#40;IQR&#44; 3&#46;5&#41;&#59; 27&#46;3&#37; of the units had more than eight physicians on staff&#44; 57&#46;6&#37; between five and eight&#44; and 15&#46;2&#37; fewer than five&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ultrasound machine availability</span><p id="par0075" class="elsevierStylePara elsevierViewall">Of all the PICUs&#44; 53&#46;1&#37; had a dedicated ultrasound machine and the rest shared it with other units in the hospital &#40;in 25&#37;&#44; the device was usually kept in the PICU and in 21&#46;9&#37; outside the PICU&#41;&#46; Only two &#40;6&#46;1&#37;&#41; of the units that responded to our survey reported not having access to an ultrasound machine&#46; We did not find an association between the availability of ultrasound systems and the number of beds&#44; the number of physicians&#44; the number of admissions per year or the type of patients routinely served in the unit&#46; Of the PICUs with ultrasound machines&#44; 43&#46;8&#37; had portable units&#44; while 56&#46;2&#37; had large non-portable systems&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Use of clinical ultrasonography</span><p id="par0080" class="elsevierStylePara elsevierViewall">Only one unit reported never having used clinical ultrasonography&#46; A total of 35&#46;5&#37; of the units reported using clinical ultrasonography daily&#44; 32&#46;3&#37; every two or three days&#44; 19&#46;4&#37; weekly and 12&#46;9&#37; only occasionally&#46; The daily use of ultrasonography was more frequent in PICUs where the ultrasound unit was kept in the PICU itself as opposed to PICUs where the machine was available but usually kept outside the PICU &#40;52&#46;9&#37; versus 12&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;026&#41;&#46; <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> compare the PICUs that used ultrasonography daily by their characteristics and type of patients served&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In 29&#37; of the PICUs&#44; more than 75&#37; of physicians used clinical ultrasonography regularly&#44; in 25&#46;8&#37; of the units&#44; this percentage of physicians ranged between 50&#37; and 70&#37;&#59; in 29&#37; of the units&#44; it was used regularly by 25&#37; to 50&#37; of physicians&#44; and in 16&#46;1&#37; of the units by fewer than 25&#37; of physicians&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> represents the frequency of the use of ultrasonography to establish different types of vascular access&#46; In most ultrasound-guided procedures for establishing central access&#44; cannulation was performed with real-time visualisation &#40;insertion of 74&#46;1&#37; of jugular vein catheters&#59; 85&#46;7&#37; of femoral vein catheters&#59; 66&#46;7&#37; of subclavian or innominate vein catheters&#59; and 75&#37; of arterial catheters&#41;&#44; and cannulation without direct visualisation after performance of ultrasonography was a much less frequent approach &#40;insertion of 25&#46;9&#37; of jugular vein catheters&#44; 14&#46;3&#37; of femoral vein catheters&#44; 26&#46;7&#37; of subclavian or innominate vein catheters and 25&#37; of arterial catheters&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the percentage of units that used ultrasonography to guide vascular cannulation for different purposes&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Training in ultrasonography</span><p id="par0100" class="elsevierStylePara elsevierViewall">Only a small percentage of the PICUs &#40;18&#46;2&#37;&#41; reported that all of their physicians had been specifically trained on the use of ultrasonography in the care of critical patients&#59; 33&#46;3&#37; of the units reported that more than 50&#37; had this training&#44; 45&#46;5&#37; of the units reported that fewer than 50&#37; had this training&#44; and 3&#37; not having trained any of the physicians&#46; Physicians had received specific training on critical care ultrasonography in intensive care units&#44; emergency departments or paediatric resuscitation units &#40;68&#46;8&#37;&#41; or through specific courses on the subject &#40;18&#46;8&#37;&#41;&#46; Training in adult units or radiology departments was less frequent &#40;3&#46;1&#37; and 6&#46;3&#37;&#44; respectively&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The presence of more than 50&#37; of physicians with training on ultrasonography for critical patient care was not associated with any of the characteristics under study&#59; however&#44; it was significantly associated with greater daily use of ultrasonography &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41; and the use of ultrasonography for the assessment of cardiac function &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41;&#44; blood volume &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; and free intraperitoneal fluid &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In 36&#46;4&#37; of the PICUs&#44; the nursing staff had training in ultrasonography&#44; and 87&#46;9&#37; of respondents answered that they thought this training was necessary&#46; Ninety-seven percent believed that if there were more training&#44; point-of-care ultrasound would be used more frequently&#46; All respondents considered that the availability of guidelines and educational materials on ultrasonography in critically ill paediatric patients in the SECIP website was helpful&#46; They also considered that skills in ultrasonography for the care of paediatric critical patients should be part of the training of paediatricians that work in PICUs&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound is a tool used increasingly in the care of critical patients and has a clear impact on the diagnostic and therapeutic approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;20</span></a> Our study describes the extent to which clinical ultrasonography is used in Spanish PICUs&#46; The results of our survey are a good reflection of the current status quo&#44; as the response rate was high&#44; greater than the one reported by Lambert et al&#46; in the United States&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> and it included PICUs of very different sizes and with different types of patients&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">One salient finding was that the availability of ultrasound machines was not associated with the size or level of care of the PICUs&#44; which may be due to many different factors &#40;the attitude of professionals&#44; the resources of each hospital&#44; etc&#46;&#41;&#46; However&#44; a more frequent use of this technique was associated with the number of admissions per year and the type of patients usually served in the PICU&#44; as well as with the existence of a transplant programme or the availability of ECMO&#46; Units that had more beds used point-of-care ultrasound more frequently&#44; but this difference was not statistically significant&#46; A study published by Lambert et al&#46;&#44; however&#44; did find a clear association between the use of this technique and the number of beds in the unit&#44; the number of admissions and the existence of paediatric intensive care training programmes&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">We ought to note that when it came to the specific applications of point-of-care ultrasound&#44; we found that this technique has ceased to be solely used to guide other procedures and has become just another tool that contributes to the assessment of multiple organs and systems&#46; The ability to quickly and directly address specific questions concerning the patient&#39;s haemodynamic&#44; respiratory or neurologic status&#44; among others&#44; helps clinical decision-making in the daily practise of paediatric intensivists&#46; In our study&#44; we found a high proportion of PICUs that used point-of-care ultrasound for purposes other than cannulation &#40;more than 70&#37; for many uses&#41;&#46; This percentage exceeded the 50&#37; reported in the study Lambert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The use of ultrasonography can reduce the risk of complications in certain procedures&#44; such as vascular cannulation or the assessment of effusion &#40;mainly pleural and pericardial&#41;&#46; We found it surprising that while the percentage of units that reported using ultrasonography to guide these procedures in our study was high&#44; its use is not yet widespread&#44; despite the mounting scientific evidence and international recommendations that support it&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">21&#44;22</span></a> More specifically&#44; when it came to the use of ultrasound for guiding vascular cannulation&#44; a high percentage of the PICUs &#40;between 30&#37; and 50&#37;&#44; depending on the type of vascular access&#41; reported ultrasound was only used sometimes&#46; Likewise&#44; the frequent use of ultrasound to guide vascular cannulation only reached approximately 60&#37; when it came to placement of jugular vein catheters&#46; Thus&#44; the use of ultrasound for guiding these procedures needs to be promoted&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">As one would expect&#44; we found that ultrasonography was used more frequently in PICUs with staff trained in its use&#46; Given the high availability of ultrasound machines&#44; we think that the development of a structured training programme in ultrasonography is essential&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Several studies have analysed the status quo of specialised training in point-of-care ultrasound in intensive and emergency care units in the United States&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;9&#44;23&#44;24</span></a> In the United States&#44; training on point-of-care ultrasound is part of the educational curriculum of paediatric intensive care and paediatric emergency care subspecialties&#46; In Spain&#44; these subspecialties are not officially recognised in paediatrics&#44; although most subspecialties have established educational curricula&#46; We believe that basic competencies in the use of point-of-care ultrasound should be included in the learning objectives of paediatricians that will be working in paediatric intensive care settings&#44; as is the case of other techniques such as incubation care or vascular cannulation&#46; This has already been done in other countries&#44; such as Canada&#44; through consensus meetings&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study shows that there is large proportion of physicians in the surveyed PICUs that had training on point-of-care ultrasonography &#40;in up to one third of the PICUs&#44; up to 50&#37; of the medical staff had training in ultrasonography&#41;&#46; This proportion was higher than the one found by the study by Lambert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> from 2011&#44; in which the percentage of institutions with formal training did not reach 30&#37;&#46; Most respondents in our study considered that the availability of online educational resources on clinical ultrasonography in paediatric patients is useful&#44; and that paediatricians that care for critical paediatric patients should be trained on this technique&#46; We believe that specific training in point-of-care ultrasound is essential to standardise its use and reduce errors in its interpretation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">The main limitation of our study&#44; which applies to all voluntary