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Raios C, Keating JL, Skinner EH, Opdam HI, Haines KJ. Exploring current physiotherapy practices in the care of people who are potential lung donors: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00001-8. [PMID: 38365522 DOI: 10.1016/j.aucc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/19/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine physiotherapists' current practices and perspectives regarding their role in caring for people who are potential lung donors in the intensive care unit (ICU). METHODS A qualitative descriptive design was used. Qualitative data were collected through audio-recorded, semistructured focus groups with a purposive sample of physiotherapists with experience working with people who are potential lung donors in ICUs. Two investigators completed independent thematic analysis to identify themes. RESULTS Seven focus groups were completed with 27 physiotherapists at six metropolitan health services in Victoria, Australia. Six key themes were identified: (i) physiotherapists' involvement in care was highly variable; (ii) physiotherapists were not aware of existing evidence or guidelines for the care of people who are potential donors and followed usual practices; (iii) a consistent vision of the physiotherapy role was lacking; (iv) physiotherapists' engagement with the team routinely involved in care of people who are potential donors varied considerably; (v) physiotherapists faced practice challenges associated with delivering care to potential donors; and (vi) several enablers could support a role for physiotherapy in this patient population. CONCLUSIONS Variability in physiotherapy practice is associated with local ICU culture, physiotherapy leadership capabilities, knowledge, and experience. The spectrum of practice ranged from physiotherapists being highly engaged to being completely uninvolved. Physiotherapists held mixed perspectives regarding whether physiotherapists should have a role in managing people who are potential lung donors. It would benefit the profession to develop consensus and standardisation of the role of physiotherapists in caring for these patients. TWEETABLE ABSTRACT Variability in views and practices amongst physiotherapists who provide care to patients who are potential lung donors in the ICU.
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Affiliation(s)
- Cassandra Raios
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of General Medicine, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Helen I Opdam
- Organ and Tissue Authority, Canberra, ACT, Australia; Department of Intensive Care, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville 3001, Victoria, Australia
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Rodrigues-Gomes RM, Lage Cendón L, Martínez Rolán R, Gelabert-González M. Respiratory physiotherapy as a tool to allow and optimize lung donation. Respir Med Case Rep 2023; 46:101917. [PMID: 37860584 PMCID: PMC10582771 DOI: 10.1016/j.rmcr.2023.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/18/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Lung donation is complex and sometimes the secretion retention makes it impossible. We report a case of a patient that was screened as potential lung donor with PaO2/FiO2 ratio below range. As in viable patients, the respiratory physiotherapist applied a ventilator-based group of techniques with removal of huge amount of secretions and consequent increase in the PaO2/FiO2 ratio that allowed the inclusion of the patient as potentially lung donor. The protocol was applied until the extraction day, with successful extraction and transplantation. We believe that respiratory physiotherapy could have a potential role in increasing lung viability.
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Affiliation(s)
- Ricardo Miguel Rodrigues-Gomes
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Rosa Martínez Rolán
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Gelabert-González
- Facultade Medicina, Universidade de Santiago de Compostela, Santiago Compostela, Spain
- Centro Hospitalario Santiago de Compostela, Santiago de Compostela, Spain
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Physiotherapy in Patients on the Organ Donation Pathway: A Survey of Current Practice. Transplant Proc 2021; 53:2157-2161. [PMID: 34389166 DOI: 10.1016/j.transproceed.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of the survey was to identify the current practices of physiotherapists in the management of patients on the organ donation pathway. METHODS The author conducted a cross-sectional telephone survey. Participants were 16 physiotherapists working in intensive care units (ICU) in Queensland, who were involved in the care of patients on the organ donation pathway. RESULTS In Queensland ICUs, only 57% of hospitals have formal guidelines for physiotherapy management of patients on the organ donation pathway. When comparing the frequency of interventions with organ donation status, 86% of physiotherapists reported increasing the frequency of interventions once a patient was considered for organ donation. Clinical reasoning was reported as the primary factor affecting intervention choice for 67% of physiotherapists, with no difference in frequency, or choice of intervention in patients for donation after circulatory death, compared with donation after brain death. In hospitals with a level I ICU (with infrequent exposure to organ donation), the use of protocols was supported by 100% of participants, whereas in hospitals with a level II and III ICU (and greater exposure), only 31% of participants supported the use of protocols. CONCLUSIONS There are wide variations and a lack of formal guidelines for physiotherapy management of patients on the organ donation pathway; however, clinical reasoning appears to be favored above protocolized management in hospitals with level II and level III ICUs.
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Neuberger J, Callaghan C. Organ utilization - the next hurdle in transplantation? Transpl Int 2020; 33:1597-1609. [PMID: 32935386 DOI: 10.1111/tri.13744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision-making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.
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Affiliation(s)
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital and the Evelina London Children's Hospital, London, UK
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Wilkey BJ, Abrams BA. Mitigation of Primary Graft Dysfunction in Lung Transplantation: Current Understanding and Hopes for the Future. Semin Cardiothorac Vasc Anesth 2019; 24:54-66. [DOI: 10.1177/1089253219881980] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary graft dysfunction (PGD) is a form of acute lung injury that develops within the first 72 hours after lung transplantation. The overall incidence of PGD is estimated to be around 30%, and the 30-day mortality for grade 3 PGD around 36%. PGD is also associated with the development of bronchiolitis obliterans syndrome, a specific form of chronic lung allograft dysfunction. In this article, we will discuss perioperative strategies for PGD prevention as well as possible future avenues for prevention and treatment.
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Tawil JN, Adams BA, Nicoara A, Boisen ML. Noteworthy Literature Published in 2018 for Thoracic Organ Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:171-187. [PMID: 31064319 DOI: 10.1177/1089253219845408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Publications of note from 2018 are reviewed for the cardiothoracic transplant anesthesiologist. Strategies to expand the availability of donor organs were highlighted, including improved donor management, accumulating experience with increased-risk donors, ex vivo perfusion techniques, and donation after cardiac death. A number of reports examined posttransplant outcomes, including outcomes other than mortality, with new data-driven risk models. Use of extracorporeal support in cardiothoracic transplantation was a prominent theme. Major changes in adult heart allocation criteria were implemented, aiming to improve objectivity and transparency in the listing process. Frailty and prehabilitation emerged as targets of comprehensive perioperative risk mitigation programs.
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Affiliation(s)
| | | | | | - Michael L Boisen
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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[Critical care management of the potential organ donor : Current recommendation for adults]. Med Klin Intensivmed Notfmed 2018; 114:132-138. [PMID: 30552454 DOI: 10.1007/s00063-018-0516-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
The shortage of donor organs has not improved in recent years. To increase the number and success of transplantation it is crucial to optimize the processes of early identification of potential organ donors and structured critical care management. The therapy starts long before brain death is diagnosed. Structured in-house organ donor management protocols ensure a highly qualified critical care that has a direct impact on the transplantation outcome. The therapy is based on the established standards. The main focus is on differentiated catecholamine and volume therapy. Vasopressin, in combination with norepinephrine, is effective for both treating vasoplegia and electrolyte disturbances. Despite poor evidence, steroids are useful for stabilizing hemodynamics and treating the consequences of neuroendocrine dysfunction. Overall, prospective studies are required to give general recommendations for critical care.
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