Pathophysiological changes in brain death and nursing care: a literature review

Abstract

Purpose: To identify and characterize the scientific outcome in physiopathological changes in brain death and the inherent nursing care in these changes. Methods: This is a review of the literature carried out in January 2011 by searching articles on the Virtual Health Library (Lilacs, Medline and Scielo) published from 2005 to 2010. We used a combination of the following descriptors: Brain Death and Tissue Donors, Brain Death and Nursing, Brain Death and Intensive Care Units. The sample was composed by ten articles, seven of which consisted by medical studies and only three nursing studies. Results: It was gathered five groups of the more prevailing physiopathological disorders found in the literature which were: Cardiovascular, Electrolyte, Endocrine and Respiratory disorders, and Hypothermia. The most frequently reported changes were hypotension, diabetes insipidus, hypernatremia, hyperglycemia, hypothermia, among others. As to nursing care to brain death patients, it was found: control of hemodynamic data, monitoring of vasoactive drug infusion, fluid balance, glycemic control, insulin administration, airway aspiration, warming of patient, and others. Conclusions: Changes described in the literature show involvement of major organs and systems in brain death patients. Even upon the lack of studies to detail specific nursing care to such group of patients, we were able to observe activities that compete or require participation of the nursing staff in their implementation which plays a fundamental role in the maintenance of potential organ donors with brain death.