surveys&#44; is that it does not reflect reality directly&#44; but rather the views of those surveyed&#46; Despite the high response rate &#40;64&#46;7&#37; of the identified units&#41;&#44; we cannot rule out the possibility that the PICUs that responded to the survey were those that use ultrasonography more frequently&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">On the other hand&#44; when it came to training on point-of-care ultrasound&#44; there were no established criteria to assess the quality and homogeneity of the training received&#44; so it may have varied widely between units&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">Point-of-care ultrasound is a frequently used technique in Spanish PICUs&#46; Ultrasound units are available at a high percentage of the PICUs independently of their level of care&#46; Point-of-care ultrasound was used not only to guide vascular cannulation or drainage placement&#44; but also for the assessment of different organs and systems to complement physical examination and monitoring&#46; Specific training is irregular and should be an essential strategy to promote its use&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres843841"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec838961"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres843840"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec838962"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
        ]
        6 => array:3 [
          "identificador" => "sec0015"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Characteristics of participating paediatric intensive care units"
            ]
            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Ultrasound machine availability"
            ]
            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Use of clinical ultrasonography"
            ]
            3 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Training in ultrasonography"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Limitations"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
        ]
        10 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-05-18"
    "fechaAceptado" => "2016-06-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec838961"
          "palabras" => array:4 [
            0 => "Ultrasound"
            1 => "Intensive care"
            2 => "Children"
            3 => "Training"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec838962"
          "palabras" => array:4 [
            0 => "Ecograf&#237;a"
            1 => "Cuidados intensivos"
            2 => "Ni&#241;os"
            3 => "Educaci&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Point-of-care &#40;bedside&#41; ultrasound is being increasingly used by paediatricians who treat critically ill children&#46; The aim of this study is to describe its availability&#44; use&#44; and specific training in Paediatric Intensive Care Units in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive&#44; cross-sectional&#44; multicentre study was performed using an online survey&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of a total of 51 PICUs identified in our country&#44; 64&#46;7&#37; responded to the survey&#46; Just over half &#40;53&#46;1&#37;&#41; have their own ultrasound machine&#44; 25&#37; share it&#44; with other units with the usual location in the PICU&#44; and 21&#46;9&#37; share it&#44; but it is usually located outside the PICU&#46; Ultrasound machine availability was not related to size&#44; care complexity&#44; or number PICU admissions&#46; The ultrasound was used daily in 35&#37; of the units&#44; and was associated with the location of the machine in the PICU &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;026&#41;&#44; the existence of a transplant program &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#44; availability of ECMO &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#44; and number of admissions &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; 45&#46;5&#37; of PICUs have less than 50&#37; of the medical staff specifically trained in bedside ultrasound&#44; and 18&#46;2&#37; have all their medical staff trained&#46; The presence of more than 50&#37; of medical staff trained was associated with a higher rate of daily use &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41;&#44; and with specific use to evaluate cardiac function &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41;&#44; intravascular volume estimation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#44; or the presence of intra-abdominal collections &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Bedside ultrasound is frequently available in Spanish PICUs&#46; Specific training is still variable&#44; but it should serve to enhance its implementation&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a a pie de cama es cada vez m&#225;s utilizada por los pediatras que tratan a ni&#241;os cr&#237;ticos&#46; El objetivo del estudio es describir la disponibilidad&#44; el uso y la formaci&#243;n espec&#237;fica existente para esta t&#233;cnica en las UCIP de nuestro entorno&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo transversal multic&#233;ntrico mediante una encuesta en l&#237;nea&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 51 UCIP en nuestro pa&#237;s&#44; el 64&#44;7&#37; respondi&#243; a la encuesta&#46; El 53&#44;1&#37; dispone de ec&#243;grafo propio&#44; el 25&#37; lo comparte con otras unidades ubic&#225;ndose en la unidad y el 21&#44;9&#37; dispone de &#233;l pero est&#225; ubicado en otra unidad&#46; La disponibilidad de ec&#243;grafo no se relacion&#243; con el tama&#241;o&#44; la complejidad asistencial o el n&#250;mero de ingresos anuales&#46; El 