Table 1 Summary of recommendations
Recommendations | Level of evidence | Grade of recommendation | Practical considerations |
|---|---|---|---|
Ventilatory support | |||
 1. We recommend using a lung-protective ventilation strategy in all PDs | Low | Strong | Vt between 6 and 8 mL/kg of predicted body weight and PEEP of 8–10-cm H2O Adjust FiO2 and PEEP to obtain SaO2 > 90% Perform apnea testing with CPAP |
 2. We suggest not using ARM routinely in PDs | Very low | Weak | ARM can be considered if there is refractory hypoxemia in hemodynamically stable PDs |
Hemodynamic support | |||
 3. We recommend performing initial volemic expansion in hemodynamically unstable PDs with hypovolemia or responsive to fluids according to fluid responsiveness assessment |  | Good clinical practice | Initial volume expansion with 30 mL/kg of crystalloids Assess fluid status and responsiveness for additional fluid replacement Preferably use dynamic parameters Neutral or negative fluid balance after achieving hemodynamic stability |
 4. We recommend administering norepinephrine or dopamine to control blood pressure in PDs who remain hypotensive after volemic expansion | Very low | Strong | Start adrenergic vasopressors to obtain a MAP ≥ 65 mm Hg Dopamine is the vasopressor of choice when there is bradycardia Consider the potential arrhythmogenic effect of dopamine, which implies the risk of PD loss due to cardiac arrest |
 5. We suggest not using low-dose dopamine for renal protection in PDs | Very low | Weak | Consider the potential arrhythmogenic effect of dopamine, which implies the risk of PD loss due to cardiac arrest |
Endocrine and electrolyte management | |||
 6. We recommend combining AVP in PDs receiving norepinephrine or dopamine | Low | Strong | Combine AVP (1 IU bolus + 0.5–2.4 IU/h) with norepinephrine or dopamine |
 7. We recommend administering AVP or DDAVP to control polyuria in PDs with diabetes insipidus | Low | Strong | AVP if vasopressors are required. DDAVP (1–2-µg IV 2–4 h) if vasopressors are not required |
 8. We suggest combining low-dose corticosteroids in PDs receiving norepinephrine or dopamine | Low | Weak | Combine 300 mg IV/day in PDs with norepinephrine or dopamine |
 9. We suggest not using thyroid hormones routinely in PDs | Very low | Weak | There are no hemodynamic benefits They can be considered if prolonged management is required |
 10. We suggest performing glycemic control in PDs | Very low | Weak | Administer insulin to achieve a glucose level of 140–180 mg/dL Monitor blood glucose at least every 6 h |
 11. We suggest maintaining serum sodium levels < 155 mEq/dL in PDs | Very low | Weak | Correct water deficit with hypotonic fluids Correct hypovolemia |
 12. We recommend maintaining serum potassium levels between 3.5 and 5.5 mEq/L in PDs | Very low | Strong |  |
 13. We recommend maintaining serum magnesium levels > 1.6 mEq/L in PDs | Very low | Strong |  |
Other aspects | |||
 14. We suggest maintaining nutritional support in PDs if well tolerated | Very low | Weak |  |
 15. We recommend using antibiotics in PDs with infection or sepsis | Low | Strong | Maintain appropriate antibiotic therapy in the donor for at least 24 h Collect cultures from different sites in all donors |
 16. We suggest maintaining body temperature above 35 °C in hemodynamically unstable PDs | Very low | Weak | Monitor core temperature Prevent and treat hypothermia in PDs receiving vasoactive amines |
 17. We suggest inducing hypothermia (34–35 °C) in PDs without hemodynamic instability | Low | Weak | Monitor core temperature Induce hypothermia by applying ice packs in PDs not receiving vasoactive amines |
 18. We suggest transfusing packed red blood cells in PDs with hemoglobin levels < 7 g/dL | Very low | Weak |  |
 19. We suggest using goal-directed protocols during the management of PDs | Very low | Weak | Monitor care using evidence-based clinical goal-directed checklists |