scholarly journals Brazilian guidelines for the management of brain-dead potential organ donors. The task force of the AMIB, ABTO, BRICNet, and the General Coordination of the National Transplant System

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Glauco Adrieno Westphal ◽  
Caroline Cabral Robinson ◽  
Alexandre Biasi Cavalcanti ◽  
Anderson Ricardo Roman Gonçalves ◽  
Cátia Moreira Guterres ◽  
...  
Keyword(s):  
Intensive Care ◽  
Body Temperature ◽  
Low Dose ◽  
Task Force ◽  
Graft Function ◽  
Red Blood Cell Transfusion ◽  
Lung Protective Ventilation ◽  
Organ Donors ◽  
Protective Ventilation Strategy ◽  
Brain Dead

Abstract Objective To contribute to updating the recommendations for brain-dead potential organ donor management. Method A group of 27 experts, including intensivists, transplant coordinators, transplant surgeons, and epidemiologists, joined a task force formed by the General Coordination Office of the National Transplant System/Brazilian Ministry of Health (CGSNT-MS), the Brazilian Association of Intensive Care Medicine (AMIB), the Brazilian Association of Organ Transplantation (ABTO), and the Brazilian Research in Intensive Care Network (BRICNet). The questions were developed within the scope of the 2011 Brazilian Guidelines for Management of Adult Potential Multiple-Organ Deceased Donors. The topics were divided into mechanical ventilation, hemodynamic support, endocrine-metabolic management, infection, body temperature, blood transfusion, and use of checklists. The outcomes considered for decision-making were cardiac arrest, number of organs recovered or transplanted per donor, and graft function/survival. Rapid systematic reviews were conducted, and the quality of evidence of the recommendations was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Two expert panels were held in November 2016 and February 2017 to classify the recommendations. A systematic review update was performed in June 2020, and the recommendations were reviewed through a Delphi process with the panelists between June and July 2020. Results A total of 19 recommendations were drawn from the expert panel. Of these, 7 were classified as strong (lung-protective ventilation strategy, vasopressors and combining arginine vasopressin to control blood pressure, antidiuretic hormones to control polyuria, serum potassium and magnesium control, and antibiotic use), 11 as weak (alveolar recruitment maneuvers, low-dose dopamine, low-dose corticosteroids, thyroid hormones, glycemic and serum sodium control, nutritional support, body temperature control or hypothermia, red blood cell transfusion, and goal-directed protocols), and 1 was considered a good clinical practice (volemic expansion). Conclusion Despite the agreement among panel members on most recommendations, the grade of recommendation was mostly weak. The observed lack of robust evidence on the topic highlights the importance of the present guideline to improve the management of brain-dead potential organ donors.

ANENCEPHALIC ORGAN DONORS

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. A42-A42
Author(s):  
Student
Keyword(s):  
Brain Death ◽  
Low Dose ◽  
Organ Donors ◽  
Policy Choices ◽  
Minute Period ◽  
Definite Time ◽  
Periodic Testing ◽  
Basic Protocol ◽  
Brain Dead ◽  
Canadian Group

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.

scholarly journals Vasopressor selection during critical care management of brain dead organ donors and the effects on kidney graft function

2020 ◽  
Vol 88 (6) ◽  
pp. 783-788
Author(s):  
Elizabeth A. Swanson ◽  
Madhukar S. Patel ◽  
Tahnee Groat ◽  
Nora E. Jameson ◽  
Margaret K. M. Ellis ◽  
...  
Keyword(s):  
Critical Care ◽  
Care Management ◽  
Graft Function ◽  
Organ Donors ◽  
Kidney Graft ◽  
Critical Care Management ◽  
Brain Dead

scholarly journals Increased resistin in brain dead organ donors is associated with delayed graft function after kidney transplantation

2013 ◽  
Vol 11 (1) ◽  
pp. 233 ◽  
Author(s):  
Simona Oltean ◽  
Rille Pullerits ◽  
Anne Flodén ◽  
Michael Olausson ◽  
Mihai Oltean
Keyword(s):  
Kidney Transplantation ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Organ Donors ◽  
Brain Dead

scholarly journals Effect of Low Dose Insulin Therapy on Normoglycemic Critically Ill Patients in Intensive Care Units

