Brain death is irreversible coma due to injury of brain hemisphere and brain stem regardless of any treatment. In brain-dead patients, acute respiratory failure frequently results from capillary endothelial damage in the lung and diabetes
insipidus
and
hypothermia occur due to brain stem compression injury. Ultimately, it has been known that the brain-dead patients progress to multiple organ failure. The primary goal of organ donor management is maintenance of optimal physiologic environment
for
organs prior to recovery. This study is performed for suggesting the guideline of the prediction and management of complications in the brain-dead patient.
We analyzed 6 brain-dead patients waiting for organ donation in the intensive care unit. The causes of brain death among the donors consisted of closed head injury in 4 patients, subarachnoid hemorrhage in 1, and drowning in 1. AaDO2
(alveolar-arterial
oxygen tension difference) and PaO2/F1O2(arterial oxygen tension/fractional inspired O2 concentration) were analyzed to demonstrate the progress of respiratory failure. Body temperature, vital signs, urine output, serum osmolality, serum K+,
serum
Na+,
AST(aspartate aminotransferase), ALT(alanine amine transferase), BUN(blood urea nitrogen) and creatinine were also analyzed in all patients.
Diabetes insipidus were found in 5 patients and hypothermia in 4 patients. AaDO2 increased and PaO2/F1O2 decreased in 5 patients with time. Hepato-renal function relatively normal during observation.
We concluded that brain-dead patients rapidly progressed to acute respiratory failure. It can be suggested that for successeful organ transplantation, organ procurement should be performed as soon as possible after brain death was
confirmed.(Korean
J
Anesthesiol 1995; 29: 718∼723)
|