Original Article
Nutrition in children with continuous renal replacement therapy
Nutrición en niños tratados con técnicas de depuración extrarrenal continua
Maria José Santiago Lozano
, Cristina Alonso Álvarez, Caterina Álvarez Heidbüchel, Sarah Fernández Lafever, Maria José Solana García, Jesús López-Herce Cid
Corresponding author
Servicio de Cuidados Intensivos Pediátricos, Departamento de Salud Pública y Maternoinfantil, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, Spain
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Lafever, Maria José Solana García, Jesús López-Herce Cid" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Maria José" "apellidos" => "Santiago Lozano" "email" => array:2 [ 0 => "mjsantiagolozano@gmail.com" 1 => "msanti20@ucm.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "Alonso Álvarez" ] 2 => array:2 [ "nombre" => "Caterina" "apellidos" => "Álvarez Heidbüchel" ] 3 => array:2 [ "nombre" => "Sarah" "apellidos" => "Fernández Lafever" ] 4 => array:2 [ "nombre" => "Maria José" "apellidos" => "Solana García" ] 5 => array:2 [ "nombre" => "Jesús" "apellidos" => "López-Herce Cid" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cuidados Intensivos Pediátricos, Departamento de Salud Pública y Maternoinfantil, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nutrición en niños tratados con técnicas de depuración extrarrenal continua" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A significant proportion of children admitted to paediatric intensive care units (PICUs) have acute kidney injury (AKI), and approximately 5% require renal replacement therapy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Continuous renal replacement therapy (CRRT) modalities are used most frequently, as they allow controlled fluid removal and unrestricted food intake.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Children with AKI are at increased risk of undernutrition, which in turn is associated with increased morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–6</span></a> Furthermore, they often develop other complications, such as haemodynamic changes, need of mechanical ventilation and decreased gastric motility due to the administration of sedatives and muscle relaxants, which increase the risk of poor enteral feeding tolerance.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand, replacement therapies may lead to loss of nutrients, amino acids, vitamins, folic acid or minerals like selenium through filtering.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies have analysed the characteristics of the nutrition given to children undergoing CRRT.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6–8</span></a> One such study found a higher incidence of gastrointestinal complications in children with AKI compared to other critically ill children, and that this incidence increased the more severe renal impairment was in these patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aims of our study were to analyse the nutritional status, nutritional intake and gastrointestinal complications of children managed with CRRT.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Sample and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a retrospective analysis of data collected prospectively in children admitted in the PICU and managed with CRRT between January 2013 and December 2017. The study was approved by the local ethics committee. We excluded patients treated with other forms of renal replacement therapy (peritoneal dialysis, immunoadsorption, plasma filtration).</p><p id="par0035" class="elsevierStylePara elsevierViewall">We collected data on the following variables: demographic and clinical variables (age, sex, weight, height, body surface area, diagnosis); indication for and characteristics of CRRT, type of nutrition, mode of delivery of enteral nutrition (gastric tube feeding, transpyloric tube feeding, oral intake), type of diet, target intake (energy and protein), time elapsed until target intake was achieved with enteral nutrition, characteristics of parenteral nutrition (total volume, protein, carbohydrate and lipid intake in the first day), gastrointestinal complications (significant abdominal distension based on the judgment of the clinician in charge, gastric residual volume [50% of the volume administered in the past 4<span class="elsevierStyleHsp" style=""></span>h], diarrhoea [more than 8 watery stools in infants aged up to 3 months, more than 4 loose stools in infants aged 3–12 months and more than 2 watery stools in children aged more than 12 months], constipation [>72<span class="elsevierStyleHsp" style=""></span>h without a bowel movement despite administration of enteral nutrition], vomiting [vomiting at least twice in 24<span class="elsevierStyleHsp" style=""></span>h]), bowel ischaemia (clinical signs [gastrointestinal bleeding, abdominal distension, decreased perfusion in abdominal wall] combined with sonographic or computed tomography findings compatible with bowel ischaemia), hypertransaminasaemia (alanine aminotransferase ALT<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>IU/L and aspartate aminotransferase<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>IU/L), need of extracorporeal membrane oxygenation (ECMO) and patient outcomes (survival, cause of death and length of stay in PICU).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although nutritional management was customised to each patient, per the established protocol the initial intake targets were 60–65<span class="elsevierStyleHsp" style=""></span>kcal/kg for energy and 1.5 a 2<span class="elsevierStyleHsp" style=""></span>g/kg for protein, and in patients in who it was possible to calculate requirements using indirect calorimetry, the energy target was 1.3 times the resting energy expenditure.