Critical care pharmacy in donor management.
Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.
Phongsamran
Paula V
PV
University of Southern California, Los Angeles, California, USA.
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001926:Brain Death / Q000378:metabolism / Q000503:physiopathology; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D019091:Critical Pathways; D004334:Drug Administration Schedule; D005440:Fluid Therapy / Q000379:methods*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D019520:Living Donors / Q000706:statistics & numerical data; D012151:Resuscitation / Q000379:methods*; D013974:Thyroxine / Q000627:therapeutic use; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000639:trends; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D007004:Hypoglycemic Agents; D007328:Insulin; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D013974:Thyroxine