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avaliamos diferen&#231;as na PA entre as art&#233;rias radial e femoral em neonatos e beb&#234;s durante o perioperat&#243;rio para determinar se houve diferen&#231;as clinicamente relevantes entre os dois locais e para identificar os grupos de pacientes nos quais essas diferen&#231;as ocorreram&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material e m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Esta foi uma an&#225;lise de dados retrospectiva e o estudo foi aprovado pelo nosso Conselho de Revis&#227;o Institucional &#40;CNUH&#8208;2015&#8208;024&#41;&#46; Analisamos retrospectivamente dados cir&#250;rgicos e m&#233;dicos de pacientes com menos de um ano submetidos a cirurgia de cora&#231;&#227;o aberto entre janeiro de 2007 e dezembro de 2013&#46; Os crit&#233;rios de exclus&#227;o foram&#58; OHS sem ACC&#44; falha no desmame do CPB&#44; convers&#227;o para auxiliar na oxigena&#231;&#227;o por membrana extracorp&#243;rea&#44; mortalidade hospitalar precoce &#40;&#60; 24 horas&#41;&#44; aus&#234;ncia de cateteriza&#231;&#227;o simult&#226;nea nas art&#233;rias radial e femoral e cardiopatia cong&#234;nita que poderia ter afetado a discrep&#226;ncia na PA dessas art&#233;rias&#44; como anomalias no arco a&#243;rtico&#46; Analisamos dados demogr&#225;ficos&#44; inclusive idade no diagn&#243;stico&#44; idade na cirurgia&#44; sexo&#44; peso&#44; estatura e &#225;rea de superf&#237;cie do corpo&#46; Em todos os pacientes&#44; tamb&#233;m analisamos fatores pr&#233;&#8208;operat&#243;rios&#44; como diagn&#243;stico card&#237;aco e medicamentos&#46; Entre os dados intraoperat&#243;rios&#44; analisamos a dura&#231;&#227;o do CPB e do ACC&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Foram colocados cateteres nas art&#233;rias radial e femoral ap&#243;s indu&#231;&#227;o de anestesia&#46; A canula&#231;&#227;o da art&#233;ria radial foi feita com um cateter Radiopaque 24 G Jelco&#174; IV &#40;Smith Medical International Ltd&#46;&#44; Rossendale&#44; Inglaterra&#41;&#46; A cateteriza&#231;&#227;o da art&#233;ria femoral foi feita com a t&#233;cnica Seldinger com um cateter Radiopaque 22&#8208;G de 4&#44;45<span class="elsevierStyleHsp" style=""></span>cm em uma cateteriza&#231;&#227;o venosa central pedi&#225;trica multil&#250;men feita com um cateter Blue FlexTip&#174; &#40;Teleflex Medical&#44; Plymouth&#44; MN&#44; EUA&#41;&#46; Os cateteres arteriais foram conectados a dois transdutores de press&#227;o &#40;kit de monitoramento Transpac&#174; IV&#59; UTI M&#233;dica&#44; San Clemente&#44; CA&#44; EUA&#41;&#46; O transdutor de press&#227;o foi colocado no n&#237;vel do &#225;trio direito&#46; A press&#227;o arterial sist&#243;lica &#40;PAS&#41;&#44; a press&#227;o arterial diast&#243;lica &#40;PAD&#41; e a PAM de cada art&#233;ria foram medidas cont&#237;nua e simultaneamente&#46; Todos os n&#250;meros foram registrados em um gr&#225;fico digital por anestesiologistas a cada cinco minutos no centro cir&#250;rgico &#40;CC&#41; e por enfermeiros da unidade de terapia intensiva &#40;UTI&#41; a cada uma hora na UTI&#46; Os d&#237;gitos isolados detalhados foram oferecidos&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Coletamos os valores da PA de ambas as art&#233;rias v&#225;rias vezes&#58; no pr&#233;&#8208;operat&#243;rio &#40;ap&#243;s inser&#231;&#227;o do cateter subsequente &#224; indu&#231;&#227;o de anestesia e antes da incis&#227;o na pele&#41;&#44; no transoperat&#243;rio &#40;ap&#243;s o in&#237;cio do CPB&#44; ap&#243;s o ACC&#44; ap&#243;s a libera&#231;&#227;o do ACC e ap&#243;s o desmame do CPB&#41; e durante o p&#243;s&#8208;operat&#243;rio &#40;a cada seis horas durante o primeiro dia na UTI&#41;&#46; Ent&#227;o&#44; comparamos os dados da PAM entre as duas art&#233;rias&#46; Os pacientes foram divididos em subgrupos de acordo com a idade &#40;neonatos e beb&#234;s rec&#233;m&#8208;nascidos com menos de tr&#234;s meses e beb&#234;s entre tr&#234;s e 12 meses&#41;&#44; de acordo com a dura&#231;&#227;o do CPB &#40;&#60; 60 minutos&#44; 60 &#8764; 120 