Prevalence of Hemodynamic, Acid and Base, Coagulation, Electrolytes, and Blood Glucose Disturbances and Requiring Inotropic Support in Patients with Brain Death on Arrival at Hospital Intensive Care Unit

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Brain death, as the loss of all brain functions including functions of the brain stem, is defined as a considerable part of mortality. Care of the patients with brain death is important as these patients are important sources for transplantation. Due to changes made in the brain and other organs, electrolyte, hemodynamic and hemostatic abnormalities have a high prevalence in patients with brain death. The recognition of these disorders is very important to have a correct view about the importance of prevention and management. The aim of this study was assessment of the prevalence of hemodynamic, acid and base, coagulation, electrolytes, and blood glucose abnormalities in patients with brain death on arrival at hospital intensive care unit (ICU).Methods: In a cross-sectional study during 2013-2014, the medical records of 119 patients with brain death who were hospitalized in ICUs of Alzahra Hospital, Isfahan, Iran, during 2010-2013 were studied. Hemodynamic, coagulation, electrolytes and glucose abnormalities, and the need for inotropic support for each patient were recorded on the data collection form. The frequency of organ donation in patients was assigned and the obtained data were analyzed using SPSS software.Findings:  In 92 patients (77.3%) organ donation was done. Impairment of pH (70.6%), prothrombin time (PT) (66.4%) and international normalized ratio (INR) (58.0%) were the most common disorders seen in the patients. Impaired glucose and sodium levels were statistically significant in organ donation and not-donation groups.Conclusion: Patients with brain death, due to disturbances in hemodynamic, hemostatic, and coagulation time, lose the ability of organ donation. So, the decision to do organ donation should be made in the shortest possible time.

Keywords

References

  1. Goila AK, Pawar M. The diagnosis of brain death. Indian J Crit Care Med 2009; 13(1): 7-11.
  2. Mizraji R, Perez S, Alvarez I. Brain death: epidemiology and quality control of solid organ donor generation. Transplant Proc 2004; 36(6): 1641-4.
  3. Lisman T, Leuvenink HG, Porte RJ, Ploeg RJ. Activation of hemostasis in brain dead organ donors: an observational study. J Thromb Haemost 2011; 9(10): 1959-65.
  4. Irwin RS, Lilly C, Rippe JM. Irwin and Rippe's manual of intensive care medicine. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013. p. 440-70.
  5. Barklin A. Systemic inflammation in the brain-dead organ donor. Acta Anaesthesiol Scand 2009; 53(4): 425-35.
  6. Levi M, van der Poll T, ten CH, van Deventer SJ. The cytokine-mediated imbalance between coagulant and anticoagulant mechanisms in sepsis and endotoxaemia. Eur J Clin Invest 1997; 27(1): 3-9.
  7. van der Poll T, Levi M, Hack CE, ten CH, van Deventer SJ, Eerenberg AJ, et al. Elimination of interleukin 6 attenuates coagulation activation in experimental endotoxemia in chimpanzees. J Exp Med 1994; 179(4): 1253-9.
  8. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344(10): 699-709.
  9. Novitzky D, Cooper DK, Reichart B. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation 1987; 43(6): 852-4.
  10. Chen EP, Bittner HB, Kendall SW, van Trigt P. Hormonal and hemodynamic changes in a validated animal model of brain death. Crit Care Med 1996; 24(8): 1352-9.
  11. Belzberg H, Shoemaker WC, Wo CC, Nicholls TP, Dang AB, Zelman V, et al. Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor. J Trauma 2007; 63(5): 1032-42.
  12. Schulte EJ, Murday H, Pfeifer G. Haemodynamic changes in patients with severe head injury. Acta Neurochir (Wien) 1980; 54(3-4): 243-50.
  13. Salim A, Martin M, Brown C, Rhee P, Demetriades D, Belzberg H. The effect of a protocol of aggressive donor management: Implications for the national organ donor shortage. J Trauma 2006; 61(2): 429-33.
  14. Giral M, Bertola JP, Foucher Y, Villers D, Bironneau E, Blanloeil Y, et al. Effect of brain-dead donor resuscitation on delayed graft function: results of a monocentric analysis. Transplantation 2007; 83(9): 1174-81.
  15. Schnuelle P, Berger S, de BJ, Persijn G, van der Woude FJ. Donor employment of vasopressors and its impact on allograft survival after transplantation. Transplant Proc 2001; 33(1-2): 1282-3.
  16. Nicolas-Robin A, Barouk JD, Amour J, Coriat P, Riou B, Langeron O. Hydrocortisone supplementation enhances hemodynamic stability in brain-dead patients. Anesthesiology 2010; 112(5): 1204-10.
  17. Masson F, Thicoipe M, Maurette M, Pinaquy C, Leger A, Erny P. Hemodynamic, coagulation and glycoregulation changes induced by brain death. Ann Fr Anesth Reanim 1990; 9(2): 115-22. [In French].
  18. Dominguez-Roldan JM, Jimenez-Gonzalez PI, Garcia-Alfaro C, Hernandez-Hazanas F, Fernandez-Hinojosa E, Bellido-Sanchez R. Electrolytic disorders, hyperosmolar states, and lactic acidosis in brain-dead patients. Transplant Proc 2005; 37(5): 1987-9.
  19. Lee JH, Kim MS, Na S, Koh SO, Sim J, Choi YS. Evaluation of acid-base status in brain dead donors and the impact of metabolic acidosis on organ retrieval. Minerva Anestesiol 2013; 79(9): 1011-20.
Journal of Isfahan Medical School
Volume 33, Issue 337 - Serial Number 337
May and June 2015
Pages 835-846

Files

History

  • Receive Date: 16 February 2015
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics