Reflections upon donation after controlled cardiac death (Maastricht type iii donors)

Rubio, Juan José Álvarez; Palacios, D.

doi:10.1016/j.medine.2016.04.007

Cited by 5 publications

(1 citation statement)

References 10 publications

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“…First, the decision of WLSTs on the grounds of futility is taken by the intensive care team responsible for the patient, according to the preestablished protocol at the Puerta de Hierro-Majadahonda University Hospital. 24,25 Once communicated to and accepted by the family, the Transplant Coordination team is contacted to raise the possibility of organ donation. After signing the corresponding informed consents, especially those regarding premortem interventions, several tests are run before donation.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Ramírez

Vázquez

Rodriguez

et al. 2021

Transplantation Direct

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Section: Surgical Techniquesmentioning

confidence: 99%

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Ramírez

Vázquez

Rodriguez

et al. 2021

Transplantation Direct

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Structural differences in the diaphragm of patients following controlled vs assisted and spontaneous mechanical ventilation

et al. 2019

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WORD COUNT: 286 1 AbstractPurpose: Ventilator-induced diaphragm dysfunction or damage (VIDD) is highly prevalent in patients under mechanical ventilation (MV), but its analysis is limited by the difficulty of obtaining histological samples. In this study we compared diaphragm histological characteristics in Maastricht III (MSIII) and brain-dead (BD) organ donors and in control subjects undergoing thoracic surgery (CTL) after a period of either controlled or spontaneous MV (CMV or SMV).Methods: In this prospective study, biopsies were obtained from diaphragm and quadriceps.Demographic variables, comorbidities, severity on admission, treatment and ventilatory variables were evaluated. Immunohistochemical analysis (fiber size and type percentages) and quantification of abnormal fibers (a surrogate of muscle damage) were performed.Results: Muscle samples were obtained from 35 patients. MSIII (n=16) had more hours on MV (either CMV or SMV) than BD (n=14) and also spent more hours, and a greater percentage of time with diaphragm stimuli (time in assisted and spontaneous modalities). Cross sectional area (CSA) was significantly reduced in the diaphragm and quadriceps in both groups in comparison with CTL (n=5).Quadriceps CSA was significantly decreased in MSIII compared to BD but there were no differences in the diaphragm CSA between the two groups. Those MSIII who spent 100 or more hours without diaphragm stimuli presented reduced diaphragm CSA without changes in their quadriceps CSA.Proportion of internal nuclei in diaphragms of MSIII tended to be higher than BD, and their proportion of lipofuscin deposits tended to be lower, though there were no differences in the quadriceps fiber evaluation. Conclusions:This study provides the first evidence in humans about the effects of different modalities of MV (controlled, assisted and spontaneous) on diaphragm myofiber damage showing that diaphragm inactivity during mechanical ventilation is associated with the development of VIDD. KeywordsVentilator-induced Diaphragm Dysfunction or damage (VIDD), Atrophy, Mechanical Ventilation, Brain Death, Maastricht III, Muscle dysfunction.Most critically ill patients admitted to the Intensive Care Unit (ICU) require mechanical ventilation (MV) due to respiratory failure. MV may be associated with adverse effects on respiratory muscles, and disuse atrophy may be the most important mechanism in patients under controlled mechanical ventilation (CMV) [1]. During CMV, the electromyographic activity of the respiratory muscle fibers is diminished or may even stop [2], resulting in a rapid development of respiratory muscle dysfunction, especially diaphragm weakness. Ventilator-induced diaphragm dysfunction (VIDD) is defined as the loss of the diaphragm's capacity to generate force, together with muscle injury and fiber atrophy, and the same acronym has been used before to describe ventilator-induced diaphragm damage [3]. Both VIDD are associated particularly with the use of MV, typically after periods of CMV [4,5,6].VIDD may play a key role in th...

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Organ donation after controlled cardiac death under Maastricht category iii: Ethical implications and end of life care

González-Méndez

López-Rodríguez

2019

Enfermería Clínica (English Edition)

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Reflections upon donation after controlled cardiac death (Maastricht type iii donors)

Cited by 5 publications

References 10 publications

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes

Structural differences in the diaphragm of patients following controlled vs assisted and spontaneous mechanical ventilation

Organ donation after controlled cardiac death under Maastricht category iii: Ethical implications and end of life care

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