Is the brain death related endocrine dysfunction an indication for hormonal substitution therapy in the early period ?
Experimental studies in animals have suggested that brain death (BD) -- related endocrinological dysregulations lead to a significant depression of cardiac pump and muscle function, however, the discussion about the relative extent of this influence remains controversal. The aim of the present study was to assess in an open chest animal model the short time course (5 hours) of hormonal (epinephrine, norepinephrine, T3, T4, ACTH, cortisol, insuline) and metabolic (glucose, lactate) changes in 10 brain dead dogs with special respect to the hemodynamic stability and myocardial pump function. After the onset of BD the concentrations of all hormonal parameters showed a significant decrease. Despite these changes, and in contrast to other studies, an adequate pump function (filling pressures, cardiac output) and muscle function (LVdp/dt) could be maintained by exclusive volume substitution without the use of hormonal or pressor agents. We conclude that in the present model a sufficient pump and muscle function can be maintained by adequate volume substitution, exclusively. The significant fall in adrenal and thyroid hormones had no direct effects on heart functional parameters in the first 5 hours after experimental BD induction.
Hagl
C
C
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School Carl-Neuberg-Strasse 1 Hannover D-30623 Germany +49 511/532 6580 +49 511/532 5404.
Szabó
G
G
Sebening
C
C
Tochtermann
U
U
Vahl
C F
CF
Sonnenberg
K
K
Hagl
S
S
D000818:Animals; D001926:Brain Death / Q000503:physiopathology*; D004195:Disease Models, Animal; D004285:Dogs; D004702:Endocrine Glands / Q000503:physiopathology*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement