Physiologic response of human brain death and the use of vasopressin for successful organ transplantation

Nakagawa, Kazuma; Tang, Julin

doi:10.1016/j.jclinane.2009.12.015

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…The hyperdynamic state, with exaggerated peripheral perfusion and oxygenation, associated with loss of central vasoconstriction in BD patients, resulted from stress response mechanisms, as opposed to metabolic vasodilation, producing high cardiac output and tissue perfusion. The use of noninvasive hemodynamic monitoring for the measurement of cardiac output and tissue perfusion provides early recognition of flow and perfusion deficits Nakawaga et al (28) United States 1.818 To describe the physiology of the Cushing reflex after severe head trauma followed by progressive hypotension refractory to phenylephrine, responsive to vasopressin while awaiting organ procurement…”

Section: 170mentioning

confidence: 99%

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Strategies for hemodynamic maintenance of potential brain-dead donor: integrative review

Fonseca¹,

Souza²,

Batista³

et al. 2021

Einstein (São Paulo)

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Objective: To learn about the scientific production on strategies adopted for hemodynamic maintenance of brain-dead patients. Methods: Integrative review with articles published between 2007 and 2019, in Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), PubMed ® and ScienceDirect. The descriptors "Hemodinâmica AND Morte Encefálica" and "Hemodynamics AND Brain Death" were used. Exclusion criteria were nonhuman research and gray literature. Results: A total of 21 articles were listed. As strategies, the use of drugs -noradrenaline (n=8), vasopressin (n=7), dobutamine (n=6), hydrocortisone (n=4) and methylprednisolone (n=4); invasive (n=10) and noninvasive (n=13) cardiac monitoring; control of ventilatory parameters (n=12); and correction of fluid and electrolyte disturbances (n=17) were highlighted. Conclusion: The main strategies found in this integrative review were regulation of blood pressure and temperature, use of catecholamines and corticosteroids, in addition to the need for an early diagnosis of brain death. However, the lack of clearer protocols on the subject is notorious, making management with the potential donor difficult.

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Section: 170mentioning

confidence: 99%

“…Tamosuitis et al (24) 2.0-9.0μg/kg/ minute 0.04-0.1μg/kg/ minute Belzberg et al (27) 5g/kg/minute Nakawaga et al (28) 3μg/kg/minute 200μg/minute 0.04-0.07U/minute Giani et al (29) 4.…”

Section: 170mentioning

confidence: 99%

Strategies for hemodynamic maintenance of potential brain-dead donor: integrative review

Fonseca¹,

Souza²,

Batista³

et al. 2021

Einstein (São Paulo)

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“…Nakagawa and Tang reported a 60-year-old woman who was confirmed BD by standard tests after a traumatic brain injury. 13 The authors described that "while waiting for organ procurement, the patient developed Cushing reflex with bradycardia and hypertension, which was followed by a precipitous decrease in blood pressure." The Cushing reflex of hypertension and bradycardia is a clinical sign seen in severe intracranial hypertension.…”

Section: Clinical Signs Compatible With Retained Brain Functionsmentioning

confidence: 99%

“…14 Agonally, the Cushing reflex disappears and is replaced with cardiovascular collapse due to the progressive loss of spinal sympathetics and total sympathetic denervation. [13][14] The Nakagawa and Tang's case described a patient who retained some degree of vasomotor brain stem function after BD determination.…”

Section: Clinical Signs Compatible With Retained Brain Functionsmentioning

confidence: 99%

Inconsistencies Between the Criterion and Tests for Brain Death

Ave¹,

Bernat

2018

J Intensive Care Med

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The whole-brain criterion of death provides that a person who has irreversibly lost all clinical functions of the brain is dead. Bedside brain death (BD) tests permit physicians to determine BD by showing that the whole-brain criterion of death has been fulfilled. In a nonsystematic literature review, we identified and analyzed case reports of a mismatch between the whole-brain criterion of death and bedside BD tests. We found examples of patients diagnosed as BD who showed (1) neurologic signs compatible with retained brain functions, (2) neurologic signs of uncertain origin, and (3) an inconsistency between standard BD tests and ancillary tests for BD. Two actions can resolve the mismatch between the whole-brain criterion of death and BD tests: (1) loosen the whole-brain criterion of death by requiring only the irreversible cessation of relevant brain functions and (2) tighten BD tests by requiring an ancillary test proving the cessation of intracranial blood flow. Because no one knows the precise brain functions whose loss is necessary to fulfill the whole-brain criterion of death, we advocate tightening BD tests by requiring the absence of intracranial blood flow.

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“…From the available data, not only vasopressin reduces the need for cathecolamines but protects organs for transplantation . However, vasopressin is not available in many countries including Italy, where instead terlipressin is licensed.…”

mentioning

confidence: 99%