Donation after Brainstem Death (DBD) Trust / Board logo –

retain or remove NHSBT logo

Donor Optimisation Extended Care Bundle as required

Patient Name_______________________ Date of Birth_________________

Unit Number________________________ Date and Time_______________

Signature _________________ Print Name __________________
Priorities to address are
1. Assess fluid status and correct hypovolaemia with fluid boluses
Y N/A
2. Introduce vasopressin infusion where required introduce flow monitoring Fluids and metabolic management
3. Perform lung recruitment manoeuvres (e.g. following apnoea tests, 1. Administer methylprednisolone (dose 15 mg/kg, max 1 g) 
disconnections, deterioration in oxygenation or suctioning) 2. Review fluid administration. IV crystalloid maintenance fluid
4. Identify, arrest and reverse effects of diabetes insipidus
(or NG water where appropriate) to maintain Na+ < 150 mmol/l 
5. Administer methylprednisolone (all donors)
Y N/A 3. Maintain urine output between 0.5 – 2.0 ml/kg/hour 
(If > 4ml/kg/hr, consider Diabetes insipidus and treat promptly with vasopressin and/or
Cardiovascular (primary target MAP 60 – 80 mm Hg) DDAVP. Dose of DDAVP 1 – 4 mcg ivi titrated to effect)
1. Review intravascular fluid status and correct hypovolaemia
4. Start insulin infusion to keep blood sugar at 4 –10 mmol/l 
with fluid boluses  (minimum 1 unit/h; add a glucose containing fluid if required to maintain blood sugar)
2. Commence cardiac output / flow monitoring  5. Continue NG feeding (unless SN-OD advises otherwise) 
3. Commence vasopressin (0.5 – 4 units/hour) where vasopressor
required, wean or stop catecholamine pressors as able  Thrombo-embolic prevention
4. Introduce dopamine (preferred inotrope) or dobutamine if required  1. Ensure anti-embolic stockings are in place (as applicable) 
5. Commence Liothyronine at 3 units/hour (+/- 4 unit bolus)  2. Ensure sequential compression devices are in place (as applicable) 
(in cases of high vaso-active drug requirements or as directed by the cardiothoracic retrieval team)
3. Continue, or prescribe low molecular weight heparin 
Respiratory (primary target PaO2  10 kPa, pH > 7.25)
Lines, Monitoring and Investigations (if not already done)
1. Perform lung recruitment manoeuvres 
2. Review ventilation, ensure lung protective strategy
1. Insert arterial line: left side preferable (radial or brachial) 
(Tidal volumes 4 – 8ml/kg ideal body weight and optimum PEEP (5 – 10 cm H2O)  2. Insert CVC: right side preferable (int jugular or subclavian) 
3. Maintain regular chest physio incl. suctioning as per unit protocol  3. Continue hourly observations as per critical care policy 
4. Maintain 30 – 45 degrees head of bed elevation  4. Maintain normothermia using active warming where required 
5. Ensure cuff of endotracheal tube is appropriately inflated  5. Perform a 12-lead ECG (to exclude Q-waves) 
6. Patient positioning (side, back, side) as per unit protocol  6. Perform CXR (post recruitment procedure where possible) 
7. Where available, and in the context of lung donation, perform 7. Send Troponin level in all cardiac arrest cases
bronchoscopy, bronchial lavage and - toilet for therapeutic purposes  (and follow-up sample where patient in ICU > 24 hours) 
Donor Optimisation Extended Care Bundle Version 20092012
8. Where available, perform an Echocardiogram  Date _________________ Time __________________
9. Review and stop all unnecessary medications 
Donation after Brainstem Death (DBD) Trust / Board logo –
retain or remove NHSBT logo
Donor Optimisation Extended Care Bundle as required
/ Board logo
Patient Name_______________________ Date of Birth_________________

Unit Number________________________ Date and Time_______________

Cardiac output / flow monitor used: ............................................................

Physiological Parameters / Goals Tick  = achieved, x = not achieved
O/A +1hr +2hrs +4hrs +6hrs +8hrs +10hrs +12hrs +14hrs +16hrs +18hrs
PaO2  10.0 kPa
(FiO2 < 0.4 as able)
          
PaCO2 5 – 6.5 kPa
(or higher as long as pH > 7.25)
          
MAP 60 – 80 mmHg           
CVP 4 – 10 mmH
(secondary goal)
          
Cardiac index > 2.1 l/min/m2           
ScvO2 > 60 %           
SVRI (secondary goal)
1800 – 2400 dynes*sec/cm5/m2
          
Temperature 36 – 37.5C           
Blood glucose 4.0 – 10.0 mmol/l           
Urine output 0.5 – 2.0 ml/kg/hour           
Signature
Print name
Date
Donor Optimisation Extended Care Bundle Version 20092012
Time

Donor Optimisation Extended Care Bundle Version 20092012