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We calculated weight and height percentiles and the corresponding z-scores using the nutrition application of the Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition, <a href="https://www.seghnp.org/nutricional">https://www.seghnp.org/nutricional</a>) using the charts published by Fernández et al. as reference, and we categorised nutritional status using the Waterlow indices for height (WIh) and weight (WIw), calculated with the following equations: WIh<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[actual height/median (expected) height for age]<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100; WIw<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>[actual weight/median (expected) weight for height]<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100. We categorised nutritional status as<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>: normal WIw<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>90%, normal WIh<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>95%; acute undernutrition (mild, WIw<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>80–90%; moderate, WIw<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>70–80%; severe, WIw<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>70%), overnutrition (WIw<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>115%), chronic undernutrition (mild, WIh<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>90–95%, moderate, WIh<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>85–90%; severe, WIh<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>85%).</p><p id="par0050" class="elsevierStylePara elsevierViewall">We analysed the association of feeding tolerance and gastrointestinal complications with the characteristics of the patient, nutritional support and the simultaneous use of ECMO and CRRT.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We performed the statistical analysis with the software IBM SPSS version 21.0. We summarised quantitative data as mean and standard deviation (SD) in case of a normal distribution and otherwise as median and interquartile range (IQR). We summarised qualitative data as percentages. To compare qualitative variables, we used the χ<span class="elsevierStyleSup">2</span> test and Fisher exact test. To compare the means of quantitative variables, we used the Student <span class="elsevierStyleItalic">t test</span>. We defined statistical significance as a <span class="elsevierStyleItalic">p-</span>value of less than 0.05.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">We analysed data for 65 children managed with CRRT over 5 years, of who 61.5% were male. The median age was 13.9 months (IQR, 4.6–80.7). The distribution of diagnoses at admission was: heart disease, 75%; abdominal surgery postoperative status, 5%, acute-on-chronic renal failure, 2%; sepsis, 3%; haemolytic uremic syndrome, 3%; respiratory failure, 3%; other, 9%. Of all patients, 92.3% were managed with mechanical ventilation and 36.9% with ECMO.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The median weight was 8.9<span class="elsevierStyleHsp" style=""></span>kg (IQR, 5.6 to 18.7<span class="elsevierStyleHsp" style=""></span>kg). The median weight <span class="elsevierStyleItalic">z</span>-score was −1.28 (IQR, −0.78 to −1.93). Eighteen patients (27.7%) had a body weight below the 3rd percentile, and 31 (48.4%) a height below the 3rd percentile. We found acute undernutrition (WIw<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90%) in 32.8% of the sample (mild in 61.9% of cases, moderate in 19% and severe in 19%) and chronic malnutrition (WIh<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>95%) in 60.9% (mild in 38.5% of cases, moderate in 33.3% and severe in 28.2%).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Continuous renal replacement therapy was initiated at a median of 3 days after admission to the PICU (IQR, 1–7 days). In all cases, it consisted of continuous venovenous haemofiltration with a Prismaflex® system (Baxter). The median duration of CRRT was 7 days (IQR, 4–16 days). The reason for discontinuation of CRRT was recovery of renal function in 70.8% of patients, death in 24.6% and switch to a different renal replacement therapy modality in 4.6%.</p><p id="par0075" class="elsevierStylePara elsevierViewall">At initiation of CRRT, 81.5% of patients were receiving nutritional support (47.7% enteral support and 33.8% parenteral support) and 18.5% were under <span class="elsevierStyleItalic">nil per os</span> with fluid replacement therapy.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the group of patients managed with enteral nutrition, the mode of delivery was transpyloric tube feeding in 75.5%, gastric tube feeding in 20.8% and oral nutrition in 3.8%.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The foods administered through enteral nutrition were: infant formula in 6%, human milk in 9%, hypercaloric infant formula (Infatrini®) in 21%, protein hydrolysate formula in 19%, hypercaloric child formula (Isosource® Junior) in 30%, a formula high in medium chain triglycerides (Monogen®) in 9%, and a formula specific for individuals with kidney injury (Suplena®) in 6%. The median time elapsed to achieving the target intake in the enteral nutrition group was 6<span class="elsevierStyleHsp" style=""></span>h (IQR, 3−12<span class="elsevierStyleHsp" style=""></span>h). The median target enteral feeding volume was of 64<span class="elsevierStyleHsp" style=""></span>mL/kg/day (IQR, 36−100<span class="elsevierStyleHsp" style=""></span>mL), with an energy intake of de 63<span class="elsevierStyleHsp" style=""></span>kcal/kg/day (IQR, 43−72<span class="elsevierStyleHsp" style=""></span>kcal) and a protein intake of 1.6<span class="elsevierStyleHsp" style=""></span>g/kg/day (IQR, 0.97–2.2<span class="elsevierStyleHsp" style=""></span>g). We did not find significant differences in the energy intake or protein intake between children managed with gastric tube feeding (median of 60<span class="elsevierStyleHsp" style=""></span>kcal/kg and 1.62<span class="elsevierStyleHsp" style=""></span>g of protein/kg) and those managed with transpyloric tube feeding (median of 67<span class="elsevierStyleHsp" style=""></span>kcal/kg and 1.55<span class="elsevierStyleHsp" style=""></span>g of protein/kg).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The median parenteral nutrition volume delivered on day 1 was 50<span class="elsevierStyleHsp" style=""></span>mL/kg/day (IQR, 39.4–62.9<span class="elsevierStyleHsp" style=""></span>mL), with delivery of 53.3<span class="elsevierStyleHsp" style=""></span>kcal/kg/day (IQR, 49–66.7<span class="elsevierStyleHsp" style=""></span>kcal), 2.0<span class="elsevierStyleHsp" style=""></span>g of protein/kg/day (IQR, 1.5–2.9<span class="elsevierStyleHsp" style=""></span>g), 8.2<span class="elsevierStyleHsp" style=""></span>g of carbohydrates/kg/day (IQR, 7,7–10,2<span class="elsevierStyleHsp" style=""></span>g) and 1.1<span class="elsevierStyleHsp" style=""></span>g/kg/day of fluids (IQR, 1–2<span class="elsevierStyleHsp" style=""></span>g).</p><p id="par0095" class="elsevierStylePara elsevierViewall">Gastrointestinal complications developed in 48 patients (73.8%) during CRRT. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the gastrointestinal complications observed in our patients by type of nutritional support. We did not find differences in the frequency of abdominal distension, presence of gastric residual volumes, vomiting, diarrhoea or constipation between patients initially managed with enteral nutrition, parenteral nutrition or fluid replacement therapy. Only 1 patient (2.1%), who was managed with parenteral nutrition, developed intestinal ischaemia. Hypertransaminasaemia was more frequent in the parenteral nutrition group, although the difference was not statistically significant. Enteral nutrition had to be discontinued in 3 patients due to suspected intestinal ischaemia, paralytic ileus and rhabdomyosarcoma of the biliary tree, and had to be reduced in 4 patients with addition of parenteral nutrition (due to intramural haematoma of the duodenum or abdominal distension). We found no differences in the incidence of gastrointestinal complications between children managed with gastric tube feeding (abdominal distension, 40%; diarrhoea, 10%; constipation, 50%) and children managed with transpyloric tube feeding (abdominal distension, 48.2%; diarrhoea, 6.8%; constipation, 51.7%), except in the incidence of vomiting, which was higher in the gastric tube group compared to the transpyloric tube group (40% vs 6.8%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.01).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Twenty-four children (36.9%) were treated simultaneously with ECMO and CRRT. Gastrointestinal complications developed in 79.1% of these patients compared to 70.7% of patients treated with CRRT alone (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.45). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> compares the gastrointestinal complications found in patients managed with ECMO and without ECMO.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The median length of stay in the PICU was of 34.5 days (IQR, 21–58.2 days). Nineteen patients died (29.2%). The most frequent cause of death was multiple organ failure (57.9%), followed by cardiac complications (21.1%), brain death (5.3%) and intestinal ischaemia (5.3%). We found body weights below the 3rd percentile in 28.9% of survivors and 21.1% of patients that died (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.758); 23.5% of children with weights below the 3rd percentile died compared to 31.9% of children with weights greater than the 3rd percentile (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.758). Furthermore, 46.5% of survivors and 50% of deceased patients had heights below the 3rd percentile (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.810). We did not find differences in the WIw or the WIh between survivors and the deceased (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The initial management in the PICU of 54.3% of survivors and 31.6% of deceased patients included enteral nutrition (<span class="elsevierStyleItalic">P<span class="elsevierStyleHsp" style=""></span>=</span><span class="elsevierStyleHsp" style=""></span>10).</p><p id="par0115" class="elsevierStylePara elsevierViewall">All patients that died experienced some form of gastrointestinal complication, but no specific gastrointestinal complication was significantly more frequent in deceased patients compared to survivors. On the contrary, vomiting was more frequent in survivors compared to deceased patients.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Although several studies have analysed the association between malnutrition and AKI and enteral nutrition tolerance in adults and children managed with CRRT,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–7</span></a> our study is the first to analyse the nutritional status of these children, the characteristics of nutritional support, treatment with ECMO and CRRT and mortality.