Ouerd Sofiane, Frenette Anne Julie, Williamson David, Serri Karim, D'Aragon Frederick, Bichet Daniel G, Charbonney Emmanuel
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Pharmacy CIUSSS du nord-de-l'Île-de-Montréal, Sacré-Coeur Hospital, Montreal, QC, Canada.
Crit Care Explor. 2023 Apr 21;5(4):0907. doi: 10.1097/CCE.0000000000000907. eCollection 2023 Apr.
The objective of this review was to depict the physiological and clinical rationale for the use of vasopressin in hemodynamic support of organ donors. After summarizing the physiological, pharmacological concepts and preclinical findings, regarding vasopressin's pathophysiological impacts, we will present the available clinical data.
Detailed search strategies in PubMed, OVID Medline, and EMBASE were undertaken using Medical Subject Headings and Key Words.
Physiological articles regarding brain death, and preclinical animal and human studies about the use of vasopressin or analogs, as an intervention in organ support for donation, were considered.
Two authors independently screened titles, abstracts, and full text of articles to determine eligibility. Data encompassing models, population, methodology, outcomes, and relevant concepts were extracted.
Following brain death, profound reduction in sympathetic outflow is associated with reduced cardiac output, vascular tone, and hemodynamic instability in donors. In addition to reducing catecholamine needs and reversing diabetes insipidus, vasopressin has been shown to limit pulmonary injury and decrease systemic inflammatory response in animals. Several observational studies show the benefit of vasopressin on hemodynamic parameters and catecholamine sparing in donors. Small trials suggest that vasopressin increase organ procurement and have some survival benefit for recipients. However, the risk of bias is overall concerning, and therefore the quality of the evidence is deemed low.
Despite potential impact on graft outcome and a protective effect through catecholamine support sparing, the benefit of vasopressin use in organ donors is based on low evidence. Well-designed observational and randomized controlled trials are warranted.
本综述的目的是描述在器官捐献者血流动力学支持中使用血管加压素的生理和临床依据。在总结了关于血管加压素病理生理影响的生理、药理概念和临床前研究结果后，我们将展示现有的临床数据。
使用医学主题词和关键词在PubMed、OVID Medline和EMBASE中进行了详细的检索策略。
考虑了关于脑死亡的生理学文章，以及关于使用血管加压素或其类似物作为器官捐献支持干预措施的临床前动物和人体研究。
两位作者独立筛选文章的标题、摘要和全文以确定其是否符合要求。提取了包括模型、人群、方法、结果和相关概念的数据。
脑死亡后，交感神经输出的显著减少与捐献者的心输出量降低、血管张力降低和血流动力学不稳定有关。除了减少儿茶酚胺需求和逆转尿崩症外，血管加压素已被证明在动物中可限制肺损伤并降低全身炎症反应。几项观察性研究表明血管加压素对捐献者的血流动力学参数和儿茶酚胺节省有益。小型试验表明血管加压素可增加器官获取量并对接受者有一定的生存益处。然而，总体而言存在偏倚风险，因此证据质量被认为较低。
尽管血管加压素对移植结果可能有影响，并通过节省儿茶酚胺支持起到保护作用，但在器官捐献者中使用血管加压素的益处基于低质量证据。有必要进行精心设计的观察性和随机对照试验。
