Volume 11 Supplement 3

Fourth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Systemic and regional hemodynamic and metabolic changes in an experimental model of brain death

  • FA De Luca1,
  • RJ CruzJr1,
  • AG Garrido1,
  • R Prist1,
  • F Scuotto1 and
  • M Rocha e Silva1
Critical Care200711(Suppl 3):P15

https://doi.org/10.1186/cc5802

Published: 19 June 2007

Introduction

Despite the evolution of transplant techniques, the great number of donated organs continues to proceed from donors in brain death (BD). The need for stabilization in patients with BD, in the view of the triggered autonomic storm, is basic in such a way that knowledge of the physiopathologic, hemodynamic and metabolic disturbances becomes essential.

Objective

We evaluated hemodynamic and metabolic changes induced by experimental BD in dogs.

Materials and methods

Ten anesthetized and ventilated mongrel dogs (17–25 kg) were subjected to BD, by brainstem herniation, induced through an intracerebral balloon filled to maintain intracranial pressure (ICP) > systolic arterial pressure for 30 minutes (baseline – T30). The animals were observed for 30 minutes thereafter (T60). Systemic hemodynamics was evaluated by arterial and pulmonary artery catheters, while regional perfusion was assessed by portal vein blood flow (PVBF) and hepatic artery blood flow (HABF) with ultrasonic flow probes.

Results

See Table 1. The data are expressed as the mean ± SEM.
Table 1

(abstract P15)

 

Baseline

T5

T15

T30

T60

Mean arterial pressure (mmHg)

115.3 ± 6.3

187.8 ± 13.6*

110.2 ± 11.1

57.4 ± 4.4*

53.8 ± 3.1*

ICP (mmHg)

19 ± 4

274 ± 16.6*

194 ± 25.2*

137 ± 12.3*

37 ± 3.31*

Cardiac index (l/min)

3 ± 0.2

3.6 ± 0.4

4 ± 0.4*

3.2 ± 0.4

2.6 ± 0.3

PVBF (ml/min)

685.6 ± 114.2

883.6 ± 167.7

1074 ± 179.2*

846 ± 165

622.9 ± 130

HABF (ml/min)

277.2 ± 33.1

521.2 ± 88*

332.1 ± 65.7

178.3 ± 39.7

134.9 ± 28*

Cerebral perfusion pressure (mmHg)

96.5 ± 6.2

-55.5 ± 30.8*

-64.3 ± 32.7*

-65.9 ± 18.2*

-15 ± 3.6*

SvO2

89.4 ± 1.7

   

86.9 ± 2.2

SpO2

94.3 ± 1.7

   

86.3 ± 2.5*

Arterial lactate (mmol/l)

0.6 ± 0.3

   

0.9 ± 0.4

Portal vein lactate (mmol/l)

0.6 ± 0.3

   

0.8 ± 0.3

Cerebral lactate (mmol/l)

1 ± 0.3

   

1.1 ± 0.5

*P < 0.05 vs baseline.

Conclusion

BD promoted an initial hyperkinetic state followed by marked hypotension without systemic and regional lactic acidosis. In spite of the severe hypotension, the hepatosplachnic blood flow was preserved.

Authors’ Affiliations

(1)
Heart Institute – InCor, University of São Paulo-SP

Copyright

© BioMed Central Ltd 2007

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