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Kamel ◽  
M R Hosny ◽  
M O Awad ◽  
A M Eid
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Intensive Care ◽  
Blood Glucose ◽  
Body Temperature ◽  
Insulin Therapy ◽  
Low Dose ◽  
Target Blood Glucose ◽  
Group 2 ◽  
Group 1

Abstract Background Insulin has anti-inflammatory effect and vasodilatory effect via endothelial NO release in arteries, veins and capillaries. Insulin inhibits release of inflammatory mediators like IL-6, TNF-α and enhances the immune function of monocytes. Stress-induced hyperglycemia is very common in the ICU, being detected in 50–85% of critically ill patients. It is defined as a blood glucose level >140 mg/dL or glycated hemoglobin (HbA1c) > 6.5 without a past history of pre-existing diabetes. Aim of the Work to evaluate the effect of low dose insulin therapy on the clinical progression of organ dysfunction and on the level of C-reactive protein (CRP), procalcitonin and lipid profile in patients known to be normoglycemic complaining of systemic inflammatory response syndrome (SIRS) or sepsis in intensive care unit. Patients and Methods The study was conducted on 60 patients which were randomized into 2 groups: 30 patients received moderate insulin therapy (group 1) and 30 patients received iv infusion of placebo (normal saline 0.9% NaCl) during the course of the study (group 2). Results There was an improvement in blood pressure, heart rate and body temperature in group 1 compared to group 2 and throughout the study period in group 1. CRP and lactate levels were declined in group 1 with better creatinine values. Triglycerides were decreased in group 1 and hypoxic index was higher in group 1 compared to group 2. Conclusion Insulin therapy with target blood glucose (120-140 mg/dL) has been found in our study that it reduces the complications of SIRS and organ failure, which was expressed by the gradual improvement in heart rate, means arterial blood pressure, body temperature, serum lactate level and urine output. These results support the hypothesis that insulin has a positive inotropic effect. Recommendations Future studies are required to compare between moderate insulin therapy with target blood glucose (120 – 140 mg/dL) and intensive insulin therapy with target blood glucose (80-110 mg/dL) as regard patients' mortality and morbidity.

Changes in visceral proteins pool in children with different types of respiratory failure

2020 ◽  
Vol 26 (2-3) ◽  
pp. 38-48
Author(s):  
O.V. Filyk ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Nutritional Status ◽  
Acute Respiratory Failure ◽  
Lung Protective Ventilation ◽  
Albumin Solution ◽  
Group I ◽  
Protective Ventilation Strategy ◽  
Group Ii

