Donación Internacional de Órganos

[EXTRACTO] Chile es un país de 17 574 003 personas y durante el año 2020 hubo solo 141 donantes efectivos acorde al Sistema Integrado de Donación y Trasplante. En 2019, la tasa nacional de donantes fue de 10,4 por millón de habitantes, siendo inferior con respecto a países vecinos como Uruguay (22,86), Argentina (19,6) y Brasil (18); y más inferior aún a países como España (49,61) o Estados Unidos (36,88) (1). En los años 2020 y el 2021 los números continuaron deteriorándose y Chile reportó una tasa de donación de órganos de 7,2 y 7,4 por millón de habitantes respectivamente. Respecto a la mortalidad en lista de espera, datos chilenos muestran una mortalidad de 17% en pacientes esperando pulmón y hasta un 32% hígado (1). Esta mortalidad es elevada, y la cifra real podría ser incluso mayor si se consideran pacientes retirados de la lista de espera antes de fallecer (producto de la progresión de su enfermedad y la perdida de ventana de oportunidad para trasplante).

Severe asthma: adding new evidence - Latin American Thoracic Society.

This document constitutes a summary of the clinical practice guidelines (CPGs) prepared at the initiative of the Latin American Thoracic Society (ALAT). Due to new evidence in the treatment of severe asthma, it was agreed to select six clinical questions, and the corresponding recommendations are provided herein. After considering the quality of the evidence, the balance between desirable and undesirable impacts and the feasibility and acceptance of procedures, the following recommendations were established. 1) We do not recommend the use of an inhaled corticosteroid (ICS) plus formoterol as rescue medication in the treatment of severe asthma. 2) We suggest performing many more high-quality randomised studies to evaluate the efficacy and safety of tiotropium in patients with severe asthma. 3) Omalizumab is recommended in patients with severe uncontrolled allergic asthma with serum IgE levels above 30 IU. 4) Anti-interleukin (IL)-5 drugs are recommended in patients with severe uncontrolled eosinophilic asthma (cut-off values above 150 cells·µL-1 for mepolizumab and above 400 cells·µL-1 for reslizumab). 5) Benralizumab is recommended in adult patients with severe uncontrolled eosinophilic asthma (cut-off values above 300 cells·µL-1). 6) Dupilumab is recommended in adult patients with severe uncontrolled allergic and eosinophilic asthma and in adult patients with severe corticosteroid-dependent asthma.

Major shifts in Amazon wildlife populations from recent intensification of floods and drought.

In the western Amazon Basin, recent intensification of river-level cycles has increased flooding during the wet seasons and decreased precipitation during the dry season. Greater than normal floods occurred in 2009 and in all years from 2011 to 2015 during high-water seasons, and a drought occurred during the 2010 low-water season. During these years, we surveyed populations of terrestrial, arboreal, and aquatic wildlife in a seasonally flooded Amazonian forest in the Loreto region of Peru (99,780 km2 ) to study the effects of intensification of natural climatic fluctuations on wildlife populations and in turn effects on resource use by local people. Shifts in fish and terrestrial mammal populations occurred during consecutive years of high floods and the drought of 2010. As floods intensified, terrestrial mammal populations decreased by 95%. Fish, waterfowl, and otter (Pteronura brasiliensis) abundances increased during years of intensive floods, whereas river dolphin and caiman populations had stable abundances. Arboreal species, including, macaws, game birds, primates, felids, and other arboreal mammals had stable populations and were not affected directly by high floods. The drought of 2010 had the opposite effect: fish, waterfowl, and dolphin populations decreased, and populations of terrestrial and arboreal species remained stable. Ungulates and large rodents are important sources of food and income for local people, and large declines in these animals has shifted resource use of people living in the flooded forests away from hunting to a greater reliance on fish.

[Mechanical ventilatory parameters guided by the low flow pressure-volume curve in patients with acute lung injury/acute respiratory distress syndrome]. / Ajuste a la ventilación mecánica guiado por curvas presión-volumen de flujo lento en pacientes con síndrome de distress respiratorio agudo e injuria pulmonar aguda.

BACKGROUND: Mechanical ventilation may contribute to lung injury and then enhance systemic inflammation. Optimal ventilatory parameters such as tidal volume (VT) and positive end expiratory pressure (PEEP) can be determined using different methods. Low flow pressure volume (P/V-LF) curve is a useful tool to assess the respiratory system mechanics and set ventilatory parameters. AIM: To set VT and PEEP according P/V-LF curve analysis and evaluate its effects on gas exchange and hemodynamic parameters. MATERIALS AND METHODS: Twenty seven patients underwent P/V-LF within the first 72 hours of acute lung injury/acute respiratory distress syndrome (ALI/ARDS). P/V-LF curves were obtained from the ventilator and both lower and upper inflexion points determined. Gas exchange and hemodynamic parameters were measured before and after modifying ventilator settings guided by P/V-LF curves. RESULTS: Ventilatory parameters set according P/V-LF curve, led to a rise of PEEP and reduction of VT: 11.6+/-2.8 to 14.1+/-2.1 cm H2O, and 9.7+/-2.4 to 8.8+/-2.2 mL/kg (p<0.01). Arterial to inspired oxygen fraction ratio increased from 158.0+/-66 to 188.5+/-68.5 (p<0.01), and oxygenation index was reduced, 13.7+/-8.2 to 12.3+/-7.2 (p<0.05). Cardiac output and oxygen delivery index (IDO2) were not modified. Demographic data, gas exchange improvement and respiratory system mechanics showed no significant difference between patients with extra-pulmonary and pulmonary ALI/ARDS. There was no evidence of significant adverse events related with this technique. CONCLUSION: P/V-LF curves information allowed us to adjust ventilatory parameters and optimize gas exchange without detrimental effects on oxygen delivery in mechanically ventilated ALI/ARDS patients.