scholarly journals Performing the Brain Death Examination and the Declaration of Pediatric Brain Death

2017 ◽  
Vol 06 (04) ◽  
pp. 229-233 ◽  
Author(s):  
Melissa Porter ◽  
Susan Martin
Keyword(s):  
Intensive Care ◽  
Brain Death ◽  
Pediatric Intensive Care ◽  
Care Providers ◽  
Apnea Test ◽  
Brain Death Determination ◽  
Definition Of ◽  
Death Determination ◽  
Pediatric Brain ◽  
The Brain

AbstractDeclaration of brain death is a clinical diagnosis made by the absence of neurological function in a comatose patient secondary to a known irreversible cause. Brain death determination is not an infrequent process in pediatric intensive care units. It is important that pediatric intensive care providers understand the definition of brain death and intensivists are able to implement brain death testing. The following is a narration detailing the process of brain death determination by physical examination. First, the prerequisites that determine patients' eligibility for brain death testing will be outlined. Next, each part of the physical exam, including the apnea test, will be described in detail. Finally, how the declaration of brain death is made is stated. In addition, special considerations and ancillary testing will be briefly highlighted.

Use of Ancillary Tests When Determining Brain Death in Pediatric Patients in the United States

2017 ◽  
Vol 32 (12) ◽  
pp. 975-980 ◽  
Author(s):  
Ariane Lewis ◽  
Nellie Adams ◽  
Arun Chopra ◽  
Matthew P. Kirschen
Keyword(s):  
United States ◽  
Brain Death ◽  
The United States ◽  
Apnea Test ◽  
Ancillary Test ◽  
Regulatory Bodies ◽  
Brain Death Determination ◽  
Death Determination ◽  
Pediatric Brain ◽  
The Brain

Although pediatric brain death guidelines stipulate when ancillary testing should be used during brain death determination, little is known about the way these recommendations are implemented in clinical practice. We conducted a survey of pediatric intensivists and neurologists in the United States on the use of ancillary testing. Although most respondents noted they only performed an ancillary test if the clinical examination and apnea test could not be completed, 20% of 195 respondents performed an ancillary test for other reasons, including (1) to convince a family that objected to the brain death determination that a patient is truly dead (n = 21), (2) personal preference (n = 14), and (3) institutional requirement (n = 5). Our findings suggest that pediatricians use ancillary tests for a variety of reasons during brain death determination. Medical societies and governmental regulatory bodies must reinforce the need for homogeneity in practice.

scholarly journals Analyzing EEG of Quasi-Brain-Death Based on Dynamic Sample Entropy Measures

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Li Ni ◽  
Jianting Cao ◽  
Rubin Wang
Keyword(s):  
Brain Death ◽  
Real Time ◽  
Time Window ◽  
Approximate Entropy ◽  
Sample Entropy ◽  
Well Performance ◽  
Entropy Measures ◽  
Brain Death Determination ◽  
Death Determination ◽  
The Brain

To give a more definite criterion using electroencephalograph (EEG) approach on brain death determination is vital for both reducing the risks and preventing medical misdiagnosis. This paper presents several novel adaptive computable entropy methods based on approximate entropy (ApEn) and sample entropy (SampEn) to monitor the varying symptoms of patients and to determine the brain death. The proposed method is a dynamic extension of the standard ApEn and SampEn by introducing a shifted time window. The main advantages of the developed dynamic approximate entropy (DApEn) and dynamic sample entropy (DSampEn) are for real-time computation and practical use. Results from the analysis of 35 patients (63 recordings) show that the proposed methods can illustrate effectiveness and well performance in evaluating the brain consciousness states.

scholarly journals The effect of incorporating an arterial pH target during apnea test for brain death determination

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ibrahim Migdady ◽  
Moein Amin ◽  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-Min Cho ◽  
...  
Keyword(s):  
Brain Death ◽  
Cleveland Clinic ◽  
Apnea Test ◽  
Arterial Ph ◽  
Common Etiology ◽  
Brain Death Determination ◽  
Blood Gas Analyses ◽  
The Impact ◽  
Death Determination ◽  
Current Guidelines

