Protocolo gerenciado de tratamento do potencial doador falecido reduz incidência de parada cardíaca antes do explante dos órgãos

Abstract

ObjectiveTo assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. MethodsA before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. ResultsA total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary. ConclusionThe adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest.

Process of Organ Donation and Tissue in Hospital Units

“…The data collection instrument was developed based on the fundamental recommended by the scientific literature [6][7][13][14][15][16], set up in a structured script non-participant observation, checklist type, composed of the following parts: personal identification data; data on the donation process related to the identification, notification, assessment and maintenance of PD, diagnosis of BD, family interview, documentation, logistics, information about the collection and results of the donation.…”

“…Body temperature Temperature > 35 ºC; use of blankets; infusion of heated fluid; use of spotlights and heating of respiratory gasses [14,16].…”

“…Respiratory function Arterial oxygen saturation≥ 95%; inspiratory oxygen fraction <0.50; arterial oxygen pressure ≥ 80 mmHg; the positive expiratory pressure of 5 cmH 2 O; CO 2 partial pressure between 35 and 45 mmHg; aspirate respiratory secretions, if necessary; high decubitus; humidification and heating gas [6,14,16].…”

“…Enteral nutritional support; collecting blood glucose every six hours; administration of desmopressin acetate urine output > 4 ml/kg/h; hypernatremia correction; maintaining blood glucose between 100 and 200 mg/dl and hyperglycemia treatment [14,16].…”

Segurança Do Paciente No Processo De Doação E Transplante De Órgãos E Tecidos

“…Alguns cuidados que devem ser realizados: manutenção térmica, hemodinâmica e do equilíbrio eletrolítico, assim como a reposição hormonal e a aplicação de regime ventilatório adequado (9) . O cuidado efetivo do potencial doador possibilita a perfusão/oxigenação adequada dos órgãos, favorecendo inclusive a realização tranquila da entrevista junto dos familiares.…”