minutos&#44; &#62; 120 minutos&#41; e de acordo com o escore inotr&#243;pico vasoativo &#40;VIS&#41; calculado a partir da m&#233;dia dos valores de VIS nas primeiras 24 horas na UTI &#40;&#60; 20&#44; 20&#8764;40&#44; &#62; 40&#41;&#46; Ent&#227;o&#44; analisamos as diferen&#231;as entre as PAMs das art&#233;rias radial e femoral em cada subgrupo&#46; O VIS foi calculado como segue&#58; dose de dopamina &#40;mcg&#47;kg&#47;min&#41; &#43; dobutamina &#40;mcg&#47;kg&#47;min&#41; &#43; 100 &#215; dose de epinefrina &#40;mcg&#47;kg&#47;min&#41; &#43; 10 &#215; dose de milrinona &#40;mcg&#47;kg&#47;min&#41; &#43; 10&#46;000 &#215; dose de vasopressina &#40;U&#47;kg&#47;min&#41; &#43; 100 &#215; dose de noradrenalina &#40;mcg&#47;kg&#47;min&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">O teste <span class="elsevierStyleItalic">t</span> independente foi usado para comparar vari&#225;veis cont&#237;nuas entre grupos&#46; A an&#225;lise de vari&#226;ncia &#40;Anova&#41; de medi&#231;&#245;es repetidas foi usada para comparar os valores seriais entre a press&#227;o arterial radial e femoral durante a opera&#231;&#227;o e a interna&#231;&#227;o na UTI&#46; Raz&#245;es de chance com intervalos de confian&#231;a de 95&#37; foram calculadas por an&#225;lise de regress&#227;o log&#237;stica de acordo com o risco de baixa press&#227;o arterial na art&#233;ria radial durante o per&#237;odo de desmame do CPB&#46; Em todas as an&#225;lises&#44; foi usado p &#60; 0&#44;05 para indicar a relev&#226;ncia estat&#237;stica&#46; Todas as an&#225;lises de dados foram feitas com o pacote de <span class="elsevierStyleItalic">software</span> estat&#237;stico SPSS &#40;IBM Estat&#237;stica para Windows&#44; Vers&#227;o 21&#46;0&#44; NY&#44; EUA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dados demogr&#225;ficos dos pacientes durante o pr&#233;&#8208;operat&#243;rio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Atenderam aos nossos crit&#233;rios de inclus&#227;o 121 pacientes submetidos a cirurgia de cora&#231;&#227;o aberto&#46; A popula&#231;&#227;o estudada consistiu em 50 pacientes &#40;41&#44;3&#37;&#41; com menos de tr&#234;s meses e 71 pacientes &#40;58&#44;7&#37;&#41; entre tr&#234;s e 12 meses&#46; O peso corporal m&#233;dio foi de 6&#44;94 &#177; 9&#44;97<span class="elsevierStyleHsp" style=""></span>kg&#46; A dura&#231;&#227;o m&#233;dia do CPB foi de 111&#44;82 &#177; 68&#44;37 minutos&#44; a dura&#231;&#227;o m&#233;dia do ACC foi de 65&#44;30 &#177; 32&#44;57 minutos e o VIS m&#233;dio foi de 28&#44;54 &#177; 24&#44;45 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; N&#227;o houve diferen&#231;a significativa na PA entre as art&#233;rias femoral e radial antes do in&#237;cio do CPB &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Monitoramento da press&#227;o intraoperat&#243;ria entre as art&#233;rias radial e femoral ao longo do tempo</span><p id="par0045" class="elsevierStylePara elsevierViewall">Do in&#237;cio ao t&#233;rmino do CPB&#44; as PAMs da art&#233;ria radial foram significativamente menores do que as PAMs da art&#233;ria femoral em cada ponto de medi&#231;&#227;o &#40;p &#60; 0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Tamb&#233;m analisamos as caracter&#237;sticas dos pacientes que apresentaram uma PAM da art&#233;ria radial inferior a 10<span class="elsevierStyleHsp" style=""></span>mmHg em compara&#231;&#227;o com a PAM da art&#233;ria femoral durante o per&#237;odo de desmame do CPB&#59; isso se aplicou a 37 pacientes &#40;30&#44;1&#37;&#41;&#46; A an&#225;lise multivariada revelou que a dura&#231;&#227;o mais longa do CPB &#40;&#62; 60 minutos&#41; representou um fator de risco de press&#227;o radial mais baixa &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Monitoramento da press&#227;o p&#243;s&#8208;operat&#243;ria entre as art&#233;rias radial e femoral ao longo do tempo</span><p id="par0050" class="elsevierStylePara elsevierViewall">Durante o p&#243;s&#8208;operat&#243;rio&#44; n&#227;o houve diferen&#231;a significativa na PAM entre as duas art&#233;rias &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Mesmo