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Limited results about treatment with total lymphoid irradiation (TLI) in lung transplant (LTx) recipients suffering from progressive bronchiolitis obliterans syndrome (BOS) have been reported. We performed a retrospective analysis of all LTx recipients undergoing TLI for progressive BOS in our center, focusing on long-term outcomes regarding overall survival and lung allograft function. Treatment with TLI (2004-2017, n = 20, 1 BOS stage 1, 6 BOS stage 2, and 13 BOS stage 3) resulted in significant attenuation of the FEV 1 -decline in the majority of patients, mainly in those with a rapid decline (P = 0.0005). This allowed bridging to redo-transplantation in five patients. However, three patients progressed from BOS to RAS following prior TLI. Overall patient survival was 44% at 2 years post-TLI and 38% after 17 years. Generally, TLI was well tolerated, with limited side effects and no serious adverse events. TLI may attenuate the decline in FEV 1 of LTx recipients with rapid progressive BOS and could thus help to bridge selected patients to redo-transplantation.

To our knowledge, this is the first report of multiple solid organ transplantation in documented telomeropathy. These cases highlight current difficulties of timely diagnosis, therapeutic approach, and postoperative complications in telomeropathy patients in whom several organs are affected.

While organ hypoperfusion caused by inadequate resuscitation has become rare in clinical practice due to the better understanding of burn shock pathophysiology, there is growing concern that increased morbidity and mortality related to over-resuscitation induced by late 20 th century resuscitation strategies based on urine output, is occurring more frequently in burn care. In order to reduce complications related to this concept of "fluid creep", such as respiratory failure and compartment syndromes, efforts should be made to resuscitate with the least amount of fluid to provide adequate organ perfusion. In this second part of a concise review, the different targets and endpoints used to guide fluid resuscitation are discussed. Special reference is made to the role of intra-abdominal hypertension in burn care and adjunctive treatments modulating the inflammatory response. Finally, as urine output has been recognized as a poor resuscitation target, a new personalized stepwise resuscitation protocol is suggested which includes targets and endpoints that can be obtained with modern, less invasive hemodynamic monitoring devices like transpulmonary thermodilution.Key words: burns; fluid resuscitation; monitoring; treatment; resuscitation endpoint/target; de-resuscitation; abdominal pressure; abdominal hypertension; abdominal compartment syndrome; personalized care; protocol; algorith Anaesthesiology Intensive Therapy 2015, vol. 47, s15-s26 As discussed in the first part of this review, following a severe burn injury, an overwhelming systemic inflammatory response, with an associated capillary leak syndrome, occurs. Due to fluid shifts that reach a maximum at 12 to 24 hours post injury, the severely burned patient experiences profound intravascular hypovolemia. During this initial "ebb" phase with profound intravascular underfilling, fluid resuscitation is of paramount importance. Moreover, the fluid needs can be enormous due to plasma and proteins leaking into the extravascular compartment. This results in a positive (daily and cumulative) fluid balance associated with well-known complications related to fluid-creep like renal and respiratory failure, gastro-intestinal dysfunction, abdominal hypertension and compartment syndromes [1].As the systemic inflammatory response diminishes, a polyuric or "flow" phase is entered, where a negative fluid balance is seen, reflecting the loss of the initial resuscitation fluids [1].Despite the fact that numerous articles regarding burn resuscitation have been published over recent decades, there is still no universal consensus on the optimal resuscitation fluid and how to achieve adequate resuscitation whilst avoiding the adverse effects of fluid overload. Thus, it is necessary to develop a dynamic fluid strategy, including an active de-resuscitation therapeutic protocol based on newly available physiologic parameters via transpulmonary thermodilution such as extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI), in combination with capillary le...

The Covid-19 pandemic could facilitate an end-of-life conversation The new “severe acute respiratory syndrome” coronavirus (SARS-CoV-2) is testing our health care system in several ways. The need for clear end-of-life conversation is, more than ever, emphasized. The potential overcrowding in health facilities creates an important ethical dilemma about which patient can occupy which hospital bed. Most caregivers understand the importance of good communication and documentation of end-of-life conversations, yet few will conduct those conversations. Often, the emphasis lies on obtaining a “do not resuscitate” code (DNR), rather than exploring the patient’s care goals and values. Early care planning (ECP) focuses on those care goals and values. On the one hand, the COVID-19 pandemic is a good starting point for initiating conversations about end-of-life. On the other hand, there are important practical limitations regarding the adequate execution of those conversations. The current pandemic teaches us that ECP should be a central part of our clinical practice. It is important that healthcare providers take responsibility for identifying and initiating those patients who would benefit from such conversations.