Ream Robert S, Armbrecht Eric S
1 Division of Pediatric Critical Care, Department of Pediatrics, Saint Louis University, St Louis, MO, USA.
2 Center for Outcomes Research, Department of Internal Medicine, Saint Louis University, St Louis, MO, USA.
Prog Transplant. 2018 Mar;28(1):4-11. doi: 10.1177/1526924817746673. Epub 2017 Dec 15.
Reports of actual pediatric organ donor management practice among US organ procurement organizations are sparse, and the use of standardized management guidelines is unknown. A recent consensus statement from the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations offers guidelines for the management of the pediatric organ donor.
To describe the use of guidelines and routine practices in the management of the pediatric organ donor with respect to hemodynamics, lung and ventilator management, fluid and electrolytes, hormonal replacement therapy, the use of blood products, thermoregulation, and prophylactic antibiotics.
Cross-sectional observational study using a survey and follow-up telephone interview with respondents from all 58 US organ procurement organizations.
All 58 US Organ Procurement Organizations participated. A majority employed written guidelines for the management of pediatric donor hemodynamics, thermoregulation, fluids, and electrolytes. Management of blood products, the lung, and mechanical ventilation were less commonly committed to written guidelines, but common practices were described. All used various forms of hormonal replacement therapy and the majority administered empiric antibiotic therapy. Wide variation was observed in the management of the lung, mechanical ventilation, and glycemic control.
Most OPOs used forms of standardized donor management for the pediatric organ donor although variation in the content of that management exists. Barriers to an evidence-based approach to the pediatric donor need to be determined and addressed.
美国器官获取组织中关于实际儿科器官捐献者管理实践的报告很少,且标准化管理指南的使用情况不明。危重病医学学会、美国胸科医师学会和器官获取组织协会最近发布的一份共识声明提供了儿科器官捐献者管理指南。
描述在儿科器官捐献者管理中,关于血流动力学、肺与呼吸机管理、液体与电解质、激素替代疗法、血液制品使用、体温调节和预防性抗生素方面,指南和常规做法的使用情况。
采用对美国所有58个器官获取组织的受访者进行调查及后续电话访谈的横断面观察性研究。
所有58个美国器官获取组织均参与了研究。大多数组织采用了关于儿科捐献者血流动力学、体温调节、液体和电解质管理的书面指南。血液制品、肺和机械通气的管理较少形成书面指南,但描述了常见做法。所有组织都使用了各种形式的激素替代疗法,大多数组织给予经验性抗生素治疗。在肺、机械通气和血糖控制的管理方面观察到很大差异。
大多数器官获取组织对儿科器官捐献者采用了标准化捐献者管理形式,尽管管理内容存在差异。需要确定并解决基于证据的儿科捐献者管理方法的障碍。