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, González Catán, Argentina
Authors: Pablo Centeno, Vilma Inés Brunetti, Ernesto Germán Monteagudo, Rogelio Matías Anchorena

Evidence-based guideline for the hormone modulation of the adult brain-dead organ donor. Vasopressin, corticosteroids and thyroid hormones use.

Pablo Centeno2, Vilma Inés Brunetti1, Ernesto Germán Monteagudo2, Rogelio Matías Anchorena2

1Laboratory, HZGA Simplemente Evita, Gonzalez Catàn, Argentina, 2Intensive Care Unit, HZGA Simplemente Evita, Gonzalez Catán, 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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