Left ventricular dysfunction in lethal severe brain injury: impact of transesophageal echocardiography on patient management.
OBJECTIVE
To evaluate the impact of transesophageal echocardiographic (TEE) studies on further patient management and incidence and degree of left ventricular (LV) dysfunction in patients with lethal severe brain injury.


METHODS
Retrospective, clinical study in two surgical intensive care units in a university hospital.


METHODS
In 51 patients with severe brain injury ultimately leading to brain death, the results of TEE studies were reviewed for evidence of newly developed LV dysfunction (i.e., regional wall motion abnormalities) and its impact on patient management.


RESULTS
Seven patients (13.7%) had a diminished LV function global (fractional area change <50%). Four of these patients (7.8%) exhibited a severely reduced LV function (fractional area change <35%). Regional wall motion abnormalities and preserved global function were found in eight patients (15.7%). Patient management was altered in all patients with diminished LV function: implementation of advanced hemodynamic monitoring (n=5), institution or adjustment of inotropes and adjustment of fluid management (n=7). In patients exhibiting a severely reduced LV function and deteriorating cardiovascular status, brain death diagnosis was established by one clinical examination in conjunction with laboratory tests, thus shortening the interval required for brain death diagnosis by about 12 h.


CONCLUSIONS
Severe LV dysfunction occurred in about 8% of our patients with severe brain injury ultimately leading to brain death. TEE may be helpful in guiding cardiovascular resuscitation ultimately leading to improved organ procurement rates.
Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University, Bachstrasse 18, 07740 Jena, Germany. Egbert.Huettemann@med.uni-jena.de
E
E
Hüttemann
C
C
Schelenz
K
K
Chatzinikolaou
K
K
Reinhart
D000328:Adult; D001926:Brain Death / Q000175:diagnosis; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D003422:Critical Care; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology