Brain Death in Canadian PICUs

Joffe, Ari R.; Shemie, Sam D.; Farrell, Catherine; Hutchison, Jamie; McCarthy-Tamblyn, Lisa

doi:10.1097/pcc.0b013e31825b5485

Cited by 29 publications

(12 citation statements)

References 35 publications

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“…Advances in anesthesia management, CPB techniques, monitoring and point-of-care testing have allowed for significant reduction in blood product transfusions in those institutions adopting blood conservation practices (75, 76) and appear to demonstrate improved clinical outcomes (77). Miniaturization of the CPB circuit (31), smaller priming volumes (78) and hemoconcentration methods (35, 36) and re-infusion of cell saver blood (79, 80) has been proven to decrease intra and post-operative blood transfusions. Although the data supporting the adoption of blood conservation measures is low-grade, the results have been uniform and consistent and it is unlikely that clinical trials will be pursued.…”

Section: Resultsmentioning

confidence: 99%

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Cholette

Willems

Valentine

et al. 2018

Pediatric Critical Care Medicine

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Section: Resultsmentioning

confidence: 99%

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Cholette

Willems

Valentine

et al. 2018

Pediatric Critical Care Medicine

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“…Dexmedetomidine can also inhibit monocyte Toll-like receptor-1 and Toll-like receptor-2 expression ( 17 ), thereby reducing the body's inflammatory response ( 18 ) and reducing the incidence of postoperative cognitive dysfunction. In addition, the use of dexmedetomidine can reduce glutamate neurotoxicity ( 19 ) and apoptosis of neuronal cells ( 20 ). Therefore, it is of great significance to relieve postoperative cognitive dysfunction in patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting

Gong

Zhong

et al. 2018

Exp Ther Med

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Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting were investigated. Eighty patients undergoing systemic anesthesia with extracorporeal coronary artery bypass grafting in The People's Hospital of Guangxi Zhuang Autonomous Region from January 2015 to August 2017 were selected and randomly divided into the observation group (n=40) and control group (n=40). The two groups were treated with dexmedetomidine and equal volume of normal saline, respectively. Moreover, safety indexes including EEG bispectral index (BIS) at 30 min before induction of anesthesia (T0), immediately after intubation (T1), when incision was made (T2), when chest was closed (T3), when operation was completed (T4) and at 6 h after operation (T5), intraoperative circulatory system-related complications, cortisol, epinephrine and norepinephrine levels at the end of surgery as well as anesthesia recovery time and postoperative mechanical ventilation time were recorded and compared. All the patients were followed up for 1 week. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were administered at 1, 3 and 7 days after operation, and the incidence of intraoperative awareness and postoperative cognitive dysfunction was recorded. BIS value in the observation group was lower than that in the control group (P<0.05) at T1-T4 time points, and the BIS value in the observation group was higher than that in the control group (P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension and hypotension in the observation group was significantly lower than those in the control group (P<0.05). At the end of operation, levels of cortisol, epinephrine and norepinephrine in the observation group were significantly lower than those in the control group (P<0.05). Anesthesia recovery time and postoperative mechanical ventilation time in the observation group was significantly shorter than the time in the control group (P<0.05). MMSE and MoCA scores of the observation group were better than those of the control group (P<0.05). The incidence of cognitive impairment and postoperative cognitive impairment in the observation group was significantly lower than those in the control group (P<0.05). Therefore, it is concluded that dexmedetomidine can effectively reduce the incidence of postoperative cognitive impairment in patients undergoing coronary artery bypass grafting, and it is of high safety for circulatory function.

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“…Process and flow characteristics in treatment locations such as the intensive care unit (ICU), pre-hospital (PH) setting, emergency department (ED) and operating room (OR) add to the complexity of implementing guideline recommendations and yet inform the development of adherence benchmarks where children with severe TBI receive care. 10,12-13 …”

Section: Introductionmentioning

confidence: 99%

Acute Care Clinical Indicators Associated With Discharge Outcomes in Children With Severe Traumatic Brain Injury*

Vavilala

Kernic

Wang

et al. 2014

Critical Care Medicine

127

113

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Objective The relationship between acute care clinical indicators in the first severe Pediatric traumatic brain injury (TBI) Guidelines and outcomes have not been examined. We aimed to develop a set of acute care guideline-influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes. Design Retrospective multicenter cohort study Setting Five regional pediatric trauma centers affiliated with academic medical centers. Patients Children under 17 years with severe TBI (admission Glasgow coma scale (GCS) score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head abbreviated injury severity score ≥ 3) who received tracheal intubation for at-least 48 hours in the intensive care unit (ICU) between 2007 -2011 were examined. Interventions None Measurements and Main Results Total percent adherence to the clinical indicators across all treatment locations (pre-hospital [PH], emergency department [ED], operating room [OR], and intensive care unit [ICU]) during the first 72 hours after admission to study center were determined. Main outcomes were discharge survival and Glasgow outcome scale (GOS) score. Total adherence rate across all locations and all centers ranged from 68-78%. Clinical indicators of adherence were associated with survival (aHR 0.94; 95 % CI 0.91, 0.96). Three indicators were associated with survival: absence of PH hypoxia (aHR 0.20; 95% CI 0.08, 0.46), early ICU start of nutrition (aHR 0.06; 95% CI 0.01, 0.26), and ICU PaCO2 >30 mm Hg in the absence of radiographic or clinical signs of cerebral herniation (aHR 0.22; 95% CI 0.06, 0.8). Clinical indicators of adherence were associated with favorable GOS among survivors, (aHR 0.99; 95% CI 0.98, 0.99). Three indicators were associated with favorable discharge GOS: all OR CPP >40 mm Hg (aRR 0.64; 95% CI 0.55, 0.75), all ICU CPP > 40mm Hg (aRR 0.74; 95% CI 0.63, 0.87), and no surgery (any type; aRR 0.72; 95% CI 0.53, 0.97). Conclusions Acute care clinical indicators of adherence to the Pediatric Guidelines were associated with significantly higher discharge survival and improved discharge GOS. Some indicators were protective, regardless of treatment location, suggesting the need for an interdisciplinary approach to the care of children with severe TBI.

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Brain Death in Canadian PICUs

Abstract: Some brain death diagnoses were not based on two examinations, and some did not include an apnea test. In patients who had two brain death examinations, discordant results were uncommon.

Cited by 29 publications

References 35 publications

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting

Acute Care Clinical Indicators Associated With Discharge Outcomes in Children With Severe Traumatic Brain Injury*

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