RESUMO
Donation after circulatory death (DCD) is practiced in several countries to increase the number of organs for transplantation. This review summarises the key points in a new protocol which will introduce controlled DCD in Denmark as an option in seriously ill patients, in whom death is inevitable and the criteria for brain death is not met. It includes a no touch period of five minutes following circulatory arrest. Rapid procurement or normothermic regional perfusion may be applied depending on the organs to be transplanted. The introduction of DCD requires thorough training of involved health personnel.
Assuntos
Sistema Cardiovascular , Obtenção de Tecidos e Órgãos , Humanos , Doadores de Tecidos , Preservação de Órgãos/métodos , DinamarcaRESUMO
We present a Danish algorithm for the neurointensive care of patients with severe traumatic brain injury. The primary goal is to avoid cerebral ischaemia and hypoxia and secondarily brain injury. Patient evaluation by a neurosurgeon is mandatory, and decision-making concerning extended cerebral monitoring should take place immediately. Treatment aiming at diminishing increased intracranial pressure should be initiated early. Early critical care management of patients with severe traumatic brain injury should be performed in a teamwork comprising various specialties.
Assuntos
Lesões Encefálicas/terapia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/cirurgia , Cuidados Críticos/métodos , Procedimentos Clínicos , Humanos , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/terapia , Monitorização Fisiológica , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Índice de Gravidade de DoençaAssuntos
Disostose Craniofacial/complicações , Apneia Obstrutiva do Sono/etiologia , Pressão Positiva Contínua nas Vias Aéreas , Disostose Craniofacial/diagnóstico por imagem , Disostose Craniofacial/cirurgia , Crescimento , Humanos , Lactente , Masculino , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Tomografia Computadorizada por Raios XRESUMO
A case of a 37-year old obese patient with alcohol, sedative and opioid abuse as well as previous admissions with chest pain is presented. The patient suffered from a large subarachnoid haemorrhage and the clinical diagnosis of brain death was made. He had substantial signs of organ failure. The patient was registered as a potential organ donor in the Danish Registry for Organ Donation, and his heart and kidneys were donated. Considering all brain dead patients as potential organ donors is important.
Assuntos
Transtornos Relacionados ao Uso de Substâncias/complicações , Doadores de Tecidos , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Transplante de Coração , Humanos , Transplante de Rim , Masculino , Transtornos Relacionados ao Uso de Opioides/complicações , Coleta de Tecidos e ÓrgãosRESUMO
The neurointensive care unit provides observation and treatment of acute, life-threatening disorders of and injuries to the central and peripheral nervous system. The primary aim of care is the prevention of secondary neuronal damage; this requires a highly multidisciplinary approach, involving neuromonitoring as well as management of systemic comorbidity and complications. This article presents major pathophysiological issues specific to neurointensive care, as well as recent advances in the management of the critically-ill neurosurgical and neurological patient.