35&#37; emplea la ecograf&#237;a diariamente&#59; esto se relacion&#243; con la ubicaci&#243;n del ec&#243;grafo en la unidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#44; con la realizaci&#243;n de trasplantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; la disponibilidad de ECMO &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; y con el n&#250;mero de ingresos anuales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41;&#46; El 45&#44;5&#37; tiene menos del 50&#37; de sus m&#233;dicos con formaci&#243;n espec&#237;fica&#59; el 18&#44;2&#37; ha formado a todos sus m&#233;dicos&#46; La presencia de m&#225;s del 50&#37; de m&#233;dicos formados se asoci&#243; con mayor utilizaci&#243;n a diario &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41; y con su uso para evaluar la funci&#243;n cardiaca &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41;&#44; la volemia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; o la presencia de l&#237;quido intraabdominal &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a a pie de cama es una t&#233;cnica frecuentemente disponible en las UCIP espa&#241;olas&#46; La formaci&#243;n espec&#237;fica para su uso es hasta el momento heterog&#233;nea pero debe servir para potenciar su implantaci&#243;n&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gonz&#225;lez Cort&#233;s R&#44; Renter Valdovinos L&#44; Coca P&#233;rez A&#44; V&#225;zquez Mart&#237;nez JL&#46; Ecograf&#237;a en el punto de cuidado en las unidades de cuidados intensivos pedi&#225;tricos espa&#241;olas&#46; An Pediatr &#40;Barc&#41;&#46; 2017&#59;86&#58;344&#8211;349&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1248
            "Ancho" => 1603
            "Tamanyo" => 119171
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Frequency of the use of ultrasonography to assist in the establishment of different vascular accesses&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Health care services&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">Number of units &#40;&#37; of total&#41;&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">Neurosurgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;97&#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">Polytrauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;90&#46;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">Oncology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;87&#46;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">Heart surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;42&#46;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">Transplants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;39&#46;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">ECMO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;30&#46;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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1425283.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Type of patients routinely admitted to participating units&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Statistically significant results are presented in boldface&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unit characteristics&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">Yes &#40;&#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">No &#40;&#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"><span class="elsevierStyleItalic">P</span>&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">Paediatrics-only ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;212&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">Availability of ultrasound machine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&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">Neurosurgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&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">Polytrauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&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">Oncology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;276&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">Cardiac surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;136&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">Transplants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;009</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">ECMO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1425284.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of PICUs that used ultrasonography daily by unit characteristics&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Statistically significant results are presented in boldface&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Yes</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median&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">IQR&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">Median&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">IQR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></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">Number of beds in PICU&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;067&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">Number of admissions&#47;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">462&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#46;015</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">Number of physicians on staff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1425285.