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Online ISSN 1827-1596
CRITICAL AND INTENSIVE THERAPY
Gravame V. 1, Porretti L. 4, Cardillo M. 4, Marchesi G. 1, Rizzi M. 1, Sacchi C. 1, Candiani A. 2, Chiaranda M. 3, Gualandris L. 6, Taioli E. 7, Scalamogna M. 5
1 Ospedali Riuniti - Bergamo, I Servizio di Anestesia e Rianimazione;
2 Spedali Civili - Brescia, II Servizio di Anestesia e Rianimazione;
3 Ospedale di Circolo - Varese, Servizio di Anestesia e Rianimazione;
4 IRCCS Ospedale Maggiore - Milano, Centro Trasfusionale e di Immunologia dei Trapianti;
5 Ospedale Maggiore - Milano, Servizio per il Prelievo e la Conservazione di Organi e Tessuti;
6 Ospedali Riuniti - Bergamo, Laboratorio Ricerche Chimico-Cliniche;
7 Ospedale Maggiore - Milano, Laboratorio di Epidemiologia
Background. In this study, the level and the variation of a number of hormone and metabolic parameters during brain death treatment in potential organ donors have been monitored.
Methods. Thirty-nine consecutive brain-dead patients were enrolled in 3 Intensive Care Units of Regional Hospitals of the North of Italy. All patients were potential organ donors and free from diseases before the accident leading to death. The levels of ADH, ACTH, TSH, prolactin, cortisol, aldosterone, FT3, FT4, renin, serum lactate and plasma osmolality were measured immediately after the diagnosis of brain death (T0), certified following the Italian law of December 29, 1993, n. 578, and after 6 hours (T6).
Results. Hormone levels were normal in the majority of subjects, and there was no significant variation during the 6 hours of the observation period. No correlation was found between the hormone levels considered and the metabolic parameters; ADH levels were not correlated with plasma osmolality. FT3 levels were below the normal range in the majority of subjects, but were not associated with a higher lactate level, which is used as a marker of a shift toward tissue anaerobic metabolism.
Conclusions. In conclusion, triiodothyronine administration to improve metabolic order and thus the function of organs for transplantation is not justified in brain-dead patients.