quando os pacientes foram divididos em subgrupos de acordo com a idade&#44; dura&#231;&#227;o do CPB e VIS&#44; a an&#225;lise n&#227;o mostrou diferen&#231;a significativa entre a PAM das art&#233;rias radial e femoral de cada subgrupo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Seguran&#231;a da cateteriza&#231;&#227;o da art&#233;ria radial e da art&#233;ria femoral e complica&#231;&#245;es relacionadas</span><p id="par0055" class="elsevierStylePara elsevierViewall">A forma&#231;&#227;o de pequenos hematomas &#40;&#60; 2<span class="elsevierStyleHsp" style=""></span>cm&#41; ocorreu em tr&#234;s pacientes e houve infec&#231;&#227;o local em um paciente&#46; N&#227;o houve caso de isquemia de membros relacionada a perfus&#227;o em qualquer das art&#233;rias&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discuss&#227;o</span><p id="par0060" class="elsevierStylePara elsevierViewall">Muitos pesquisadores t&#234;m relatado a seguran&#231;a da cateteriza&#231;&#227;o da art&#233;ria femoral durante cirurgia card&#237;aca em adultos&#59;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5</span></a> contudo&#44; h&#225; poucos estudos sobre as caracter&#237;sticas do monitoramento da press&#227;o arterial femoral em neonatos e beb&#234;s&#46; No presente estudo&#44; examinamos as diferen&#231;as entre a press&#227;o arterial femoral e radial em neonatos e beb&#234;s e revelamos que a press&#227;o arterial radial foi normalmente subestimada em compara&#231;&#227;o com a press&#227;o arterial femoral durante o per&#237;odo do CPB&#8208;on nessa popula&#231;&#227;o&#46; Contudo&#44; esse fen&#244;meno n&#227;o permaneceu no per&#237;odo da UTI&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Em geral&#44; como a onda de press&#227;o arterial se move em dire&#231;&#227;o &#224; art&#233;ria perif&#233;rica&#44; a press&#227;o sist&#243;lica aumenta gradualmente e a por&#231;&#227;o sist&#243;lica da onda se estreita&#46; A press&#227;o diast&#243;lica normalmente diminui e a press&#227;o m&#233;dia permanece inalterada ou diminui minimamente&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> Contudo&#44; esse fen&#244;meno &#233; influenciado pelo quadro cl&#237;nico do paciente&#44; inclusive a presen&#231;a de doen&#231;a vascular perif&#233;rica&#44; o uso de agentes vasoativos e a temperatura corporal&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7&#8211;9</span></a>A cirurgia card&#237;aca com CPB &#233; o fator que mais afeta as diferen&#231;as na press&#227;o intra&#8208;arterial entre as art&#233;rias central e perif&#233;rica e diversos estudos relataram esses achados durante e ap&#243;s a cirurgia card&#237;aca em adultos&#59; isso fez com que o CPB se tornasse uma caracter&#237;stica patofisiol&#243;gica estabelecida na cirurgia card&#237;aca em adultos&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#44;2</span></a> A disfun&#231;&#227;o vasomotora ap&#243;s cirurgia card&#237;aca com CPB resulta em resist&#234;ncia vascular perif&#233;rica reduzida&#44; que se manifesta clinicamente como uma subestima&#231;&#227;o da PA nas art&#233;rias perif&#233;ricas&#46; Esse fen&#244;meno ocorre ap&#243;s permeabilidade vascular anormal e edema do tecido&#44; o que pode contribuir para a disfun&#231;&#227;o do cora&#231;&#227;o&#44; pulm&#227;o&#44; c&#233;rebro&#44; dos rins e de outros &#243;rg&#227;os&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">10&#44;11</span></a> Assim&#44; embora a press&#227;o arterial perif&#233;rica&#44; bem como a press&#227;o arterial radial&#44; seja mais comumente monitorada durante a cirurgia card&#237;aca&#44; ela tende a ser subavaliada e sua confiabilidade tem sido questionada&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">A press&#227;o arterial radial reduzida pode ser causada por vasoespasmo como resultado de alguns mecanismos termorregulat&#243;rios&#59; da mesma forma&#44; gradientes press&#243;ricos das art&#233;rias femoral e radial t&#234;m sido observados em pacientes com parada circulat&#243;ria hipot&#233;rmica ou em pacientes