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of units that used ultrasonography daily and units that did not&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Purpose&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">&#37; of units that used ultrasound&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">Assessment of free intraperitoneal fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;2&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">Diagnosis and drainage of pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;3&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">Assessment of cardiac function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;7&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">Diagnosis and drainage of pericardial effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;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">Head ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;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">Assessment of increased intracranial pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;3&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">Diagnosis of pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">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">Diagnosis of other lung diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;7&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">Assessment of blood volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;7&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">Renal ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;3&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">Management of cardiorespiratory arrest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;7&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">Assessment of optic nerve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&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">Transcranial Doppler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;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">Basic echocardiography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;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">Assessment of airway&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1425286.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Percentage of units that used ultrasonography to guide vascular cannulation for different purposes&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;L&#46; Moore"
                            1 => "J&#46;A&#46; Copel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra0909487"
                      "Revista" => array:7 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
                        "volumen" => "364"
                        "paginaInicial" => "749"
                        "paginaFinal" => "757"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21345104"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915014002226"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effect of point-of-care ultrasonography on imaging studies in the medical ICU"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Oks"
                            1 => "K&#46;L&#46; Cleven"
                            2 => "J&#46; Cardenas-Garcia"
                            3 => "J&#46;A&#46; Schaub"
                            4 => "S&#46; Koenig"
                            5 => "R&#46;I&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.14-0728"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2014"
                        "volumen" => "146"
                        "paginaInicial" => "1574"
                        "paginaFinal" => "1577"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25144593"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasound in pediatric clinical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;J&#46; McLario"
                            1 => "A&#46;B&#46; Sivitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2015.22"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2015"
                        "volumen" => "169"
                        "paginaInicial" => "594"
                        "paginaFinal" => "600"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25893571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bedside ultrasound in pediatric emergency medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Levy"
                            1 => "V&#46;E&#46; Noble"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2007-1816"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2008"
                        "volumen" => "121"
                        "paginaInicial" => "e1404"
                        "paginaFinal" => "e1412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18450883"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915014016499"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bedside ultrasound in pediatric practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;L&#46; Vieira"
                            1 => "R&#46; Bachur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2013-0750"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2014"
                        "volumen" => "133"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24344106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasonography by pediatric emergency medicine physicians"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "American Academy of Pediatrics Committee on Pediatric Emergency Medicine&#44; Society for Academic Emergency Medicine Academy of Emergency Ultrasound&#44; American College of Emergency Physicians Pediatric Emergency Medicine Committee&#44; World Interactive Network Focused on Critical Ultrasound"
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Marin"
                            1 => "R&#46;E&#46; Lewiss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2015-0343"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2015"
