Detailed evaluation of cardiovascular function by hemodynamic “profiling” during donor care may be necessary to select appropriate treatment for hypotension. Preload, systemic vascular resistance, heart rate, and contractility are all determinants of cardiac output and blood pressure. This review discusses the measurement, physiological limitations, and pharmacological manipulation of those variables during care of selected donors.
Get full access to this article
View all access options for this article.
References
1.
PownerDJDarbyJM. Management of variations in blood pressure during care of organ donors. Prog Transplant.2000;10:25–32.
2.
TruwittJD. The pulmonary artery catheter in the ICU, part 1: Technique and measurements. J Crit Illness.2003;18:9–19.
3.
KalassianKGRaffinTA. The technique of thermodilution cardiac output measurement. J Crit Illness.1996;11:249–256.
NiemannCUHenthronTKKrejcieTCShanksCAEnders-KleinCAvramMJ. Indocyanine green kinetics characterize blood volume and flow distribution and their alteration by propanolol. Clin Pharmacol Ther.2000;67:632–650.
7.
KalraPRAnagnostopoulosCBolgerAPCoatsAJSAnkerSD. The regulation and measurement of plasma volume in heart failure. J Am Coll Cardiol.2002;39:1901–1908.
8.
GoyRWLChinJWLooCC. Pulse dye densitometry: A novel bedside monitor of circulating blood volume. Ann Acad Med Singapore.2001;30:192–198.
9.
BrownJM. Use of echocardiography for hemodynamic monitoring. Crit Care Med.2002;30:1361–1364.
10.
CheathamMLNelsonLDChangMCSafcsakK. Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure. Crit Care Med.1998;26:1801–1806.
11.
ReuseCVincentJLPinskyMR. Measurements of right ventricular volumes during fluid challenge. Chest.1990;98:1450–1454.
12.
EisenberyPRJaffeASSchusterDP. Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients. Crit Care Med.1984;12:549–553.
13.
StaudingerTLocherGJLaczikaK. Diagnostic validity of pulmonary artery catheterization for residents at an intensive care unit. J Trauma.1998;44:902–906.
14.
MimozORaussARekikNBrum-BuissonCLemaireFBrochardL. Pulmonary artery catheterization in critically ill patients: A prospective analysis of outcome changes associated with catheter- prompted changes in therapy. Crit Care Med.1994;22:573–579.
15.
ForresterJSDiamondGMcHughTJSwanHJC. Filling pressures in the right and left sides of the heart in acute myocardial infarction. N Engl J Med.1971;285:190–193.
16.
PackmanMIRackowEC. Optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock. Crit Care Med.1983;11:165–169.
17.
SamiiKConseillerCViarsP. Central venous pressure and pulmonary wedge pressure: A comparative study in anesthetized surgical patients. Arch Surg.1976;111:1122–1125.
18.
GodjeOPeyerlMSeebauerTLammPMairHReichartB. Central venous pressure, pulmonary capillary wedge pressure and intratoracic blood volumes as preload indicators in cardiac surgery patients. Eur J Cardiothorac Surg.1998;13:533–539.
19.
RaperRSibbaldWJ. Misled by the wedge? The Swan-Ganz catheter and left ventricular preload. Chest.1986;89:427–434.
20.
ZileMRBrutsaertDL. New concepts in diastolic dysfunction and diastolic heart failure: Part 2 casual mechanisms and treatment. Circulation.2002;105:1503–1508.
21.
LeathermanJWMariniJJ. Clinical use of the pulmonary artery catheter. In: HallJBSchmidtGAWoodLDH, eds. Principles of Critical Care.2nd ed.New York, NY: McGraw-Hill; 1998:155–176.
22.
RajacichNBurchardKWHasanFMSinghAK. Central venous pressure and pulmonary capillary wedge pressure as estimates of left atrial pressure: Effects of positive end-expiratory pressure and catheter tip malposition. Crit Care Med.1989;17:7–11.
23.
PennefatherSHBullockREMantleDDarkJH. Use of low dose arginine vasopressin to support brain-dead organ donors. Transplantation.1995;59:58–62.
24.
IwaiASakanoTUenishiMSugimotoHYoshiokaTSugimotoT. Effects of vasopressin and catecholamines on the maintenance of circulatory stability in brain-dead patients. Transplantation.1989;48:613–617.
25.
PennefatherSHBullockREDarkJH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation.1993;56:1418–1422.
26.
HuntSABaldwinJBaumgartnerW. Cardiovascular management of a potential heart donor: A statement from the Transplantation Committee of the American College of Cardiology. Crit Care Med.1996;24:1599–1601.
27.
DujardinKSMcCullyRBWijdicksEF. Myocardial dysfunction associated with brain death: Clinical, echocardiographic, and pathologic features. J Heart Lung Transplant.2001;20:350–357.
StoddardMFLongakerRA. The role of transesophageal echocardiography in cardiac donor screening. Am Heart J.1993;125:1676–1681.
30.
VedrinneJMVedrinneCDorezDBretMCoronelBColpartJJ. Transesophageal echogardiography assessment of heart in brain dead patients before harvesting. Transplant Proc.1995;27:1655.
31.
DowneyJMHenschG. Sequence of cardiac activation and ventricular mechanics. In: SperelakisN, ed. Heart Physiology and Pathophysiology.4th ed.New York, NY: Academic Press; 2001:3–18.
32.
DwyerKMTraskAL. Shock: An overview. In: IrwinRSRippeJM, eds. Manual of Intensive Care Medicine.3rd ed.Philadelphia, Pa: Lippincott, Williams and Wilkins; 2000:721–727.
33.
PownerDJ. Effects of gene induction and cytokine production in donor care. Prog Transplant.2003;13:9–16.
34.
ConnorsAFSperoffTDawsonNV. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA.1996;276:889–897.
35.
ConnorsAF. Right heart catheterization: Is it effective?New Horizons.1997;5:195–200.
36.
SaudhamJDHullRDBrantRF. A randomized, controlled trial of the use of pulmonary-artery catheters in *high-risk surgical patients. N Engl J Med.2003;348:5–14.
37.
Taylor RW and Pulmonary Artery Catheter Consensus Conference Participants. Pulmonary artery catheter consensus conference: Consensus statement. New Horizons.1997;5:175–194.
