1,721,173 research outputs found
Acute Lung Injury in Patients with Severe Brain Injury: A Double Hit Model
No full textThe presence of pulmonary dysfunction after brain injury is well recognized. Acute lung injury (ALI) occurs in 20% of patients with isolated brain injury and is associated with a poor outcome. The "blast injury" theory, which proposes combined "hydrostatic" and "high permeability" mechanisms for the formation of neurogenic pulmonary edema, has been challenged recently by the observation that a systemic inflammatory response may play an integral role in the development of pulmonary dysfunction associated with brain injury. As a result of the primary cerebral injury, a systemic inflammatory reaction occurs, which induces an alteration in blood-brain barrier permeability and infiltration of activated neutrophils into the lung. This preclinical injury makes the lungs more susceptible to the mechanical stress of an injurious ventilatory strategy. Tight CO(2) control is a therapeutic priority in patients with acute brain injury, but the use of high tidal volume ventilation may contribute to the development of ALI. Establishment of a therapeutic regimen that allows the combination of protective ventilation with the prevention of hypercapnia is, therefore, required. Moreover, in patients with brain injury, hypoxemia represents a secondary insult associated with a poor outcome. Optimal oxygenation may be achieved by using an adequate FiO(2) and by application of positive end-expiratory pressure (PEEP). PEEP may, however, affect the cerebral circulation by hemodynamic and CO(2)-mediated mechanisms and the effects of PEEP on cerebral hemodynamics should be monitored in these patients and used to titrate its application
Anesthetic optimization for nonheartbeating donors
No full textPURPOSE OF REVIEW:
One of the newest strategies to enlarge the pool of organ donors is to consider the category of donors after cardiac death rather than only after brain death. Prompt and accurate identification of potential donors and appropriate care is necessary to optimize the management of nonheartbeating donors.
RECENT FINDINGS:
Organ procurement derived from donors after cardiac death is becoming a part of the policy of major transplantation hospitals, forcing them to consider the practical interventions and ethical implications regarding this practice. Typical donors are patients affected by irreversible brain injuries, high spinal cord injury and end-stage musculoskeletal diseases. To start the process the following three conditions must be met. Withdrawal of life-sustaining therapies must be considered independently from transplantation. Withdrawal of life support requires a careful titration of the drugs controlling pain, anxiety and discomfort. Organ harvesting has to be initiated after at least 2-5 min of confirmed cardiac death.
SUMMARY:
In order to increase the number of organs available for transplantation, donation from nonheartbeating donors has been recently proposed. Identification of the key aspects of the donation after cardiac death should be fully achieved by the team involved in the transplantation program. Development of hospital policies and identification of receivers who are most likely to benefit from this strategy require further studies to assess long-term outcome and to identify ethical aspects concerning different religious and cultural backgrounds
Miscibilità di Polietileni Funzionalizzati di Basso Peso Molecolare come Tenacizzanti per Resine Epossidiche
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