Abstract Background Persistent apnea despite an adequate rise in arterial pressure of CO2 is an essential component of the criteria for brain death (BD) determination. Current guidelines vary regarding the utility of arterial pH changes during the apnea test (AT). We aimed to study the effect of incorporating an arterial pH target < 7.30 during the AT (in addition to the existing PaCO2 threshold) on brain death declarations. Methods We performed retrospective analysis of consecutive adult patients who were diagnosed with BD and underwent AT at the Cleveland Clinic over the last 10 years. Data regarding baseline and post-AT blood gas analyses were collected and analyzed. Results Ninety-eight patients underwent AT in the study period, which was positive in 89 (91%) and inconclusive in 9 (9%) patients. The mean age was 50 years old (standard deviation [SD] 16) and 54 (55%) were female. The most common etiology BD was hypoxic ischemic brain injury (HIBI) due to cardiac arrest (42%). Compared to those with positive AT, patients with inconclusive AT had a higher post-AT pH (7.24 vs 7.17, p = 0.01), lower PaO2 (47 vs 145, p < 0.01), and a lower PaCO2 (55 vs 73, p = 0.01). Among patients with a positive AT using PaCO2 threshold alone, the frequency of patients with post-AT pH < 7.30 was 95% (83/87). Conclusion Implementing a BD criteria requiring both arterial pH and PaCO2 thresholds reduced the total number of positive ATs; these inconclusive cases would have required longer duration of AT to reach both targets, repeated ATs, or ancillary studies to confirm BD. The impact of this on the overall number BD declarations requires further research.

Brain Death, Organ Donation, and Transplantation

2018 ◽  
pp. 276-285
Author(s):  
Hilary H. Wang ◽  
David M. Greer
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
The United States ◽  
Apnea Test ◽  
Unit Management ◽  
Legal Context ◽  
History Of ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.

Variability in Pediatric Brain Death Determination and Documentation in Southern California

PEDIATRICS ◽  
2008 ◽  
Vol 121 (5) ◽  
pp. 988-993 ◽  
Author(s):  
M. Mathur ◽  
L. Petersen ◽  
M. Stadtler ◽  
C. Rose ◽  
J. C. Ejike ◽  
...  
Keyword(s):  
Brain Death ◽  
Southern California ◽  
Brain Death Determination ◽  
Death Determination ◽  
Pediatric Brain

744: Sensitivity of Arterial pH Changes During Apnea Test for Brain Death Determination

2020 ◽  
Vol 49 (1) ◽  
pp. 368-368
Author(s):  
Ibrahim Migdady ◽  
Moein Amin ◽  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-Min Cho ◽  
...  
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Ph Changes ◽  
Arterial Ph ◽  
Brain Death Determination ◽  
Death Determination

scholarly journals 833: IMPACT OF THE UPDATED GUIDELINE FOR PEDIATRIC BRAIN DEATH DETERMINATION ON CURRENT PRACTICE

2021 ◽  
Vol 50 (1) ◽  
pp. 411-411
Author(s):  
Conrad Krawiec ◽  
Mohan Mysore ◽  
Mudit Mathur ◽  
Xinying Fang ◽  
Shou Zhou ◽  
...  
Keyword(s):  
Brain Death ◽  
Current Practice ◽  
Brain Death Determination ◽  
Death Determination ◽  
Pediatric Brain

Confounding Brain Stem Function During Pediatric Brain Death Determination: Two Case Reports

2017 ◽  
Vol 32 (7) ◽  
pp. 676-679 ◽  
Author(s):  
Gregory Hansen ◽  
Ari R. Joffe
Keyword(s):  
Brain Death ◽  
Brain Stem ◽  
Case Reports ◽  
Clinical Signs ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination ◽  
Pediatric Brain

A patient who has been declared brain dead is considered to be both legally and clinically dead. However, we report 2 pediatric cases in which the patients demonstrated clinical signs of brain stem function that are not recognized or tested in current Canadian or US guidelines.

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