</p><p id="par0125" class="elsevierStylePara elsevierViewall">A substantial proportion of children admitted to the PICU are malnourished, and malnutrition is associated with poorer outcomes.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> Kyle et al. found that a higher proportion of children with AKI not managed with CRRT had acute malnutrition (33%) compared to children without AKI.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Another previous study that analysed the nutritional status of 174 children managed with CRRT found that 35% had body weights below the 3rd percentile and 56% had a weight-for-height of less than 0.85.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The mortality of children with a body weight below the 3rd percentile was significantly higher compared to all other patients (51% versus 33%; <span class="elsevierStyleItalic">P<span class="elsevierStyleHsp" style=""></span>=</span><span class="elsevierStyleHsp" style=""></span>.037). The multivariate analysis found that underweight was significantly associated with mortality.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Our study also revealed that a high proportion of children managed with CRRT had acute or chronic malnutrition, but we did not find evidence of an association between nutritional status and mortality.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The energy requirements of critically ill children in the first days in the PICU range from 40 to 60<span class="elsevierStyleHsp" style=""></span>kcal/kg/day.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> No studies in the literature have analysed the energy intake of children with AKI undergoing CRRT. Although indirect calorimetry is the ideal method to estimate the energy requirements of patients,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> this technique is available in few facilities. In our study, nutritional management achieved an energy intake of 63<span class="elsevierStyleHsp" style=""></span>kcal/kg/day, but we were unable to determine whether this intake was sufficient.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Achieving an adequate protein intake is an essential goal of nutritional management in critically ill children, as it is necessary to prevent muscle catabolism and promote protein synthesis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> A protein intake of at least 1.5<span class="elsevierStyleHsp" style=""></span>g/kg/day is recommended for critically ill children.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> A decreased protein intake is generally recommended in children with AKI, but in children treated with CRRT, this technique carries out the filtering function of the kidney and thus it is not necessary to restrict protein intake. Some authors consider that children with AKI managed with CRRT require a protein intake of 1.5 to 2.5<span class="elsevierStyleHsp" style=""></span>g/kg/day to compensate losses to filtration and guarantee a positive nitrogen balance.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,14</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In our sample, children managed with enteral nutrition received an amount of protein at the lower limit of the recommended range (1.6<span class="elsevierStyleHsp" style=""></span>g/kg/day), although we did not analyse the nitrogen balance. In opposition, protein intake was higher on day 1 of nutritional support in children managed with parenteral nutrition (2<span class="elsevierStyleHsp" style=""></span>g/kg/day). These findings were consistent with those of a study conducted by Wong Vega et al. in 41 children managed with CRRT, in which those receiving enteral nutrition had a lower protein intake compared to those managed with parenteral nutrition.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Enteral nutrition is the nutritional support modality of choice in most critically ill children because it preserves normal bowel physiology, stimulates the immune system, reduces bacterial translocation and is associated with a decreased incidence of sepsis and multiple organ failure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Parenteral nutrition should be reserved for patients that cannot tolerate enteral nutrition or when the latter cannot deliver sufficient amounts of energy and protein.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, there is a widespread belief that AKI can reduce tolerance of enteral nutrition, resulting in the management of many critical patients with AKI with parenteral nutrition.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,7</span></a> A recent study found that only 12% of children managed with CRRT received exclusive enteral nutrition.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, in our experience transpyloric tube feeding is a good alternative in critically ill children, as it prevents the problems associated with inadequate gastric emptying, can be used in patients under deep sedation and muscle relaxation, and allows a quick increase of feeding volumes to meet the target energy intake.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–17</span></a> In our study, transpyloric tube feeding was the modality used in 75% of patients managed with enteral nutrition and was associated with a decreased frequency of vomiting compared with gastric tube feeding. This could explain the higher proportion of patients that received enteral nutrition compared to other studies. For this reason, we believe that transpyloric tube feeding could be considered the first line of nutritional support in critically ill children under CRRT.