AUTONOMIC CARDIOVASCULAR STATE AFTER SEVERE BRAIN INJURY AND BRAIN-DEATH IN CHILDREN

Objective: To study and compare the autonomic cardiovascular state of children after severe brain injury and brain death. Design: Prospective clinical study. Setting: Pediatric ICU. Patients: Pediatric patients suffering severe brain injury caused by trauma, anoxia, or hemorrhage. Intervention: None. Measurements and Main Results: We analyzed cardiorespiratory parameters, heart rate power spectra, plasma catecholamine concentrations, and the response to the cold pressor test in nine brain-dead patients and compared the results with the test findings of 11 patients with severe brain injury. Low-frequency total heart rate power (p < .03), peak amplitude (p < .02), and plasma catecholamine concentrations (p < .001) were different with no overlap of values between groups. Cold pressor testing in patients with severe brain injury showed changes in respiratory rate and low-frequency heart rate power that were +/- 20% to 100% from baseline values; however, there were no measurable changes in brain-dead patients. Conclusions. Our results support the concept of a damaged sympathetic cardiovascular system in severe brain injury and complete interruption of the autonomic cardiovascular pathways in brain death. Since determination of brain death may be difficult, our findings have implications for corroborating brain death using autonomic cardiovascular testing.