                        "volumen" => "135"
                        "paginaInicial" => "e1113"
                        "paginaFinal" => "e1122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25825532"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915013007375"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of emergency ultrasound in pediatric emergency departments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;C&#46; Chamberlain"
                            1 => "S&#46;R&#46; Reid"
                            2 => "M&#46; Madhok"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e3182259908"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "628"
                        "paginaFinal" => "632"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21712744"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bedside ultrasound education in pediatric emergency medicine fellowship programs in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Cohen"
                            1 => "S&#46;J&#46; Teach"
                            2 => "J&#46;I&#46; Chapman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e318267a771"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "845"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22929139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of emergency ultrasound in United States pediatric emergency medicine fellowship programs in 2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; Marin"
                            1 => "N&#46;S&#46; Zuckerbraun"
                            2 => "J&#46;M&#46; Kahn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "1357"
                        "paginaFinal" => "1363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22922615"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of ultrasound-guided radial artery cannulation in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Ganesh"
                            1 => "R&#46; Kaye"
                            2 => "A&#46;M&#46; Cahill"
                            3 => "W&#46; Stern"
                            4 => "R&#46; Pachikara"
                            5 => "P&#46;R&#46; Gallagher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e31819368ca"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "10"
                        "paginaInicial" => "45"
                        "paginaFinal" => "48"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19057451"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International evidence-based recommendations on ultrasound-guided vascular access"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lamperti"
                            1 => "A&#46;R&#46; Bodenham"
                            2 => "M&#46; Pittiruti"
                            3 => "M&#46; Blaivas"
                            4 => "J&#46;G&#46; Augoustides"
                            5 => "M&#46; Elbarbary"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2597-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2012"
                        "volumen" => "38"
                        "paginaInicial" => "1105"
                        "paginaFinal" => "1117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22614241"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided thoracentesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46; Feller-Kopman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.6.1709"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "129"
                        "paginaInicial" => "1709"
                        "paginaFinal" => "1714"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16778292"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung ultrasound in critically ill patients&#58; comparison with bedside chest radiography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Xirouchaki"
                            1 => "E&#46; Magkanas"
                            2 => "K&#46; Vaporidi"
                            3 => "E&#46; Kondili"
                            4 => "M&#46; Plataki"
                            5 => "A&#46; Patrianakos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-011-2317-y"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2011"
                        "volumen" => "37"
                        "paginaInicial" => "1488"
                        "paginaFinal" => "1493"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21809107"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915015301854"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care echocardiography by pediatric emergency physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Longjohn"
                            1 => "J&#46; Wan"
                            2 => "V&#46; Joshi"
                            3 => "J&#46; Pershad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0b013e318226c7c7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2011"
                        "volumen" => "27"
                        "paginaInicial" => "693"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21811201"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasound for pediatric shock"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;B&#46; Park"
                            1 => "B&#46;C&#46; Presley"
                            2 => "T&#46; Cook"
                            3 => "G&#46;E&#46; Hayden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0000000000000519"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "591"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26241714"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915015013088"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinician-performed abdominal sonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Dickman"
