[Resuscitation of children in the brain death state from the view of organ procurement for therapeutic purposes].
Thirty-six brain-dead children were managed to allow organ harvesting, which was possible in 21 (7 multi-organ). Optimal ventilation allowed for normal PaO2 and PaCO2 (mean +/- SEM FiO2 = 0.50 +/- 0.05). The management of hemodynamics was quite difficult and cardiac arrest may be due to patient transport, electrolyte disorders and dehydration. Vascular filling was of main importance and required standard solutes (5 or 2.5% glucose, normal saline, Ringer lactate) at a rate of 3.0 +/- 0.5 ml/kg/h, adapted for electrolytes (mainly KCl); sometimes, other solutes may be used: blood (17 patients), human 20% serum albumin (17 patients), plasma (9 patients). This filling was sufficient for 15 patients; the others required inotropic agents: dopamine (17 +/- 8 micrograms/kg/min), dobutamine (42 +/- 18 micrograms/kg/min). Diuresis was more than 3 ml/kg/h in 38% of the patients and desmopressin was used in 3 cases. Hypothermia (minimum 31.2 degrees) had no major consequence. No infection was found. Quality of management of brain-dead patients is of main importance; the possibility of organ harvesting must be evoked in such situations and is the first step in organ transplantations.
Cochat
P
P
Unité de Réanimation, Hôpital Edouard Herriot, Lyon.
Lavocat
M P
MP
Floret
D
D
Berthier
J C
JC
Teyssier
G
G
D000293:Adolescent; D001926:Brain Death / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004231:Diuresis; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D012151:Resuscitation; D009927:Tissue and Organ Procurement / Q000592:standards*
D004280:Dobutamine; D004298:Dopamine
Réanimation des enfants en état de mort cérébrale en vue d'un prélèvement d'organes à but thérapeutique.