Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj...
-
Upload
leilani-clowe -
Category
Documents
-
view
214 -
download
0
Transcript of Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj...
![Page 1: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/1.jpg)
Donor Donor Management Management
Somchai Limsrichamrern, M.D.Department of Surgery
Faculty of Medicine, Siriraj Hospital
![Page 2: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/2.jpg)
Pathophysiology of brain death
Cushing’s response Autonomic storm Decreased hepatic perfusion due to
intrahepatic shunt Neurogenic pulmonary edema Catecholamine decreased to below
baseline in 15 minute
![Page 3: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/3.jpg)
Pathophysiology of brain death
Abolished vagal tone Decreased carbon dioxide production Arterial and venous vasomotor collapse Activation of proinflammaory and
immunoregulatory pathway
![Page 4: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/4.jpg)
Routine care and monitoring
Arterial line CVP Temperature Hourly urine output Frequent laboratory tests Swan-Ganz catheter
![Page 5: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/5.jpg)
Goal of management
Organ viability and function after transplantation correlates with donor care
To increase usability of organs To optimize organ perfusion and tissue
oxygen delivery
![Page 6: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/6.jpg)
Goal of management Systolic blood pressure: 100-120 mmHg Central venous pressure: 8-10 mmHg Urine output: 100-300 ml/hr Core temperature: > 35º c Arterial oxygen pressure: 80-100 mmHg Oxygen saturation: > 95% pH: 7.35-7.45 Hematocrit: 30-35%
![Page 7: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/7.jpg)
Cardiovascular support
Hypertension Hypotension Hypovolemia Decreased vascular resistance
![Page 8: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/8.jpg)
Cause of hypotension Hypovolemia Hypothermia Cardiac dysfunction
Arrhythmia Acidosis Hypoxemia Excessive PEEP Congestive heart failure Myocardial sequelae of autonomic storm
![Page 9: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/9.jpg)
Cause of hypotension
Cardiac dysfunction Cardiac injury Preexisting cardiac disease Hypophosphatemia Hypocalcemia
Drug side effect or overdose (beta blocker, calcium channel blocker)
![Page 10: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/10.jpg)
Hypovolemia
Arterial and venous vasomotor collapse Dehydration (fluid restriction) Insufficient resuscitation Polyuria (Osmotic diuresis, diabetes
insipidus, hypothermia) Third space loss Decreased intravascular oncotic pressure
![Page 11: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/11.jpg)
Cardiovascular support
Optimize volume status Dopamine is the drug of choice Try to avoid α-adrenergic agonist Urine output not reliable
![Page 12: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/12.jpg)
Respiratory support
Frequent endotrachial suctioning Use low level of PEEP Tidal volume 10-15 ml/kg Maintain PaO2 greater than 100 mmHg
Avoid using high PEEP Increase FiO2 non-lung donor
![Page 13: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/13.jpg)
Renal function
Maintain adequate perfusion Maintain adequate urine output Minimize use of vasopressor Polyuria (DI, osmotic diuresis) Diabetes insipidus found in 80%
![Page 14: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/14.jpg)
Central diabetes insipidus
Urine output > 500 ml/hr Serum sodium > 155 mEq/L Urine specific gravity < 1.005 Serum osmolarity > 305 mOsm/L
![Page 15: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/15.jpg)
Effect of hypernatremia
Hypernatremia was associated postoperative graft dysfunction
Graft loss in up to 33% Correction of hypernatremia Keep final serum sodium level < 155
mEq/L
Liver Transpl Surg - 1999 Sep; 5(5): 421-8
![Page 16: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/16.jpg)
Treatment of DI
Hypotonic solution (D5W, .45NaCl) Desmopressin 1-2 µg IV every 8-12 hr Vasopressin infusion 1.2 unit/hr
![Page 17: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/17.jpg)
Endocrine therapy
Low T3 level: routine use not recommended
Steroid: may decrease proinflammatory reaction, routine use not recommended
Insulin: use to treat hyperglycemia, increase hepatic glycogen storage
![Page 18: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/18.jpg)
Prevention of hypothermia
Brain dead donors are poikilothermic Maintain temperature > 35ºc Prevent heat loss Rewarm
![Page 19: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/19.jpg)
Organ preservation
To preserve the viability of organ for as long as possible
Hypothermia slows metabolism Cooling organs from 37 to 0 degree
Celsius slows metabolism by a factor of 12-13
Ischemia causes cell swelling
![Page 20: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/20.jpg)
Organ preservation
Collin’s solution University of Wisconsin solution Both are high in potassium UW solution contain impermeants which
help reduce cell swelling
![Page 21: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/21.jpg)
Ideal cadaver donor
Young adult with no significant medical problem
Brain death due to closed head injury No extracerebral trauma Brief hospitalization Normal blood pressure and heart rate without
vasopressor Excellent organ function
![Page 22: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/22.jpg)
Contraindication
Unknown cause of death Extracranial malignancy HIV + Uncontrolled sepsis especially fungal
![Page 23: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/23.jpg)
Relative contraindication
Extreme age Intracranial malignancy HCV + or HB core antibody + Bacteremia Procurement injury Preexisting medical problem
![Page 24: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/24.jpg)
ขั้��นตอนการขั้อร�บบร�จาค พบผู้��ป่�วยที่��อาจเป่�นผู้��บริ�จาคอว�ยวะ ย�นย�นภาวะสมองตาย แพที่ย�แจ�งข่!าวสมองตายแก่!ญาต� ผู้��ป่ริะสานงานข่อบริ�จาคจาก่ญาต� แจ�งศู�นย�ริ�บบริ�จาคอว�ยวะสภาก่าชาดไที่ย ตริวจย�นย�นภาวะสมองตายและความเหมาะสมในก่าริเป่�นผู้��บริ�จาค
![Page 25: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/25.jpg)
Pitfall
Care of potential donor Diagnosis of brain death Documentation of brain death Consent form Preparation for organ retrieval Operative injury Packaging
![Page 26: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/26.jpg)
Diagnosis of brain dead
Drug Hypothermia Decorticate Decerebrate Spinal cord injury
![Page 27: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/27.jpg)
Documentation of brain death
![Page 28: Donor Management Somchai Limsrichamrern, M.D. Department of Surgery Faculty of Medicine, Siriraj Hospital.](https://reader033.fdocuments.net/reader033/viewer/2022051614/551a6fac550346545e8b605c/html5/thumbnails/28.jpg)
Thank you.