[Circulatory instability in potential donor organ patients in a state of brain death. Investigation of predictive factors].

OBJECTIVE

To assess the factors influencing and predicting the degree of circulatory impairment of the brain-dead cardiac donors (BDCD).

DESIGN

Retrospective study.

SETTING

General ICU of a 1400 bed High Specialty Regional Hospital.

PATIENTS: 53 patients undergoing brain death (BD) assessment as suitable cardiac-donors.

INTERVENTIONS: Fluids were given up to a central venous pressure (CVP) > 5 mmHg and adrenergic drugs in a sequential manner trying to keep the systolic blood pressure > 90 mmHg.

METHODS

Every hour during the time of BD assessment were recorded: invasive blood pressure (BP), CVP, fluid balance, the demographic data, the dosage of adrenergic drugs, the cause of admission, the time from admission to ICU to BD, the report of an echocardiogram. The patients were divided into 4 classes according to the dosage of the adrenergic drugs required to achieve the pressure-goal. The 4 classes were compared for the above mentioned parameters.

RESULTS

No differences were found among the 4 groups.

CONCLUSIONS

In BDCD the degree of circulatory instability and vasopressor needs cannot be anticipated by the parameters examined. This could be due partly to the relative homogeneity of these patients, since they underwent a clinical selection and similar interventions, partly to a possibly inadequate standard of monitoring. Anyway the unique hemodynamic situation after BD is probably not very affected by the previous events. Further studies are necessary to explain the variability of the circulatory instability and to assess its effects on the quality of the transplanted organs.