title: [Circulatory instability in potential donor organ patients in a state of brain death. Investigation of predictive factors].
abstract: OBJECTIVE
  To assess the factors influencing and predicting the degree of circulatory impairment of the brain-dead cardiac donors (BDCD).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  General ICU of a 1400 bed High Specialty Regional Hospital.
  
  
  METHODS
  53 patients undergoing brain death (BD) assessment as suitable cardiac-donors.
  
  
  METHODS
  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.
authors.affiliation: II Servizio di Anestesia e Rianimazione, Azienda Ospedaliera, S. Maria della Misericordia, Udine.
authors.forename: S
authors.initials: S
authors.lastname: Di Bartolomeo
authors.forename: M
authors.initials: M
authors.lastname: Bertolissi
authors.forename: G
authors.initials: G
authors.lastname: Nardi
authors.forename: A
authors.initials: A
authors.lastname: De Monte
mesh_terms: D000293:Adolescent; D018663:Adrenergic Agents / Q000627:therapeutic use; D000328:Adult; D001775:Blood Circulation / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D001926:Brain Death / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D018663:Adrenergic Agents