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A Canadian survey of critical care physicians’ hemodynamic management of deceased organ donors

  • Anne Julie FrenetteEmail author
  • Emmanuel Charbonney
  • Frederick D’Aragon
  • Karim Serri
  • Pierre Marsolais
  • Michaël Chassé
  • Maureen Meade
  • David Williamson
  • for the Canadian Critical Care TrialsGroup
Reports of Original Investigations

Abstract

Purpose

We sought to characterize Canadian physicians’ perspectives and stated practices regarding their hemodynamic care of deceased organ donors.

Methods

We designed a 24-item electronic survey that was independently pretested for relevance, clarity, and intra-rater reliability by ten critical care clinicians. With the help of provincial organ donation organizations (ODO), we identified intensive care units (ICUs) with a high volume of adult deceased donors (defined by the management of five or more donors per year for two consecutive years). Medical directors of these high-volume ICUs helped identify ICU physicians to whom our survey was emailed.

Results

Of the 448 ICU physicians from 37 centres in nine provinces that were emailed, 184/448 (41.1%) responded to one or more survey questions. Respondents identified specialist nurses from ODOs as their primary source of guidance in donor care (107/165; 60%). They typically diagnosed an autonomic storm according to a rise in blood pressure (159/165; 96.4%) and/or heart rate (135/165; 81.8%); nevertheless, their stated management varied substantially. After termination of the autonomic storm, preferred first-line vasopressors were norepinephrine (93/164; 56.7%) and vasopressin (68/164; 41.5%). Twenty-one respondents (21/162; 13.0%) reported that they never administer inotropes to donors. Corticosteroid and thyroid hormone prescriptions for all donors was reported by 62/161 (37.6%) and 50/161 (31.1%) respondents, respectively. Respondents perceived an influence from ODO nurses or transplant physicians when prescribing corticosteroids (77/161; 47.8%) and/or thyroid hormones (33/161; 20.5%)

Conclusion

We observed important variability in self-perceived practices of ICU physicians in the hemodynamic management of deceased donors, particularly in the treatment of the autonomic storm, in the prescription of hormone therapy, and in the administration of inotropes.

Sondage canadien sur la prise en charge hémodynamique des donneurs d’organes décédés par les médecins des soins intensifs

Résumé

Objectif

Nous avons tenté de caractériser les perspectives et les pratiques déclarées des médecins canadiens concernant les soins hémodynamiques prodigués aux donneurs d’organes décédés.

Méthode

Nous avons mis au point un sondage électronique comportant 24 éléments et l’avons préalablement testé pour déterminer sa pertinence, sa clarté et sa fidélité interobservateur par dix médecins de soins intensifs. Avec l’aide des organismes de dons d’organes (ODO) provinciaux, nous avons identifié les unités de soins intensifs (USI) prenant en charge un volume élevé de donneurs adultes décédés (prise en charge de cinq donneurs ou plus par an pendant deux années consécutives). Les directeurs médicaux de ces USI à haut volume nous ont aidé à identifier les médecins de l’USI à qui envoyer le sondage par courriel.

Résultats

Parmi les 448 médecins de l’USI issus de 37 centres dans neuf provinces ayant reçu le sondage, 184/448 (41,1 %) ont répondu à une question ou plus de notre questionnaire. Les répondants ont identifié les infirmières spécialisées des ODO en tant que source principale de conseils quant aux soins à prodiguer aux donneurs (107/165; 60 %). Un diagnostic de tempête adrénergique était fréquemment posé suite à une augmentation de la tension artérielle (159/165; 96,4 %) et/ou de la fréquence cardiaque (135/165; 81,8 %); toutefois, la prise en charge déclarée variait considérablement. Après la fin de la tempête adrénergique, les vasopresseurs de première intention les plus utilisés étaient la norépinéphrine (93/164; 56,7 %) et la vasopressine (68/164; 41,5 %). Vingt-et-un répondants (21/162; 13,0 %) ont rapporté ne jamais administrer d’inotropes aux donneurs. Les prescriptions systématiques de corticostéroïdes et d’hormones thyroïdiennes à tous les donneurs ont été rapportées par 62/161 (37,6 %) et 50/161 (31,1 %) répondants, respectivement. Les répondants se sentaient influencés par les infirmières des ODO et les médecins spécialisés en greffe lors de la prescription des corticostéroïdes (77/161; 47,8 %) et/ou des hormones thyroïdiennes (33/161; 20,5 %).

Conclusion

Nous avons observé une variabilité considérable dans les pratiques perçues des médecins de l’USI quant à la prise en charge hémodynamique des donneurs décédés, particulièrement en ce qui a trait au traitement de la tempête adrénergique, à la prescription de thérapie hormonale et à l’administration d’inotropes.

Notes

Acknowledgements

We would like to thank Dr. Matthew-John Weiss and Dr. Sonny Dhanani for their thorough review of the manuscript.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Sangeeta Mehta, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Anne Julie Frenette, Emmanuel Charbonney Karim SerriMaureen Meade, and David Williamson contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Frederick D’Aragon and Pierre Marsolais contributed to the conception and design of the study. Michael Chassé contributed to the conception and design of the study and analysis of the data.

Financial support

None.

Supplementary material

12630_2019_1388_MOESM1_ESM.pdf (51 kb)
Supplementary material 1 (PDF 51 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  • Anne Julie Frenette
    • 1
    • 2
    Email author
  • Emmanuel Charbonney
    • 1
    • 3
  • Frederick D’Aragon
    • 4
    • 8
  • Karim Serri
    • 1
    • 3
  • Pierre Marsolais
    • 1
    • 3
  • Michaël Chassé
    • 3
    • 5
  • Maureen Meade
    • 6
    • 7
  • David Williamson
    • 1
    • 2
  • for the Canadian Critical Care TrialsGroup
  1. 1.Hôpital du Sacré-Coeur de Montréal and Centre de recherche de l’Hôpital du Sacré-Coeur de MontréalMontréalCanada
  2. 2.Faculté de PharmacieUniversité de MontréalMontréalCanada
  3. 3.Faculté de MédecineUniversité de MontréalMontréalCanada
  4. 4.Anesthesia DepartmentCentre Hospitalier Universitaire de Sherbrooke (CHUS)SherbrookeCanada
  5. 5.Centre Hospitalier de l’Université de MontréalMontréalCanada
  6. 6.Hamilton Health Sciences CentreHamiltonCanada
  7. 7.Department of MedicineMcMaster UniversityHamiltonCanada
  8. 8.CHUS Research CenterSherbrookeCanada

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