                            1 => "M&#46;O&#46; Tessaro"
                            2 => "A&#46;C&#46; Arroyo"
                            3 => "L&#46;E&#46; Haines"
                            4 => "J&#46;P&#46; Marshall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00068-015-0508-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Trauma Emerg Surg"
                        "fecha" => "2015"
                        "volumen" => "41"
                        "paginaInicial" => "481"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26038027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of transcranial Doppler in neurocritical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Saqqur"
                            1 => "D&#46; Zygun"
                            2 => "A&#46; Demchuk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000260633.66384.FB"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "S216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17446782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal ultrasonography in critically ill patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Barozzi"
                            1 => "M&#46; Valentino"
                            2 => "A&#46; Santoro"
                            3 => "E&#46; Mancini"
                            4 => "P&#46; Pavlica"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000260631.62219.B9"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "S198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17446779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National survey of bedside ultrasound use in pediatric critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;L&#46; Lambert"
                            1 => "J&#46;R&#46; Boker"
                            2 => "F&#46;A&#46; Maffei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0b013e3182266a51"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "12"
                        "paginaInicial" => "655"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21725274"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub ahead of print&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic and therapeutic impact of point-of-care ultrasonography in the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Bernier-Jean"
                            1 => "M&#46; Albert"
                            2 => "A&#46;L&#46; Shiloh"
                            3 => "L&#46;A&#46; Eisen"
                            4 => "D&#46; Williamson"
                            5 => "Y&#46; Beaulieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0885066615606682"
                      "Revista" => array:2 [
                        "tituloSerie" => "J Intensive Care Med"
                        "fecha" => "2015"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "National Institute for Health Care and Excellence &#40;NICE&#41;&#46; Guidance on the use of ultrasound locating devices for placing central venous catheters&#46; NICE technology appraisal guidance&#46; 2002 &#91;accessed 04&#46;03&#46;16&#93;&#46; Available from&#58; <a href="https://www.nice.org.uk/guidance/ta49">https&#58;&#47;&#47;www&#46;nice&#46;org&#46;uk&#47;guidance&#47;ta49</a>"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;D&#46; Froehlich"
                            1 => "M&#46;R&#46; Rigby"
                            2 => "E&#46;S&#46; Rosenberg"
                            3 => "R&#46; Li"
                            4 => "P-L&#46;J&#46; Roerig"
                            5 => "K&#46;A&#46; Easley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31819b570e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "37"
                        "paginaInicial" => "1090"
                        "paginaFinal" => "1096"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19237922"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric emergency medicine fellow training in ultrasound&#58; Consensus educational guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;L&#46; Vieira"
                            1 => "D&#46; Hsu"
                            2 => "J&#46; Nagler"
                            3 => "L&#46; Chen"
                            4 => "R&#46; Gallagher"
                            5 => "J&#46;A&#46; Levy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/acem.12087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2013"
                        "volumen" => "20"
                        "paginaInicial" => "300"
                        "paginaFinal" => "306"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23517263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Establishing intensivist-driven ultrasound at the PICU bedside&#8212;It&#39;s about time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Su"
                            1 => "A&#46; Pustavoitau"
                            2 => "E&#46;L&#46; Hirshberg"
                            3 => "A&#46; Nishisaki"
                            4 => "T&#46; Conlon"
                            5 => "D&#46;B&#46; Kantor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PCC.0000000000000168"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "15"
                        "paginaInicial" => "649"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24977438"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Defining competencies for ultrasound-guided bedside procedures&#58; consensus opinions from Canadian physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;M&#46; Brown"
                            1 => "M&#46; Otremba"
                            2 => "L&#46;A&#46; Devine"
                            3 => "C&#46; Gray"
                            4 => "S&#46;J&#46; Millington"
