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Hemodynamic management in brain dead donors
Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importa...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529942/ https://www.ncbi.nlm.nih.gov/pubmed/34722170 http://dx.doi.org/10.5500/wjt.v11.i10.410 |
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author | Lazzeri, Chiara Bonizzoli, Manuela Guetti, Cristiana Fulceri, Giorgio Enzo Peris, Adriano |
author_facet | Lazzeri, Chiara Bonizzoli, Manuela Guetti, Cristiana Fulceri, Giorgio Enzo Peris, Adriano |
author_sort | Lazzeri, Chiara |
collection | PubMed |
description | Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities (marginal donors). In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management (focusing on vasoactive drugs) and monitoring (therapeutic goals). Evidence on management in elderly DBDs is also summarized. Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted. Careful monitoring of selected parameters (possibly including serial echocardiography) is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals. Despide worldwide differences, norepinephrine is the vasoactive of choice in most countries but, whenever higher doses (> 0.2 mcg/kg/min) are needed, a second vasoactive drug (vasopressin) is advisable. Hormonal therapy (desmopressin, corticosteroid and thyroid hormone) are suggested in all DBDs independently of hemodynamic instability. In the single patient, therapeutic regimen (imprimis vasoactive drugs) should be chosen also according to the potential organs retrievable (i.e. heart vs liver and kidneys). |
format | Online Article Text |
id | pubmed-8529942 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-85299422021-10-28 Hemodynamic management in brain dead donors Lazzeri, Chiara Bonizzoli, Manuela Guetti, Cristiana Fulceri, Giorgio Enzo Peris, Adriano World J Transplant Minireviews Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities (marginal donors). In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management (focusing on vasoactive drugs) and monitoring (therapeutic goals). Evidence on management in elderly DBDs is also summarized. Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted. Careful monitoring of selected parameters (possibly including serial echocardiography) is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals. Despide worldwide differences, norepinephrine is the vasoactive of choice in most countries but, whenever higher doses (> 0.2 mcg/kg/min) are needed, a second vasoactive drug (vasopressin) is advisable. Hormonal therapy (desmopressin, corticosteroid and thyroid hormone) are suggested in all DBDs independently of hemodynamic instability. In the single patient, therapeutic regimen (imprimis vasoactive drugs) should be chosen also according to the potential organs retrievable (i.e. heart vs liver and kidneys). Baishideng Publishing Group Inc 2021-10-18 2021-10-18 /pmc/articles/PMC8529942/ /pubmed/34722170 http://dx.doi.org/10.5500/wjt.v11.i10.410 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/ |
spellingShingle | Minireviews Lazzeri, Chiara Bonizzoli, Manuela Guetti, Cristiana Fulceri, Giorgio Enzo Peris, Adriano Hemodynamic management in brain dead donors |
title | Hemodynamic management in brain dead donors |
title_full | Hemodynamic management in brain dead donors |
title_fullStr | Hemodynamic management in brain dead donors |
title_full_unstemmed | Hemodynamic management in brain dead donors |
title_short | Hemodynamic management in brain dead donors |
title_sort | hemodynamic management in brain dead donors |
topic | Minireviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529942/ https://www.ncbi.nlm.nih.gov/pubmed/34722170 http://dx.doi.org/10.5500/wjt.v11.i10.410 |
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