2013 - ISODP 2013 Congress
Oral Presentation 6 on Deceased Donor Management
13.3 - Evidence-based guideline for the hormone modulation of the adult brain-dead organ donor. Vasopressin, corticosteroids and thyroid hormones use.
Presenter: Vilma I., Brunetti, GonzÃ¡lez CatÃ¡n, Argentina
Authors: Pablo Centeno, Vilma InÃ©s Brunetti, Ernesto GermÃ¡n Monteagudo, Rogelio MatÃas Anchorena
Evidence-based guideline for the hormone modulation of the adult brain-dead organ donor. Vasopressin, corticosteroids and thyroid hormones use.
Pablo Centeno2, Vilma InÃ©s Brunetti1, Ernesto GermÃ¡n Monteagudo2, Rogelio MatÃas Anchorena2
1Laboratory, HZGA Simplemente Evita, Gonzalez CatÃ n, Argentina, 2Intensive Care Unit, HZGA Simplemente Evita, Gonzalez CatÃ¡n, Argentina
Background: There is disagreement about the best hormone treatment indicated for the brain-dead (BD) organ donor (OD), maybe because there is no high-quality guideline published.
Aims and objectives: Establishing hormone modulation strategies to optimize: circulatory function, organ procurement, graft survival, benefits and costs. These outcomes were used to formulate PICO questions for every hormonal treatment. Target population: BD people and possibly OD older than 14 years old, in intensive care units. Target group: OD manager physicians.
Methods: Systematic literature search in PubMed using keywords of the PICO questions added to a Google search of the references of interest. FLCritica 1.1.1 (Osteba) was used for the critical appraisal of literature. Evidence grading system, and grading system for recommendations: SIGN. Agreement method: nominal group.
Brief summary of key recommendations: We recommend administering methilprednisolone (1 gr bolus) soon after BD, repeating doses every 24 hours, recommendation grade (RG): A. Both in case of haemodynamic impairment (HI) or diabetes insipidus (DI), we recommend using vasopressin (AVP) as first choice, RG: B, starting with 1 U bolus, followed by infusion (maximum dose: 2.4 U/h), RG: D. We suggest using norepinephrine as a second choice to treat HI, RG: B. We suggest using desmopressin as a second choice to treat DI or to enhance AVP use, RG: D. We suggest treating hypernatremia, RG: D. We do not recommend the use of thyroid hormones.
Implementation and monitoring of guideline: Several indicators were developed for monitoring the described outcomes. A check list and a quick consult guideline stands out. Update: every 2 years.
External assessment by using the AGREE instrument. Domain scores: each of the six are independently above 80 %.
Conclusions: The present guideline simplifies the access to data based on evidence which might improve the standardizing criteria and outcomes.
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