Abstract
To investigate the adrenocortical function in brain-dead, potential organ donors, 36 patients (27 men, 9 women) with severe brain injury (BI), having a mean age of 42 ± 18 years were studied. Group A, consisted of 20 BI patients who did not develop brain-death (BD), and group B, was comprised of 16 BI patients who became brain-dead. Of these, seven patients were admitted in the hospital after clinical BD. In all patients (group A and group B), a morning blood sample was obtained upon admission in the ICU to determine baseline plasma cortisol levels. Subsequently, 1 μg of corticotropin (ACTH, synacthen) was administered intravenously and a second blood sample was drawn 30 min following the injection. In group B patients, the same procedure was repeated the morning following the confirmation of BD. Patients having a cortisol level of at least 18 μg/dl following the administration of ACTH were defined as responders. After the occurrence of BD, group B patients had significantly lower values for baseline (8.8 ± 6.3 vs 17.0 ± 6.6 μg/dl, P < 0.001) and stimulated (16.8 ± 6.5 vs. 23.9 ± 5.7 μg/dl, P = 0.001) plasma cortisol levels compared to group A patients. Hormonal data of the nine brain-dead patients studied upon admission in the ICU and after the occurrence of BD were the following: baseline plasma cortisol 23.8 ± 12.0 vs 7.1 ± 4.3 μg/dl, P = 0.008, and stimulated plasma cortisol 28.9 ± 10.5 vs 16.0 ± 4.4 μg/dl, P = 0.01. Thirteen group B patients (81%) and two group A patients (10%) were non-responders to synacthen (P < 0.0001). In group B patients, baseline and stimulated cortisol concentrations were significantly related (r = 0.72, P = 0.002), whereas there was no correlation between baseline cortisol and the increment in cortisol (r =-0.33, P = 0.21). In conclusion, adrenal cortisol secretion following dynamic stimulation is deficient in a substantial proportion of brain-dead patients. This finding calls for reconsideration of corticosteroid replacement therapy, at least in a subset, of brain-dead potential organ donors.
Highlights
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Smaller aerosol particles resulted in greater drug delivery in vitro when using the modified Aeroneb Pro during controlled mechanical ventilation (CMV)
We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001
Summary
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]. The aim of this study was to assess the respiratory effects of sufentanil and remifentanil in postsurgical critically ill patients during spontaneous ventilation since the drugs show pharmacokinetic and pharmacodynamic properties which make them attractive for intensive care use. Preliminary evidence suggests that hU-II levels during cardiac surgery are increased in patients with myocardial dysfunction [2] It is not known, if hU-II plasma concentrations are related to pulmonary capillary wedge pressure (PCWP) as an estimate of left ventricular filling pressure. AAF in cardiac surgery postoperative period has been implicated as a complication that leads to longer ICU and hospital stay and to augmented costs It has not been associated with increased mortality rates. We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.
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