cir&#250;rgicos gravemente doentes tratados com doses elevadas de agentes vasoativos&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">9&#44;12&#44;13</span></a> Chauhan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> relataram que o monitoramento da press&#227;o arterial femoral &#40;FAP&#41; era mais confi&#225;vel durante a parte inicial do CPB em 60 pacientes de todas as idades &#40;faixa&#58; 3&#8208;65 anos&#41; submetidos a cirurgia card&#237;aca&#46; Esses autores constataram que a press&#227;o arterial femoral era maior do que a press&#227;o arterial radial durante o CPB&#44; principalmente durante o in&#237;cio do CPB&#59; contudo&#44; as diferen&#231;as entre a press&#227;o arterial radial e femoral foram menores ap&#243;s 60 minutos do CPB&#46; Sua popula&#231;&#227;o estudada consistiu em 60 pacientes e incluiu uma faixa et&#225;ria abrangente&#59; isso representou uma grande diferen&#231;a em compara&#231;&#227;o com este estudo&#46; Aqui&#44; tivemos como foco pacientes com menos de um ano e descobrimos que a press&#227;o arterial femoral era maior no in&#237;cio do CPB e imediatamente ap&#243;s a libera&#231;&#227;o do ACC em todos os neonatos e beb&#234;s&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No presente estudo&#44; n&#227;o confirmamos o local da ponta distal do cateter femoral&#59; contudo&#44; o comprimento do cateter da art&#233;ria femoral era de 4&#44;45<span class="elsevierStyleHsp" style=""></span>cm&#44; o que significa que podemos supor que&#44; em pacientes mais novos&#44; a ponta distal estaria localizada na aorta descendente e&#44; em pacientes mais velhos&#44; ela poderia estar localizada na aorta descendente ou na bifurca&#231;&#227;o de art&#233;rias il&#237;acas&#46; Embora a press&#227;o arterial femoral represente a press&#227;o a&#243;rtica central de forma mais precisa&#44; existem relatos de complica&#231;&#245;es causadas por cateteriza&#231;&#227;o da art&#233;ria femoral&#46; Diversos estudos t&#234;m indicado uma taxa de complica&#231;&#227;o de 2&#44;4&#8208;25&#44;0&#37; associada &#224; cateteriza&#231;&#227;o da art&#233;ria femoral em neonatos e beb&#234;s&#46; Dumond et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> relataram que a incid&#234;ncia de perda do pulso pedal&#44; na parte distal do cateter&#44; em neonatos e beb&#234;s&#44; estava relacionada ao tamanho do cateter e &#224; dura&#231;&#227;o do uso&#46; A dura&#231;&#227;o mais longa ou o tamanho maior estavam diretamente relacionados a complica&#231;&#245;es relacionadas a perfus&#227;o decorrentes da cateteriza&#231;&#227;o da art&#233;ria femoral&#46; No presente estudo&#44; foram observadas apenas complica&#231;&#245;es tempor&#225;rias e insignificantes&#44; como pequenos hematomas e eritemas locais&#59; n&#227;o observamos complica&#231;&#227;o importante&#44; como isquemia de membros associada a canula&#231;&#227;o da art&#233;ria femoral&#46; Entretanto&#44; estudos prospectivos com ultrassonografia serial agora s&#227;o necess&#225;rios para determinar completamente a seguran&#231;a da canula&#231;&#227;o da art&#233;ria femoral&#46; Al&#233;m disso&#44; manobras ass&#233;pticas devem ser feitas por um m&#233;dico experiente e &#233; essencial monitorar com cuidado o local de inser&#231;&#227;o e a cor do membro distal no local de cateteriza&#231;&#227;o&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Este estudo foi limitado por seu car&#225;ter retrospectivo e pelo fato de que foi um &#250;nico estudo institucional com uma pequena amostra de pacientes com diversas cardiopatias cong&#234;nitas&#46; Na UTI&#44; usamos medi&#231;&#245;es da PA por hora&#44; o que nem sempre representa o padr&#227;o de PA durante a hora inteira&#46; Adicionalmente&#44; quando avaliamos as complica&#231;&#245;es&#44; n&#227;o usamos m&#233;todo de diagn&#243;stico objetivo como ultrassom&#46; Segundo nossa experi&#234;ncia&#44; o n&#250;mero de tentativas nas art&#233;rias radial e femoral aumenta em crian&#231;as mais doentes e mais novas&#46; Assim&#44; poder&#237;amos teorizar que o aumento no n&#250;mero de