Malnutrition has substantial clinical and socioeconomic significance. Early nutritional disturbances may adversely affect the course of existing lung diseases in early childhood and increase the risk of lung disease in adults. Early diagnosis with combination of clinical examination, anthropometric and laboratory methods in children with acute respiratory failure help to improve results of treatment, and laboratory markers which quickly respond to changes in nutrition will provide optimal monitoring for patients and conditions for immediate correction of these disorders by physicians. The aim of the study was to determine the features of visceral proteins pool (albumin and transthyretin) in children with different types of respiratory failure and duration of their stay in the intensive care unit depending on the plan of nutritional disorders monitoring and correction. Material and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 237 patients aged from 1 month to 18 years and distributed them into a control group, Group I, and Group II. In Groups I and II patients with acute respiratory failure were included who were mechanically ventilated for more than 2 days. Group I included patients who received lung-protective ventilation strategy and assessment of nutritional status; Group II included patients who received diaphragm-protective in addition to lung-protective ventilation strategy; the results of nutritional status assessment were taken into account as well. The atients were divided into age subgroups: 1st subgroup - children from1 month to 1 year of age; 2nd subgroup - children of 1 - 3 years; 3rd subgroup - children of 3 - 6 years; 4th subgroup - children of 6 - 13 years; 5th subgroup - children of 13 - 18 years. The stages of the study were the following: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The primary endpoint was the duration of stay in the intensive care department. The additional assessment criteria included serum albumin and transthyretin levels, the frequency of transfusions of albumin solution, and the frequency of changes in nutritional therapy procedure. The statistical analysis of the study results was performed using MS Excel 2017 with the calculation of the median [IQR - interquartile range], and p-values calculations. Results and Discussion. As a result of the analysis of data on the visceral pool of proteins, it should be noted that the most common disorders were found in patients of the 1st, 2nd and 5th age subgroups: in 1st age subgroup there were disorders related to albumin and transthyretin level; in 2nd age subgroup -to transthyretin level, in 5th age subgroup -to albumin. This might be explained in terms of malnutrition impact on development of body weight deficit and lower body mass index in children of 1st and 2nd age subgroups. On the other hand, in 5th age subgroup nutritional deficiency might be the basis for the emergence of serious diseases that are directly related to nutritional status (severe bacterial infections) and lead to their severe course. The analysis of the frequency of transfusions of albumin solution found that it was performed: in the 1st age subgroup - in 50% of patients of Group I and 0% patients of Group II; in the 2nd age subgroup there were no patient received albumin solution; in the 3rd age subgroup - in 30% of patients of I group and in 0% of patients of II group; in the 4th group - in 20% of patients in Group I and in 0% patients in Group II; in 5th age subgroup - in 0% patients of Group I and in 50% of patients in Group II. The change in the procedure of the nutritional therapy was carried out: in 1st age subgroup - 18% in Group I, 0% in Group II; in 2nd age subgroup - 0% patients in Group I and 30% patients of Group II; in 3rd age subgroup - 0% patients in Group I and 33% patients of Group II; in 4th age subgroup - 40% in Group I and 50% in GroupII; in 5th age subgroup - 0% in Group I and 43% in Group II. Conclusions. It was found that the duration of stay in the intensive care unit depends on principles of monitoring and correction of nutritional disorders in children with respiratory failure. A reliable twofold decrease of the time spent in the intensive care unit was achieved in Group II in comparison with Group I and in the 2nd age subgroup; the time of ICU stay also decreased 2.3 times in 5th age subgroup (p<0.05). Keywords: visceral proteins, children, acute respiratory failure

USE OF LOW DOSE ARGININE VASOPRESSIN TO SUPPORT BRAIN-DEAD ORGAN DONORS

1995 ◽  
Vol 59 (1) ◽  
pp. 58-62 ◽  
Author(s):  
Stephen H. Pennefather ◽  
Robert E. Bullock ◽  
David Mantle ◽  
John H. Dark
Keyword(s):  
Arginine Vasopressin ◽  
Low Dose ◽  
Organ Donors ◽  
Brain Dead

scholarly journals Effect of Aprotinin and Avifavir® Combination Therapy for Moderate COVID-19 Patients

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1253
Author(s):  
Andrey A. Ivashchenko ◽  
Valeria N. Azarova ◽  
Alina N. Egorova ◽  
Ruben N. Karapetian ◽  
Dmitry V. Kravchenko ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Body Temperature ◽  
Combination Therapy ◽  
Serine Proteases ◽  
Clinical Status ◽  
Single Center ◽  
Single Center Study ◽  
D Dimer ◽  
Center Study

COVID-19 is a contagious multisystem inflammatory disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied the efficacy of Aprotinin (nonspecific serine proteases inhibitor) in combination with Avifavir® or Hydroxychloroquine (HCQ) drugs, which are recommended by the Russian Ministry of Health for the treatment therapy of moderate COVID-19 patients. This prospective single-center study included participants with moderate COVID-19-related pneumonia, laboratory-confirmed SARS-CoV-2, and admitted to the hospitals. Patients received combinations of intravenous (IV) Aprotinin (1,000,000 KIU daily, 3 days) and HCQ (cohort 1), inhalation (inh) treatment with Aprotinin (625 KIU four times per day, 5 days) and HCQ (cohort 2) or IV Aprotinin (1,000,000 KIU daily for 5 days) and Avifavir (cohort 3). In cohorts 1–3, the combination therapy showed 100% efficacy in preventing the transfer of patients (n = 30) to the intensive care unit (ICU). The effect of the combination therapy in cohort 3 was the most prominent, and the median time to SARS-CoV-2 elimination was 3.5 days (IQR 3.0–4.0), normalization of the CRP concentration was 3.5 days (IQR 3–5), of the D-dimer concentration was 5 days (IQR 4 to 5); body temperature was 1 day (IQR 1–3), improvement in clinical status or discharge from the hospital was 5 days (IQR 5–5), and improvement in lung lesions of patients on 14 day was 100%.

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