Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC / Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations

Los cuidados intensivos orientados a la donación (CIOD) se definen como el inicio o la continuación de medidas de soporte vital, incluyendo la ventilación mecánica, en pacientes con lesión cerebral catastrófica y alta probabilidad de evolucionar a muerte encefálica, en los que se ha descartado cualquier tipo de tratamiento. Los CIOD incorporan la opción de la donación de órganos permitiendo un enfoque holístico en los cuidados al final de la vida coherente con los deseos y valores del paciente. Si el paciente no evoluciona a muerte encefálica, se deben retirar las medidas de soporte vital valorando la donación en asistolia controlada. Los CIOD respetan el marco ético y legal y contribuyen a aumentar las probabilidades de los pacientes de acceder a la terapia de trasplante, generando salud, incrementando la donación en un 24% con una media de 2,3 órganos trasplantados por donante y contribuyendo a la sostenibilidad del sistema sanitario. Estas recomendaciones ONT-SEMICYUC proporcionan una guía para facilitar una práctica armonizada de los CIOD en las UCI españolas. (AU)

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs. (AU)

[Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations]. / Cuidados intensivos orientados a la donación de órganos. Recomendaciones ONT-SEMICYUC.

Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.

[Ischemic optic neuropathy in the multiple trauma victim]. / Neuropatía óptica isquémica en el paciente politraumatizado.

Ischemic optic neuropathy is an uncommon of blindness in the critically ill patient that occurs especially in multiple trauma victims with no direct injury of the eyeball. We present the case of a young male patient with total bilateral blindness after profound hemorrhagic shock secondary to thoracoabdominal non-penetrating traumatism caused by crushing. A search of the literature was conducted, identifying prolonged arterial hypotension and sudden drop in hematocrit value as the most important risk factors.

Neuropatía óptica isquémica en el paciente politraumatizado / Ischemic optic neuropathy in the multiple trauma victim

neuropatía óptica isquémica es una causapoco conocida de ceguera en el paciente crítico yespecialmente en el politraumatizado sin daño directodel globo ocular. Presentamos el caso de unpaciente joven que desarrolla una ceguera bilateralcompleta tras sufrir un profundo shock hemorrágicosecundario a un traumatismo toracoabdominalcerrado por aplastamiento. Se ha realizado una revisión de la literatura relacionada y se han identificado como factores de riesgo más importantes la hipotensión arterial prolongada y el descenso brusco del hematocrito

Ischemic optic neuropathy is an uncommon ofblindness in the critically ill patient that occurs especially in multiple trauma victims with no directinjury of the eyeball. We present the case of ayoung male patient with total bilateral blindnessafter profound hemorrhagic shock secondary tothoracoabdominal non-penetrating traumatismcaused by crushing. A search of the literature wasconducted, identifying prolonged arterial hypotensionand sudden drop in hematocrit value as the most important risk factors (AU)