Recrutamento alveolar pós teste de apnéia

Vista frontal Hôpital Pitié Salpêtrière, entrada pelo Bd de l´Hôpital, Paris, França

Muito interessante a abordagem do grupo do Hôpital Pitié-Salpêtrière sobre recrutamento alveolar em paciente provável doador de pulmão.

Após teste de apnéia, há considerável queda da relação PaO2/FiO2 e essa pode ser melhorada com o recrutamento. Isso serve para todos os doadores. A garantia de boa relação ventilação perfusão vai nos ajudar em todos os órgãos!

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Benefit of a single recruitment maneuver after an apnea test for the diagnosis of brain death


Paries M, Boccheciampe N, Raux M, Riou B, Langeron O, Nicolas-Robin A



Introduction: Many potential lung transplants are lost because of hypoxemia during donor
management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain
death in potential lung donors, was involved in the decrease in the ratio of partial pressure of
arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver
performed just after the apnea test can reverse this alteration.

Methods: In this case-control study, we examined the effectiveness of the recruitment
maneuver with a comparison cohort of brain dead patients who did not receive the maneuver.
Patients were matched one-to-one on the basis of initial PaO2/FiO2 and on the duration of
mechanical ventilation before the apnea test. PaO2/FiO2 was measured before (T1), at the end
(T2) and two hours after apnea test (T3).

Results: Twenty-seven patients were included in each group. The apnea test was associated
with a significant decrease in PaO2/FiO2 from 284 ± 98 to 224 ± 104 mmHg (P<0.001). The
decrease in PaO2/FiO2 between T1 and T3 was significantly lower in the recruitment
maneuver group than in the control group (-4 (-68 – 57) vs -61 (-110 – -18) mmHg, P=0.02).
The number of potential donors with PaO2/FiO2 > 300 mmHg decreased by 58% (95% CI:
28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group
(P<0.001).

Conclusions: The apnea test induced a decrease in PaO2/FiO2 in potential lung donors. A
single recruitment maneuver performed immediately after the apnea test can reverse this
alteration and may prevent the loss of potential lung donors.

Ondansetrona: Não use mais que 16 mg!

FDA: Single Dose of IV Ondansetron Should Not Exceed 16 mg Due to Risk of QT Prolongation Tags: Arrhythmias ondansetron Pain Management ROCKVILLE, Md -- June 29, 2012 --

The US Food and Drug Administration (FDA) is informing healthcare professionals and the public that preliminary results from a recently completed clinical study suggest that a 32-mg single intravenous dose of ondansetron (Zofran) may cause QT interval prolongation, which could pre-dispose patients to develop Torsades de Pointes.

GlaxoSmithKline (GSK) has announced changes to the Zofran drug label to remove the 32-mg single intravenous dose. The updated label will state that ondansetron can continue to be used in adults and children with chemotherapy-induced nausea and vomiting at the lower intravenous dose recommended in the drug label, a dose of 0.15 mg/kg administered every 4 hours for 3 doses; however, no single intravenous dose should exceed 16 mg. Information from the new clinical study will be included in the updated drug label.

The FDA will evaluate the final study results when available, and will work with GSK to explore an alternative single dose regimen that is both safe and effective for the prevention of chemotherapy-induced nausea and vomiting in adults. The new information on QT prolongation does not change any of the recommended oral dosing regimens for ondansetron. It also does not change the recommended lower dose intravenous dosing of ondansetron to prevent post-operative nausea and vomiting. As part of the ongoing safety review of ondansetron, the FDA continues to assess data about the risk of QT prolongation and will update the public when more information becomes available. Additional Information for Healthcare Professionals (updated from 9/15/2011)· ECG changes including QT interval prolongation have been observed in patients receiving ondansetron. In addition, Torsade de Pointes has been reported in some patients receiving ondansetron.

 - The use of a single 32-mg intravenous dose of ondansetron should be avoided. New information indicates that QT prolongation occurs in a dose-dependent manner, and specifically at a single intravenous dose of 32 mg.

 - Patients who may be at particular risk for QT prolongation with ondansentron are those with congenital long QT syndrome, congestive heart failure, bradyarrhythmias, or patients taking concomitant medications that prolong the QT interval - Electrolyte abnormalities should be corrected prior to the infusion of ondansetron.

- The lower dose intravenous regimen of 0.15 mg/kg every 4 hours for 3 doses may be used in adults with chemotherapy-induced nausea and vomiting. However, no single intravenous dose of ondansetron should exceed 16 mg due to the risk of QT prolongation.

- The new information does not change any of the recommended oral dosing regimens for ondansetron, including the single oral dose of 24 mg for chemotherapy induced nausea and vomiting.

- The new information also does not change the recommended lower dose intravenous dosing to prevent post-operative nausea and vomiting.

SOURCE: US Food and Drug Administration