Medicina intensiva
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Recently, the work group made up of the National Transplant Organization (Organización Nacional de Trasplantes, ONT), Spanish Society of Intensive, Critical Medicine and Coronary Units (Sociedad Española de Medicina Intensiva, Crítica y de Unidades Coronarias, SEMICYUC) and other Scientific Societies have recommended using 15 mg/kg of methyl prednisolone during the management of lung donors after brain death. This recommendation is based on descriptive and retrospective studies. However, the review of different experimental and clinical studies also suggests a potential benefit of using steroids in either thoracic or abdominal organ donors during management strategies. ⋯ It would be very recommendable to carry out prospective and comparative studies to demonstrate these potential utilities. Meanwhile and knowing the deleterious effects of inflammatory activity arising during and after brain death, we recommend using 15 mg/kg of methyl prednisolone in the organ donor management, as soon as possible. The potential benefit of its immunomodulation effects, its low cost and the absence of major side effects can justify this recommendation.
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Static pressure-volume curves of the respiratory system from patients with acute lung injury have been extensively studied as a marker of aeration and recruitment phenomena and as a tool to set mechanical ventilation. The inflection points of these curves allow to identify both the pressures in which recruitment starts and finishes and those in which derecruitment starts. However, setting the ventilatory parameters based on these curves has some problems, derived from the fact that setting PEEP and plateau pressures in these patients must balance between the benefits of recruitment and the risks of overstretching caused by high pressures. It remains to be determined if new data derived from these curves are useful to optimize ventilatory settings or to predict the response of a patient to a change in the ventilatory settings.