tentativas radiais em crian&#231;as mais doentes &#40;<span class="elsevierStyleItalic">bypass</span> mais demorado&#41; e mais novas poderia traumatizar a art&#233;ria e ent&#227;o contribuir para o menor n&#250;mero de leituras obtidas&#46; S&#227;o necess&#225;rios estudos adicionais para investigar o n&#250;mero de tentativas de canula&#231;&#227;o e as diferen&#231;as de press&#227;o relacionadas&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Em nossa popula&#231;&#227;o estudada espec&#237;fica&#44; a press&#227;o arterial radial foi normalmente subestimada em compara&#231;&#227;o com a press&#227;o arterial femoral ap&#243;s o in&#237;cio do CPB e que as diferen&#231;as entre a press&#227;o arterial radial e femoral foram mais marcadas em pacientes com CPB mais longo&#46; Tamb&#233;m identificamos que essas diferen&#231;as de press&#227;o n&#227;o foram evidentes durante o per&#237;odo da UTI&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Financiamento</span><p id="par0090" class="elsevierStylePara elsevierViewall">Bolsa &#40;CRI 11083&#8208;33&#41; do Instituto de Pesquisa Biom&#233;dica do Hospital Universit&#225;rio Nacional de Chonnam e bolsa &#40;NRF&#8208;2016R1D1A1A02937493&#44; NRF&#8208;2015R1C1A1A02037778 e NRF&#8208;2016R1D1A3B03935986&#41; do Minist&#233;rio da Educa&#231;&#227;o e da Funda&#231;&#227;o de Pesquisa Nacional da Coreia do Sul&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflitos de interesse</span><p id="par0095" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflito de interesses&#46;</p></span></span>"
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            2 => "Congenital heart disease"
            3 => "Invasive blood pressure monitoring"
            4 => "Femoral artery"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec1285615"
          "palabras" => array:5 [
            0 => "Beb&#234;"
            1 => "Neonato"
            2 => "Cardiopatia cong&#234;nita"
            3 => "Monitoramento da press&#227;o arterial invasiva"
            4 => "Art&#233;ria femoral"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Several reports claim that blood pressure &#40;BP&#41; in the radial artery may underestimate the accurate BP in critically ill patients&#46; Here&#44; the authors evaluated differences in mean blood pressure &#40;MBP&#41; between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The medical records of children under 1 year of age who underwent open&#8208;heart surgery between 2007 and 2013 were retrospectively reviewed&#46; Radial and femoral BP were measured simultaneously&#44; and the differences between these values were analyzed at various times&#58; after catheter insertion&#44; after the initiation of cardiopulmonary bypass &#40;CPB&#8208;on&#41;&#44; after aortic cross clamping &#40;ACC&#41;&#44; after the release of ACC&#44; after weaning from CPB&#44; at arrival in the intensive care unit &#40;ICU&#41;&#44; and every 6<span class="elsevierStyleHsp" style=""></span>h during the first day in the ICU&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 121 patients who underwent open&#8208;heart surgery met the inclusion criteria&#46; During the intraoperative period&#44; from the beginning to the end of CPB&#44; radial MBPs were significantly lower than femoral MBPs at each time&#8208;point measured &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Multivariate analysis showed that longer CPB time &#40;&#62;60<span class="elsevierStyleHsp" style=""></span>min&#44; odds ratio&#58; 7&#46;47&#41; was a risk factor for lower radial pressure&#46; However&#44; discrepancies between these two values disappeared after arrival in the ICU&#46; There was no incidence of ischemic complications associated with the catheterization of both arteries&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The authors suggest that femoral arterial pressure monitoring can be safely performed&#44; even in neonates&#44; and provides more accurate BP values during CPB&#8208;on periods&#44; and immediately after weaning from CPB&#44; especially when CPB time was greater