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Very few studies have analysed the tolerability and adverse effects of enteral nutrition in patients with AKI.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We found a high incidence of gastrointestinal complications in our patients, in agreement with the findings of a previous study in which the frequency of complications was significantly higher in children with AKI compared to all other critically ill children.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The most frequent gastrointestinal complication in our sample was abdominal distension, followed by constipation, vomiting and diarrhoea, with no significant differences between children managed with enteral versus parenteral nutrition. This suggests that these complications are not a direct result of nutrition and rather depend on the disease of the patient and its severity.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our study, enteral nutrition only had to be permanently discontinued in 3 patients, and this was not a direct consequence of nutritional support in any case. Our findings show that while the incidence of gastrointestinal complications in children managed with enteral nutrition is high, most of them are not serious and do not require definitive discontinuation of enteral nutrition.</p><p id="par0165" class="elsevierStylePara elsevierViewall">There is a dearth of data on the nutritional management of children treated with ECMO. Some authors have reported the nearly exclusive use of parenteral nutrition due to the potential risk of inadequate intestinal perfusion and mesenteric ischaemia giving rise to necrotising enterocolitis, intestinal ischaemia, intestinal perforation or gastrointestinal bleeding, while others have reported the use of enteral nutrition.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">A substantial percentage of patients in the sample (36.9%) were managed with ECMO and CRRT at the same time. We have not found any previous study analysing nutrition in critical patients managed concurrently with both techniques. We found a slightly higher incidence of gastrointestinal complications in children in this group compared to children managed with CRRT alone, but the difference was not statistically significant. Our results suggest that enteral nutrition is safe in children managed with both ECMO and CRRT and should be the first-line nutritional therapy in these patients once respiratory and haemodynamic stability is achieved.</p><p id="par0175" class="elsevierStylePara elsevierViewall">On the other hand, there are no published studies analysing the association of nutritional status, type of nutritional support, energy intake and protein intake with patient outcomes in children with AKI managed with CRRT. Our study did not find evidence of an association between the type of nutritional management (enteral or parenteral) and mortality. We did not find a higher incidence of gastrointestinal complications in patients that died compared to survivors. Only 1 patient died from a gastrointestinal complication (intestinal ischaemia), and the complication was not secondary to nutrition. These findings support the use of enteral nutrition as the first line of nutritional management in these patients.</p><p id="par0180" class="elsevierStylePara elsevierViewall">There are several limitations to our study. It was a retrospective study with a relatively small sample of patients and in a single PICU, and therefore multicentre studies are required to confirm our findings. In addition, the energy requirements of patients were not determined by indirect calorimetry and we did not analyse the nitrogen balance. Thus, we do not know whether the energy and protein intakes were adequate in each patient. We only compared the energy and protein intake in the group managed with enteral nutrition versus the group managed with parenteral nutrition on day 1, as the highest amounts delivered were not documented. Furthermore, we did not assess the potential impact of other factors, such as disease severity, the patient’s diagnosis and the use of other drugs on enteral tolerance and the development of gastrointestinal complications.</p><p id="par0185" class="elsevierStylePara elsevierViewall">In conclusion, there is a high incidence of undernutrition in critically ill children with AKI requiring CRRT, but undernutrition is not associated with an increase in mortality. Most children treated with CRRT tolerate enteral nutrition, and while there is a high probability that they will experience gastrointestinal complications, these seldom require discontinuation of enteral nutrition. Children treated with ECMO and CRRT simultaneously did not exhibit a higher incidence of gastrointestinal complications compared to children treated with CRRT alone.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1336770" "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" => "xpalclavsec1230931" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1336771" "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" => "xpalclavsec1230932" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Sample and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-03-28" "fechaAceptado" => "2019-08-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1230931" "palabras" => array:5 [ 0 => "Children" 1 => "Continuous renal replacement therapy" 2 => "Nutrition" 3 => "Extracorporeal membrane oxygenation" 4 => "Gastrointestinal complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1230932" "palabras" => array:5 [ 0 => "Niños" 1 => "Técnicas de depuración extrarrenal continua" 2 => "Nutrición" 3 => "Oxigenación por membrana extracorpórea" 4 => "Complicaciones digestivas" ] ] ] ] "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="spar0030" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to analyse the nutritional state, diet and gastrointestinal complications of children that require continuous renal replacement therapy (CRRT).