Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

Lavoisier - Tập 24 - Trang 140-151 - 2015
B. Champigneulle1,2, J. Charpentier1,3
1Service de Réanimation Médicale, Hôpital Cochin, AP-HP, Paris, France
2Université Paris Descartes, Sorbonne Paris Cité, Paris, France
3Coordination des prélèvements d’organes et de tissus, hôpital Cochin, AP-HP, Paris, France

Tóm tắt

During brain death (BD) process, several mechanisms may induce cardio-circulatory failure. These mechanisms are secondary to brain ischemia and involve a catecholamine storm, a systemic inflammatory state and a hormonal dysfunction. Donor past history and associated medical context may worsen the hemodynamic failure. Objectives of early recognition and treatment of cardiocirculatory failure in potentials BD donors are: to preserve the viability of the potential grafts, to improve organ’s function and to increase the number of recovered organs. Hemodynamic resuscitation is principally based on the use of inotropic agents in case of myocardial dysfunction, the correction of hypovolemia and the use of vasopressors (norepinephrine) adapted using a cardiovascular monitorage. Systematic hormone therapy is still debated. Associated supportive treatment includes correction of metabolic and electrolytic disorders, avoidance of hypothermia and management of diabetes insipidus. Aggressive management must be conducted until aortic clamping during organ recovery in operating room. Potential BD donor must be managed like any other intensive care unit patient.

Tài liệu tham khảo

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