Revelly Jean-Pierre, Imperatori Luca, Maravic Philippe, Schaller Marie-Denise, Chioléro René
Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
Intensive Care Med. 2006 May;32(5):708-12. doi: 10.1007/s00134-006-0116-7. Epub 2006 Mar 14.
To evaluate the feasibility of implementing a program of controlled non-heart beating organ donation, in patients undergoing the withdrawal of intensive care treatment.
Prospective observational study. Medical and Surgical ICUs in a tertiary university hospital.
Consecutive patients younger than 70 years dying in the ICU after treatment withdrawal for dire neurological prognosis.
We analyzed prospectively collected data from the ICU clinical information system. Seventy-three of 516 ICU deaths (13%) were identified, equally distributed among traumatic, stroke, and anoxic brain injury. The management and the course in these three diagnostic categories were similar. All patients underwent withdrawal of mechanical ventilation and half were extubated. Median time to death was of 4.8 h (IQR 1.4-11.5). In 70% of cases the patient received analgesia and 30% sedation. Such treatment was not related to earlier death. Hypotension was observed in 50% of patients during the 30 min preceding cardiac death.
With our current management of terminal patients controlled non-heart beating organ procedure may be difficult due to the duration and variability of the dying process. This observation suggests that we can perform better by evaluating this process more closely.
评估在接受重症监护治疗撤机的患者中实施控制性非心脏跳动器官捐献项目的可行性。
前瞻性观察性研究。一所三级大学医院的内科和外科重症监护病房。
因严重神经预后在重症监护病房治疗撤机后死亡的70岁以下连续患者。
我们前瞻性地分析了从重症监护病房临床信息系统收集的数据。516例重症监护病房死亡患者中有73例（13%）被确定，在创伤、中风和缺氧性脑损伤中分布均匀。这三个诊断类别的管理和病程相似。所有患者均接受了机械通气撤机，半数患者拔管。死亡中位时间为4.8小时（四分位间距1.4 - 11.5）。70%的病例患者接受了镇痛治疗，30%接受了镇静治疗。这种治疗与较早死亡无关。在心脏死亡前30分钟内，50%的患者出现低血压。
鉴于目前对终末期患者的管理，由于死亡过程的持续时间和变异性，控制性非心脏跳动器官捐献程序可能会很困难。这一观察结果表明，通过更密切地评估这一过程，我们可以做得更好。