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis of a database, which included the information about patients who required CRRT between the years 2013 and 2017. Data were collected on the replacement technique, type of nutrition, calorie and protein intake, gastrointestinal complications, and clinical course. Children on extracorporeal membrane oxygenation (ECMO) were compared with the rest of patients.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 65 children (61.5% male) were treated with CRRT, and 24 patients (37%) also needed ECMO support. Just over one-quarter (27.7%) of patients had a weight less than P3, and 48.4% of them a height less than P3. At the beginning of the technique, 31 children (47.7%) received enteral nutrition, at the end, there were 52 patients receiving enteral nutrition (80%). The transpyloric tube was used to provide nutrition in 76% of the cases. The median calorie intake was 63<span class="elsevierStyleHsp" style=""></span>kcal/kg/day, and the protein intake was 1.6<span class="elsevierStyleHsp" style=""></span>g/kg/day. There were gastrointestinal difficulties during the process in 48 patients (73.8%), with 29 (44.6%) patients being diagnosed with gastric distension or excessive gastric remains, 22 (33.8%) with constipation, 8 (12.3%) with vomiting, and 4 (6.1%) diarrhoea. One patient treated with ECMO presented with intestinal ischaemia. Enteral nutrition was cancelled in 3 patients (4.6%) due to the complications. There was no relationship between complications and type of diet or ECMO assistance.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A high percentage of children treated with CRRT showed undernutrition but they had adequate tolerance to the enteral nutrition. Although the gastrointestinal complications percentage was high in a the low number of subjects, these complications are the reason why enteral nutrition was stopped. ECMO patients do not show higher incidence of digestive complications.</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">Introducción</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio ha sido analizar el estado de nutrición, la alimentación y las complicaciones digestivas de los niños que precisan técnicas de depuración extrarrenal continua (TDEC).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo realizado sobre una base de datos prospectiva de los niños tratados con TDEC entre 2013 y 2017. Se analizaron las características de los pacientes, la técnica de depuración, el tipo de nutrición, el aporte calórico y proteico, las complicaciones digestivas y la evolución clínica.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">65 niños (61,5% varones) fueron tratados con TDEC y 24 (37%) precisaron soporte con oxigenación con membrana extracorpórea (ECMO). Un 27,7% tenían un peso inferior al percentil 3 y un 48,4% una talla inferior al P3. Al inicio de la TDEC 31 niños (47,7%) recibían nutrición enteral y 52 (80%) al final de la misma. La nutrición enteral fue por sonda transpilórica en el 76%. La mediana de aporte calórico fue de 63<span class="elsevierStyleHsp" style=""></span>kcal/kg/día y la del aporte proteico de 1,6<span class="elsevierStyleHsp" style=""></span>g/kg/día. 48 pacientes (73,8%) presentaron complicaciones digestivas: 29 (44,6%) distensión gástrica o restos gástricos excesivos, 22 (33,8%) estreñimiento, 8 (12,3%) vómitos y 4 (6,1%) diarrea. Un paciente con ECMO presentó isquemia intestinal. En 3 pacientes (4,6%) se tuvo que suspender la nutrición enteral por complicaciones. No existió relación entre las complicaciones y el tipo de alimentación o la asistencia en ECMO.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Un elevado porcentaje de niños tratados con TDEC presentan malnutrición, pero la mayoría pueden ser alimentados con nutrición enteral. Aunque el porcentaje de complicaciones digestivas es elevado, en pocos pacientes se tiene que suspender la nutrición enteral.</p></span>" "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" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano MJS, Álvarez CA, Heidbüchel CA, Lafever SF, García MJS, Cid JL-H. Nutrición en niños tratados con técnicas de depuración extrarrenal continua. An Pediatr (Barc). 2020;92:208–214.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total, % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Enteral nutrition, % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parenteral nutrition % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fluid therapy, % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastrointestinal complications (overall) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.560 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal distention and gastric residual volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.320 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.770 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constipation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.790 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.360 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal ischaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertransaminasaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.063 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291936.