than 60<span class="elsevierStyleHsp" style=""></span>min&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Diversos relatos alegam que a press&#227;o arterial &#40;PA&#41; na art&#233;ria radial poder&#225; subestimar a PA precisa em pacientes gravemente doentes&#46; Aqui&#44; avaliamos diferen&#231;as na press&#227;o arterial m&#233;dia &#40;PAM&#41; entre a art&#233;ria radial e femoral durante cirurgia card&#237;aca pedi&#225;trica para determinar a efic&#225;cia do monitoramento da PA da art&#233;ria femoral&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos uma an&#225;lise retrospectiva de prontu&#225;rios m&#233;dicos de crian&#231;as com menos de 1 ano de idade submetidas a cirurgia de cora&#231;&#227;o aberto entre 2007 e 2013&#46; As PAs radial e femoral foram auferidas simultaneamente&#44; as diferen&#231;as entre esses valores foram analisadas diversas vezes&#58; ap&#243;s a inser&#231;&#227;o do cateter&#44; ap&#243;s o in&#237;cio do bypass cardiopulmonar &#40;CPB-on&#41;&#44; ap&#243;s pin&#231;amento cruzado da aorta &#40;ACC&#41;&#44; ap&#243;s a libera&#231;&#227;o do ACC&#44; ap&#243;s desmame do CPB&#44; na entrada na unidade de terapia intensiva &#40;UTI&#41; e a cada 6 horas durante o primeiro dia na unidade de terapia intensiva &#40;UTI&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um total de 121 pacientes submetidos a cirurgia de cora&#231;&#227;o aberto atenderam aos nossos crit&#233;rios de inclus&#227;o&#46; Durante o transoperat&#243;rio&#44; do in&#237;cio ao t&#233;rmino do CPB&#44; as PAMs da art&#233;ria radial foram significativamente menores do que as PAMs da art&#233;ria femoral em cada ponto de medi&#231;&#227;o &#40;p &#60; 0&#44;05&#41;&#46; A an&#225;lise multivariada mostrou que a dura&#231;&#227;o mais longa do CPB &#40;&#62; 60 minutos&#44; Raz&#227;o de Chance &#61; 7&#44;47&#41; representou um fator de risco de press&#227;o radial mais baixa&#46; Contudo&#44; as diferen&#231;as entre esses dois valores desapareceram ap&#243;s a entrada na UTI&#46; N&#227;o houve incid&#234;ncia de complica&#231;&#245;es isqu&#234;micas associadas &#224; cateteriza&#231;&#227;o de ambas as art&#233;rias&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Sugerimos que o monitoramento da press&#227;o arterial femoral pode ser realizado com seguran&#231;a&#44; mesmo em neonatos&#44; e fornece valores da PA mais precisos durante per&#237;odos de CPBon e imediatamente ap&#243;s o desmame do CPB&#44; principalmente nos casos em que a dura&#231;&#227;o do CPB foi superior a 60 minutos&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Como citar este artigo&#58; Cho HJ&#44; Lee SH&#44; Jeong IS&#44; Yoon NS&#44; Ma JS&#44; Ahn BH&#46; Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass&#46; J Pediatr &#40;Rio J&#41;&#46; 2018&#59;94&#58;76&#8211;81&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2643
            "Ancho" => 2328
            "Tamanyo" => 221783
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Altera&#231;&#227;o da press&#227;o arterial m&#233;dia na art&#233;ria radial e femoral de acordo com o tempo&#46; A&#44; Compara&#231;&#227;o da press&#227;o arterial m&#233;dia durante o intraoperat&#243;rio &#40;a&#44; b&#44; c&#44; d&#58; p &#60; 0&#44;05&#41; B&#44; Compara&#231;&#227;o da press&#227;o arterial m&#233;dia nas primeiras 24 horas do p&#243;s&#8208;operat&#243;rio&#46; ACC&#44; pin&#231;amento cruzado da aorta&#59; CPB&#44; <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#59; UTI&#44; unidade de terapia intensiva&#59; PAM&#44; press&#227;o arterial m&#233;dia&#59; PreOp&#44; pr&#233;&#8208;operat&#243;rio&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ACC&#44; pin&#231;amento cruzado da aorta&#59; CPB&#44; <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#59; DSV&#44; defeito do septo ventricular&#59; TAPVR&#44; retorno pulmonar venoso an&#244;malo total&#59; TGA&#44; transposi&#231;&#227;o de grandes art&#233;rias&#59; TOF&#44; tetralogia de Fallot&#59; VIS&#44; escore inotr&#243;pico vasoativo&#46;</p>"
