nach oben

Neurocritical Care

Erschienen in:

01.02.2010 | Original Article

Brain Tissue Oxygenation in Children Diagnosed With Brain Death

verfasst von: Anthony A. Figaji, Samuel J. Kent

Erschienen in: Neurocritical Care | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Background

Diagnosing brain death in children is challenging. Guidelines recommend using confirmatory testing to provide ancillary information to support the diagnosis. Brain tissue oxygenation (PbtO₂) is being increasingly used in the adult neurocritical care for continuous monitoring of the adequacy of brain oxygenation; however, data in pediatrics is limited. Evidence from adult studies suggests that persistent PbtO₂ of 0 mmHg is associated with brain death, but this relationship has not yet been demonstrated in children; therefore, we examined our experience with PbtO₂ monitoring and brain death in children with acute neurological pathology.

Methods

We retrospectively reviewed patient records from a prospectively maintained database of 85 children who were ventilated for coma due to acute neurological injury and who received intracerebral monitoring.

Results

We identified five children who had suffered brain death while being monitored. PbtO₂ had decreased to 0 mmHg in all five children at the time of brain death diagnosis. In contrast, PbtO₂ in patients, who did not develop brain death, never decreased to 0 mmHg. We review the benefits and drawbacks of using brain tissue oxygenation as ancillary information in diagnosing brain death in children.

Conclusions

Preliminary data from this study suggest that PbtO₂ decreases to 0 mmHg when brain death occurs in children. Further study is needed to determine the limitations, and the sensitivity and specificity of this finding in a larger group of children.

President’s Commission. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981; 246(19):2184–6.

Academy of Medical Royal Colleges. A code of practice for the diagnosis and confirmation of death. London: Academy of the Medical Royal Colleges; 2008.

Academy of Medical Royal Colleges. A code of practice for the diagnosis of brain stem death. London: Department of health; 1998.

Australian and New Zealand Intensive Care Society. Recommendations on brain death and organ donation. 2nd ed. Melbourne: Australian and New Zealand Intensive Care Society; 1998.

Task Force for the Determination of Brain Death in Children. Guidelines for the determination of brain death in children. Task Force for the Determination of Brain Death in Children. Arch Neurol. 1987;44(6):587–8.

Green JB, Lauber A. Return of EEG activity after electrocerebral silence: two case reports. J Neurol Neurosurg Psychiatry. 1972;35(1):103–7.CrossRefPubMed

Montes JE, Conn AW. Near-drowning: an unusual case. Can Anaesth Soc J. 1980;27(2):172–4.CrossRefPubMed

Shemie SD, Pollack MM, Morioka M, Bonner S. Diagnosis of brain death in children. Lancet Neurol. 2007;6(1):87–92.CrossRefPubMed

Baines PB. Diagnosis and management of brain death in children. Curr Paediatr. 2005;15(4):301–7.CrossRef

10.

Kohrman MH, Spivack BS. Brain death in infants: sensitivity and specificity of current criteria. Pediatr Neurol. 1990;6(1):47–50.CrossRefPubMed

11.

Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology. 2002;58(1):20–5.PubMed

12.

Bell MDD, Moss E, Murphy PG. Brainstem death testing in the UK—time for reappraisal? Br J Anaesth. 2004;92(5):633–40.CrossRefPubMed

13.

Heran MK, Heran NS, Shemie SD. A review of ancillary tests in evaluating brain death. Can J Neurol Sci. 2008;35(4):409–19.PubMed

14.

Blend MJ, Pavel DG, Hughes JR, et al. Normal cerebral radionuclide angiogram in a child with electrocerebral silence. Neuropediatrics. 1986;17(3):168–70.CrossRefPubMed

15.

Drake B, Ashwal S, Schneider S. Determination of cerebral death in the pediatric intensive care unit. Pediatrics. 1986;78(1):107–12.PubMed

16.

Monterio LM, Bollen CW, van Huffelen AC, Ackerstaff RGA, Jansen NJG, van Vught AJ. Transcranial Doppler ultrasonography to confirm brain death: a meta analysis. Intensive Care Med. 2006;32:1937–44.CrossRef

17.