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Frequency of gastrointestinal complications. Comparison by type of nutrition.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No ECMO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ECMO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients, <span class="elsevierStyleItalic">n</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastrointestinal complications during CRRT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.450 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal distention and gastric residual volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.130 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.530 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constipation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.860 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.360 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal ischaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.370 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertransaminasaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291937.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Gastrointestinal complications in children managed with ECMO versus children managed without ECMO.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">CRRT, continuous renal replacement therapy SD, standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Survivors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deceased \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients, <span class="elsevierStyleItalic">n</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (70.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (29.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waterlow index for weight, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">102 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.286 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waterlow index for height, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.735 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Target enteral energy intake (kcal/kg/day), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.7 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.093 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Target enteral protein intake (g/kg/day), mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.437 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gastrointestinal complications during CRRT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.093 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abdominal distention and gastric residual volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.554 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diarrhoea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.590 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constipation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.237 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intestinal ischaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.710 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertransaminasaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.696 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2291935.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Comparison of nutritional status, nutritional intake and gastrointestinal complications between survivors and deceased patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Specialized nutritional support interventions in critically ill patients on renal replacement therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 54 | 33 | 87 |
| 2024 September | 48 | 31 | 79 |
| 2024 August | 73 | 64 | 137 |
| 2024 July | 47 | 27 | 74 |
| 2024 June | 40 | 33 | 73 |
| 2024 May | 50 | 38 | 88 |
| 2024 April | 35 | 35 | 70 |
| 2024 March | 32 | 23 | 55 |
| 2024 February | 34 | 26 | 60 |
| 2024 January | 25 | 27 | 52 |
| 2023 December | 27 | 22 | 49 |
| 2023 November | 33 | 29 | 62 |
| 2023 October | 45 | 23 | 68 |
| 2023 September | 36 | 30 | 66 |
| 2023 August | 38 | 16 | 54 |
| 2023 July | 55 | 26 | 81 |
| 2023 June | 52 | 24 | 76 |
| 2023 May | 46 | 23 | 69 |
| 2023 April | 27 | 9 | 36 |
| 2023 March | 55 | 25 | 80 |
| 2023 February | 40 | 17 | 57 |
| 2023 January | 36 | 20 | 56 |
| 2022 December | 65 | 29 | 94 |
| 2022 November | 65 | 31 | 96 |
| 2022 October | 84 | 43 | 127 |
| 2022 September | 31 | 17 | 48 |
| 2022 August | 47 | 46 | 93 |
| 2022 July | 48 | 34 | 82 |
| 2022 June | 33 | 35 | 68 |
| 2022 May | 46 | 40 | 86 |
| 2022 April | 33 | 35 | 68 |
| 2022 March | 45 | 50 | 95 |
| 2022 February | 38 | 35 | 73 |
| 2022 January | 45 | 34 | 79 |
| 2021 December | 39 | 59 | 98 |
| 2021 November | 38 | 35 | 73 |
| 2021 October | 57 | 75 | 132 |
| 2021 September | 37 | 32 | 69 |
| 2021 August | 37 | 50 | 87 |
| 2021 July | 47 | 28 | 75 |
| 2021 June | 29 | 60 | 89 |
| 2021 May | 51 | 39 | 90 |
| 2021 April | 56 | 57 | 113 |
| 2021 March | 50 | 27 | 77 |
| 2021 February | 30 | 24 | 54 |
| 2021 January | 49 | 17 | 66 |
| 2020 December | 40 | 15 | 55 |
| 2020 November | 34 | 27 | 61 |
| 2020 October | 27 | 20 | 47 |
| 2020 September | 44 | 31 | 75 |
| 2020 August | 144 | 15 | 159 |
| 2020 July | 327 | 19 | 346 |
| 2020 June | 109 | 22 | 131 |
| 2020 May | 102 | 27 | 129 |
| 2020 April | 65 | 15 | 80 |
| 2020 March | 67 | 30 | 97 |
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