          "tablatextoimagen" => array:1 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vari&#225;vel<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;25 &#177; 2&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Peso corporal &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#193;rea de superf&#237;cie do corpo &#40;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Doen&#231;a de base</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DSV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78 &#40;64&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TOF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TAPVR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TGA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;5&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;11&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">111&#44;82 &#177; 68&#44;37&nbsp;\t\t\t\t\t\t\n
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                  \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 &#40;21&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;44&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 120 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;33&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Dura&#231;&#227;o do ACC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;30 &#177; 32&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>&#60; 60 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;29&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>60&#8208;120 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;62&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>&#62; 120 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">VIS</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;54 &#177; 24&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>&#60; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;57&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>20&#8208;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;24&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>&#62; 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;19&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2408840.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Os dados s&#227;o apresentados como o n&#250;mero de casos &#40;&#37;&#41; para vari&#225;veis categ&#243;ricas ou como m&#233;dia &#177; desvios&#8208;padr&#227;o para vari&#225;veis cont&#237;nuas&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">O VIS &#233; apresentado como valores m&#233;dios nas primeiras 24 horas na UTI&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas do paciente durante o perioperat&#243;rio &#40;n &#61; 121&#41;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ACC&#44; pin&#231;amento cruzado da aorta&#59; CPB&#44; <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#59; FAP&#44; press&#227;o arterial femoral&#59; GP&#44; gradiente press&#243;rico&#59; IC&#44; intervalo de confian&#231;a&#59; m&#44; m&#233;dia&#59; RAP&#44; press&#227;o arterial radial&#59; VIS&#44; escore inotr&#243;pico vasoativo&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GP &#40;mFAP &#8211; mRAP&#41; &#62; 10 mmHg</th></tr><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">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
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                  \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">raz&#227;o de chance&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC de 95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor de <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \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">Dura&#231;&#227;o do ACC &#62; 60 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;17&#8208;0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">Dura&#231;&#227;o do CPB &#62; 60 minutos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;89&#8208;19&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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
