目的:描述西班牙毁灭性脑损伤患者器官捐献相关的临终护理实践。
方法:回顾性队列的多中心前瞻性研究。
方法:2014年11月1日至2015年4月30日。
方法:获得器官采购授权的68家医院。
方法:死于毁灭性脑损伤的患者(可能的供体)。年龄:1个月-85岁。
方法:护理类型,脑死亡后的捐赠,循环系统死亡后的捐赠,插管/通气,转交给捐助者协调员。
结果:总共确定了1,970个可能的捐献者,其中一半在重症监护病房(ICU)接受积极治疗,直到脑死亡(27%),心脏骤停(5%)或停止维持生命治疗(19%)。其余的,10%的人被送进ICU以方便器官捐献,而39%没有入住ICU。在那些演变成脑死亡状况的患者中(n=695),大多数过渡到实际捐赠(n=446;64%)。在退出维持生命治疗后死亡的人中(n=537),循环死亡捐献者后,有45人(8%)转化为实际捐赠。循环系统死亡计划后缺乏专门的捐赠是不捐赠的主要原因。37%的可能捐献者在死亡时没有插管/通气,主要是因为主管专业人员没有考虑捐赠改变丢弃治疗性插管。36%的可能捐助者从未被推荐给捐助者协调员。
结论:尽管西班牙对死者的捐赠进行了优化,在ICU以外的可能供体的识别方面,以及在停药维持生命治疗后死亡的患者循环死亡后的捐献考虑方面,仍有改善的机会.
OBJECTIVE: To describe end-of-life care practices relevant to organ donation in patients with devastating brain injury in Spain.
METHODS: A multicenter prospective study of a retrospective cohort.
METHODS: 1 November 2014 to 30 April 2015.
METHODS: Sixty-eight hospitals authorized for organ procurement.
METHODS: Patients dying from devastating brain injury (possible donors). Age: 1 month-85 years.
METHODS: Type of care, donation after brain death, donation after circulatory death, intubation/ventilation, referral to the donor coordinator.
RESULTS: A total of 1,970 possible donors were identified, of which half received active treatment in an Intensive Care Unit (ICU) until brain death (27%), cardiac arrest (5%) or the withdrawal of life-sustaining therapy (19%). Of the rest, 10% were admitted to the ICU to facilitate organ donation, while 39% were not admitted to the ICU. Of those patients who evolved to a brain death condition (n=695), most transitioned to actual donation (n=446; 64%). Of those who died following the withdrawal of life-sustaining therapy (n=537), 45 (8%) were converted into actual donation after circulatory death donors. The lack of a dedicated donation after circulatory death program was the main reason for non-donation. Thirty-seven percent of the possible donors were not intubated/ventilated at death, mainly because the professional in charge did not consider donation alter discarding therapeutic intubation. Thirty-six percent of the possible donors were never referred to the donor coordinator.
CONCLUSIONS: Although deceased donation is optimized in Spain, there are still opportunities for improvement in the identification of possible donors outside the ICU and in the consideration of donation after circulatory death in patients who die following the withdrawal of life-sustaining therapy.