                            5 => "I&#46;W&#46;Y&#46; Ma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7863/ultra.15.01063"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Ultrasound Med"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "129"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26657751"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0021915015001112"
                          "estado" => "S300"
                          "issn" => "00219150"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:3 [
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">We thank the representatives of every participating unit for collaborating in the collection of data through the online survey&#44; which we proceed to list alphabetically&#58; Amalia Mart&#237;nez Ant&#243;n &#40;Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#41;&#44; Antonio Bonillo Perales &#40;Complejo Hospitalario Torrec&#225;rdenas&#41;&#44; Antonio Jim&#233;nez Bravo de Laguna &#40;Complejo Hospitalario Universitario Insular Maternoinfantil de Canarias&#41;&#44; Antonio Rodr&#237;guez N&#250;&#241;ez &#40;Complexo Hospitalario Universitario de Santiago&#41;&#44; Asunci&#243;n Pino V&#225;zquez &#40;Hospital Cl&#237;nico Universitario de Valladolid&#41;&#44; Bego&#241;a Arias Novas &#40;Hospital Universitario Sanitas La Zarzuela&#41;&#44; Carlos Sol&#237;s Reyes &#40;Hospital Universitario Nuestras Se&#241;ora de la Candelaria&#41;&#44; Concha Go&#241;i Orayen &#40;Complejo Hospitalario de Navarra&#41;&#44; Corsino Rey Gal&#225;n &#40;Hospital Universitario Central de Asturias&#41;&#44; Roberto Reig S&#225;enz &#40;Hospital General Universitario de Alicante&#41;&#44; Eduard Carreras Gonz&#225;lez &#40;Hospital de la Santa Creu i Sant Pau&#41;&#44; Ender O&#241;ate Vergara &#40;Hospital Universitario Donostia&#41;&#44; Francisco Jos&#233; Cambra Lassaloa &#40;Hospital Sant Joan de D&#233;u&#41;&#44; Gerardo Romera Modamio &#40;Hospital Universitario HM Madrid-Montepr&#237;ncipe&#41;&#44; Guillermo Milano Manso &#40;Hospital Regional Universitario de M&#225;laga&#41;&#44; Irene Centelles Sales &#40;Hospital General Universitario de Castell&#243;n&#41;&#44; Javier Pilar Orive &#40;Hospital Universitario de Cruces&#41;&#44; Jes&#250;s de la Cruz Moreno &#40;Complejo Hospitalario de Ja&#233;n&#41;&#44; Joan Ballcels Ram&#237;rez &#40;Hospital Vall d&#8217;Hebron&#41;&#44; Jos&#233; Luis V&#225;zquez Mart&#237;nez &#40;Hospital Universitario Ram&#243;n y Cajal&#41;&#44; Juan Carlos de Carlos &#40;Hospital Universitario Son Espases&#41;&#44; Luis Moreno Fern&#225;ndez &#40;Hospital San Rafael&#41;&#44; Luis Renter Valdovinos &#40;Hospital Universitario Parc Tauli&#41;&#44; Manuel Ortiz Pallar&#233;s &#40;Hospital Xeral de Vigo&#41;&#44; Mario S&#225;nchez Fern&#225;ndez &#40;Hospital Universitari Dr&#46; Josep Trueta&#41;&#44; Montserrat Nieto Moro &#40;Hospital Infantil Universitario Ni&#241;o Jes&#250;s&#41;&#44; Paula Madurga Revilla &#40;Hospital Universitario Miguel Servet&#41;&#44; Rafael Gonz&#225;lez Cort&#233;s &#40;Hospital General Universitario Gregorio Mara&#241;&#243;n&#41;&#44; Susana Jaraba Caballero &#40;Hospital Universitario Reina Sof&#237;a de C&#243;rdoba&#41;&#44; Susana Reyes Dom&#237;nguez &#40;Hospital Cl&#237;nico Universitario Virgen de la Arrixaca&#41; and Sylvia Belda-Hofheinz &#40;Hospital Universitario Doce de Octubre&#41;&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008600000006/v1_201705270049/S2341287917300844/v1_201705270049/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008600000006/v1_201705270049/S2341287917300844/v1_201705270049/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287917300844?idApp=UINPBA00005H"
]

Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2016.06.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	5	10
2024 October	70	26	96
2024 September	77	23	100
2024 August	67	59	126
2024 July	78	28	106
2024 June	51	32	83
2024 May	44	28	72
2024 April	56	45	101
2024 March	40	24	64
2024 February	43	29	72
2024 January	35	28	63
2023 December	33	20	53
2023 November	36	21	57
2023 October	34	27	61
2023 September	33	24	57
2023 August	43	18	61
2023 July	45	29	74
2023 June	40	34	74
2023 May	52	20	72
2023 April	40	24	64
2023 March	67	24	91
2023 February	97	24	121
2023 January	34	23	57
2022 December	72	26	98
2022 November	60	36	96
2022 October	76	40	116
2022 September	37	27	64
2022 August	38	51	89
2022 July	47	36	83
2022 June	76	42	118
2022 May	58	33	91
2022 April	45	47	92
2022 March	55	55	110
2022 February	29	30	59
2022 January	26	37	63
2021 December	46	48	94
2021 November	35	50	85
2021 October	69	73	142
2021 September	28	37	65
2021 August	18	45	63
2021 July	39	36	75
2021 June	28	43	71
2021 May	33	49	82
2021 April	68	75	143
2021 March	55	34	89
2021 February	25	13	38
2021 January	38	25	63
2020 December	23	16	39
2020 November	26	17	43
2020 October	20	22	42
2020 September	32	20	52
2020 August	17	16	33
2020 July	32	20	52
2020 June	30	11	41
2020 May	24	17	41
2020 April	22	9	31
2020 March	41	23	64
2020 February	25	12	37
2020 January	27	30	57
2019 December	33	25	58
2019 November	26	14	40
2019 October	33	16	49
2019 September	38	22	60
2019 August	38	15	53
2019 July	37	27	64
2019 June	19	34	53
2019 May	75	23	98
2019 April	78	25	103
2019 March	35	26	61
2019 February	33	15	48
2019 January	39	26	65
2018 December	28	18	46
2018 November	79	26	105
2018 October	137	17	154
2018 September	69	14	83
2018 August	1	0	1
2018 July	4	0	4
2018 June	3	0	3
2018 May	10	0	10
2018 April	37	0	37
2018 March	90	0	90
2018 February	9	0	9
2018 January	16	0	16
2017 December	21	0	21
2017 November	14	0	14
2017 October	19	0	19
2017 September	25	0	25
2017 August	21	0	21
2017 July	21	0	21
2017 June	51	29	80
2017 May	8	25	33

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter