CICM SAQ 2012.1 Q1

Temperature Maintenance:

• Hypothermia is common due to: cold fluids, heat loss through exposure, inability to vasoconstrict or shiver, reduced metabolic rate.
• Maintain normal core temperature
  — Cover patient
  — Warm room
  — Warming blanket
  — Warm fluids especially high volume o Humidification

Respiratory support:

• Aim to avoid fluid overload
• Aim for adequate Sp02 and normocarbia with lowest Fi02 and limit tidal volumes
• Bronchoscopy for persisting collapse
• Chest physiotherapy may be helpful

Circulatory Support:

• Immediately prior to brain death there is often a period of sympathetic hyperactivity with associated tachycardia and hypertension. This is lost following brain death commonly resulting in vasodilation and hypotension
• Maintain adequate mean arterial pressure. Use judicious volume expansion and low dose
• inotropes (usually noradrenaline)
• Monitor peripheral perfusion and urine output regularly
• Continue maintenance fluids

Metabolic haematology and biochemistry:

• Diabetes insipidus is common and if not recognized and treated can quickly lead to hypernatraemia and hyperosmolality
• Measure electrolytes and creatinine regularly and treat as appropriate to maintain normal
• ranges
• Treat Diabetes insipidus with desmopressin (DDAVP) 4-8μgrams intravenously and repeat if necessary, or low dose vasopressin
• Start low dose insulin infusion if blood glucose persistently above 12mmol/L
• Stop bleeding, correct coaguloapthy, thrombocytopaenia and anaemia
• Avoid hypernatraemia
• Other electrolyte abnormalities – K, PO4, Ca, Mg
• Consider thyroxine replacement

Communication:

• Family – counsel, explain, keep updated
• Liaison with donor coordinator and surgical retrieval teams