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                  \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&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;25&#8208;1&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><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">VIS &#62; 20 durante Desmame do CBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97&#8208;1&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lises multivari&#225;veis de baixa press&#227;o arterial na art&#233;ria radial durante o per&#237;odo de desmame do CPB</p>"
        ]
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      3 => array:8 [
        "identificador" => "tbl0015"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CPB&#44; <span class="elsevierStyleItalic">bypass</span> cardiopulmonar&#59; FAP&#44; press&#227;o arterial femoral&#59; m&#44; m&#233;dia&#59; RAP&#44; press&#227;o arterial radial&#59; s&#44; sist&#243;lica&#59; VIS&#44; escore inotr&#243;pico vasoativo&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
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                  \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">Vari&#225;vel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Subtipo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1 hora&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">6 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">12 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">18 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">24 horas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor de <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idade</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 3 meses</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">mRAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;47&#177;14&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;28&#177;19&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;18&#177;11&#44;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">62&#44;17&#177;19&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;22&#177;16&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">72&#44;14&#177;17&#44;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#44;22&#177;16&#44;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="6" align="left" valign="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">72&#44;83&#177;10&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&#44;85&#177;10&#44;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;96&#177;9&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">60&#8208;120 minutos</td><td class="td" title="\n
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                  \t\t\t\t">67&#44;04&#177;8&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#44;66&#177;8&#44;21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69&#44;86&#177;17&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">69&#44;37&#177;16&#44;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">&#62; 120 minutos</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">mRAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;67&#177;12&#44;98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;44&#177;11&#44;53&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;15&#177;15&#44;58&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;98&#177;13&#44;68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">mFAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">63&#44;82&#177;13&#44;93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;00&#177;12&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;34&#177;22&#44;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;76&#177;18&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " rowspan="6" align="left" valign="\n
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                  \t\t\t\t">VIS</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">&#60; 20</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">mRAP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">76&#44;32&#177;11&#44;84&nbsp;\t\t\t\t\t\t\n
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