the first. All aspects of DBD can be performed by the treating intensivist. Management of haemodynamic instability secondary to brain death Brain death can lead to a neuro-humoral response leading to profound circulatory instability which can last hours. Diabetes Insipidus, loss of sympathetic tone, hypothermia and lost pituitary function contribute to this. Diabetes Insipidus Vasopressin 2-5 units in 1litre of – fluid: replace urine output + 10% per hour OR 1 unit/kg in 50ml at 1-3ml/hr (0.02-0.06 units/kg/hr) Circulatory dysfunction inotrope and vasopressor – (minimum neccessay) as required. Methylprednisolone 15mg/kg. Triiodothyronine (T3) for myocardial dysfunction: based on echocardiographic findings and in consultation with the cardiac intensivist or cardiologist. Maintain normoglycaemia with infusion of 50% dextrose, or an infusion of insulin (0.05-0.1 unit/kg/hr) as needed. Treat coagulopathy with FFP. Give platelets if bleeding due to platelet count <50 x 109 Stable gas exchange (PaCO2 + PaO2 as close to normal as possible); prevent atelectasis (PEEP 5-10 cm + ETT suction); use low tidal volumes to avoid volutrauma. 2. Donation following Circulatory Death (DCD) Main considerations DCD is to be considered for all patients where withdrawal of life sustaining therapies is going to occur. The intensivist, the treating unit consultant and the family must agree on withdrawal of life sustaining therapies first before consideration of organ donation. All units involved must document this in the medical record. Designated intensivist a second intensivist provides – the donation counselling and seeks consent for DCD. Designated officer (representing the hospital) a – number of senior medical staff are registered as designated officers and their consent on behalf of the
the first. All aspects of DBD can be performed by the treating intensivist. Management of haemodynamic instability secondary to brain death Brain death can lead to a neuro-humoral response leading to profound circulatory instability which can last hours. Diabetes Insipidus, loss of sympathetic tone, hypothermia and lost pituitary function contribute to this. Diabetes Insipidus – Vasopressin 2-5 units in 1litre of fluid: replace urine output + 10% per hour OR 1 unit/kg in 50ml at 1-3ml/hr (0.02-0.06 units/kg/hr) Circulatory dysfunction – inotrope and vasopressor (minimum neccessay) as required. Methylprednisolone 15mg/kg. Triiodothyronine (T3) for myocardial dysfunction: based on echocardiographic findings and in consultation with the cardiac intensivist or cardiologist. Maintain normoglycaemia with infusion of 50% dextrose, or an infusion of insulin (0.05-0.1 unit/kg/hr) as needed. Treat coagulopathy with FFP. Give platelets if bleeding due to platelet count <50 x 109 Stable gas exchange (PaCO2 + PaO2 as close to normal as possible); prevent atelectasis (PEEP 5-10 cm + ETT suction); use low tidal volumes to avoid volutrauma. 2. Donation following Circulatory Death (DCD) Main considerations DCD is to be considered for all patients where withdrawal of life sustaining therapies is going to occur. The intensivist, the treating unit consultant and the family must agree on withdrawal of life sustaining therapies first before consideration of organ donation. All units involved must document this in the medical record. Designated intensivist – a second intensivist provides the donation counselling and seeks consent for DCD. Designated officer (representing the hospital) – a number of senior medical staff are registered as designated officers and their consent on behalf of the
PICU%20Guidelines%20Nov%2015th%202017.docx