Maas AI, Fleckenstein W, de Jong DA, et al. Monitoring cerebral oxygenation: Experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension. Acta Neurochir Suppl (Wien). 1993;59:50–7.

18.

Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007; 24(suppl 1): chapter X. doi: 10.1089/neu.2007.9999.

19.

Figaji AA, Fieggen AG, Argent AC, Leroux PD, Peter JC. Does adherence to treatment targets in children with severe traumatic brain injury avoid brain hypoxia? A brain tissue oxygenation study. Neurosurgery. 2008;63(1):83–91.CrossRefPubMed

20.

Figaji AA, Zwane E, Thompson C, et al. Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury: part 1: relationship with outcome 2009 (epub before print).

21.

Stiefel MF, Udoetuk JD, Spiotta AM, Gracias VH, Goldberg A, Maloney-Wilensky E, et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg. 2006;105(4):568–75.CrossRefPubMed

22.

Valadka AB, Gopinath SP, Contant CF, Uzura M, Robertson CS. Relationship of brain tissue PO₂ to outcome after severe head injury. Crit Care Med. 1998;26(9):1576–81.CrossRefPubMed

23.

Scheufler KM, Röhrborn HJ, Zentner J. Does tissue oxygen-tension reliably reflect cerebral oxygen delivery and consumption? Anesth Analg. 2002;95:1042–8.CrossRefPubMed

24.

Smith ML, Counelis GJ, Maloney-Wilensky E, Stiefel MF, Donley K, LeRoux PD. Brain tissue oxygen tension in clinical brain death: a case series. Neurol Res. 2007;29(7):755–9.CrossRefPubMed

25.

Palmer S, Bader MK. Brain tissue oxygenation in brain death. Neurocrit Care. 2005;1(2):17–22.CrossRef

26.

Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chap. 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient. Pediatr Crit Care Med. 2003;4:S65–7.CrossRefPubMed

27.

Lang EW, Mulvey JM, Mudaliar Y, Dorsch NWC. Direct cerebral oxygenation monitoring—a systematic review of recent publications. Neurosurg Rev. 2007;30(2):1437–2320.CrossRef

28.

Stiefel MF, Udoetuk JD, Storm PB, et al. Brain tissue oxygen monitoring in pediatric patients with severe traumatic brain injury. J Neurosurg. 2006;105:281–6.PubMed

29.

Narotam PK, Burjonrappa SC, Raynor SC, et al. Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome. J Pediatr Surg. 2006;41:505–13.CrossRefPubMed

30.

Valadka AB, Hlatky R, Furuya Y, et al. Brain tissue PO₂: correlation with cerebral blood flow. Acta Neurochir Suppl. 2002;81:299–301.PubMed

31.

Scheufler KM, Lehnert A, Rohrborn HJ, et al. Individual value of brain tissue oxygen pressure, microvascular oxygen saturation, cytochrome redox level, and energy metabolites in detecting critically reduced cerebral energy state during acute changes in global cerebral perfusion. J Neurosurg Anesthesiol. 2004;16:210–9.CrossRefPubMed

32.

Doppenberg EM, Watson JC, Broaddus WC, et al. Intraoperative monitoring of substrate delivery during aneurysm and hematoma surgery: initial experience in 16 patients. J Neurosurg. 1997;87:809–16.CrossRefPubMed

Titel: Brain Tissue Oxygenation in Children Diagnosed With Brain Death
verfasst von: Anthony A. Figaji
Samuel J. Kent
Publikationsdatum: 01.02.2010
Verlag: Humana Press Inc
Erschienen in: Neurocritical Care / Ausgabe 1/2010
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-009-9298-5

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2010

How I Manage the Adult Potential Organ Donor: Donation After Cardiac Death (Part 2)

Effect of Shivering on Brain Tissue Oxygenation During Induced Normothermia in Patients With Severe Brain Injury

Acute Granulomatous Acanthamoeba Encephalitis in an Immunocompetent Patient

Polyneuropathy Associated with Cholesterol Crystal Embolism

Subjecting Acute Ischemic Stroke Patients to Continuous Tube Feeding and an Intensive Computerized Protocol Establishes Tight Glycemic Control