Blood pressure and heart rate variability and baroreflex sensitivity before and after brain death

Objectives-To evaluate spontaneous blood pressure and heart rate variability and spontaneous baroreflex sensitivity before and after brain death. Methods-Spontaneous variability of arterial blood pressure and heart rate-estimated by power spectra of systolic (SBP) and diastolic blood pressure (DBP) and pulse interval (Pl)-and spontaneous baroreflex sensitivity (BRS)-estimated by the alpha index and the sequence technique-were evaluated in 11 patients twice: shortly before and 1 hour after the onset of brain death. Results-Significant spectral changes occurred after brain death: a general power reduction in PI spectra; a shift of SBP, DBP and PI powers toward the lower frequencies, resulting in a greater slope of the "1/f" spectral trends; and a marked reduction of SBP and DBP powers (-93%) and of SBP-PI coherence (-63%) at 0.1 Hz. The estimated average BRS was relatively high before brain death (around 11 ms/mm Hg), and fell close to 0 or even was not detectable at all after brain death. Conclusions-Parameters describing spontaneous blood pressure and heart rate variability and indexes reflecting the baroreflex function, which were relatively normal up to a few hours before brain death, underwent marked changes with the onset of brain death. All the changes found are likely to reflect the cessation of activity of the cardiovascular brain stem centres. These findings indicate that techniques of blood pressure and heart rate spectral analysis and of dynamic assessment of baroreflex sensitivity may be useful to complement the diagnosis of brain stem death.