Analysis of Multiorgan Failure in Brain-Dead Patients / 대한마취과학회지

ABSTRACT

BACKGROUND: Brain death is irreversible coma due to injury of brain hemisphere and brain stem regardless of any treatment. In brain-dead patients, diabetes insipidus, hypothermia, acute respiratory failure, and multiorgan failure occur due to brain stem compression injury. The primary goal of organ donor management is maintenance of optimal physiologic environment for organs prior to donation. This study is performed for suggesting the guideline of the prediction and management of multiorgan failure in the brain-dead patient. METHODS: We analyzed 16 brain-dead patients waiting for organ donation in the intensive care unit. The causes of brain death among the donors consisted of closed head injury in 8 patients, subarachnoid hemorrhage in 4, drowning in 1, aplastic anemia in 1, asthmatic attack in 1 and falling-down injury in 1. PaO2/FIO2 (arterial oxygen tension/fractional inspired O2 concentration) was analyzed to demonstrate the progress of respiratory failure. Body temperature, vital signs, urine output, serum osmolarity, urine osmolarity, serum K+, serum Na+, AST(aspartate aminotransferase), ALT(alanine aminotransferase), total bilirubin, BUN(blood urea nitrogen) and creatinine were also analyzed in all patients. RESULTS: Diabetes insipidus were found in 15 patients, hypothermia in 8, renal dysfunction in 2, hepatic dysfunction in 0, and acute respiratory failure in 2 at the time of arrival to intensive care unit. Diabetes insipidus was found in 16patients, hypothermia in 0, renal dysfunction in 0, hepatic dysfunction in 0, and acute respiratory failure in 9 at 16 hours after arrival to intensive care unit. CONCLUSIONS: We concluded that hepatic and renal functions were well preserved for long time after brain death and brain-dead patients rapidly progressed to acute respiratory failure. It can be suggested that organ procurement should be performed as soon as possible after brain death was confirmed for successeful organ transplantation.