Changes in the intracranial pulse pressure waveform associated with brain death

Dominguez-Roldan, J.M.; Barrera-Chacon, J.M; Martín-Bermúdez, R.; Murillo-Cabezas, Francisco; García-Alfaro, C.; Rincón-Ferrari, M.D.

doi:10.1016/s0041-1345(99)00517-5

Cited by 8 publications

(6 citation statements)

References 4 publications

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“…Most studies explore the association between neuromonitoring data and the timing of BD, although a few attempt to predict this result. [7][8][9] In light of these limitations, studies that use serum biomarkers to predict BD development after TBI have specifically focused on the S100B protein.…”

mentioning

confidence: 99%

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Egea-Guerrero

Murillo-Cabezas

Gordillo-Escobar

et al. 2013

Journal of Neurotrauma

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Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] £ 8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations ( p < 0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24 h post-admission had odds ratios (ORs) of 21.35 ( p = 0.005) and 4.9 ( p = 0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24 h S100B sample in the model (OR = 15.5; p = 0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p = 0.001) for 24 h S100B determinations. The cut off was set at 0.372 lg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV] = 18.7% and negative predictive value [NPV] = 98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.

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mentioning

confidence: 99%

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Egea-Guerrero

Murillo-Cabezas

Gordillo-Escobar

et al. 2013

Journal of Neurotrauma

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“…Interestingly, the ICPW obtained from invasive ICP analysis has been already described in BD. Domínguez et al [22] identified a P2-predominant pattern, although not specific to BD, once observed in both BD and survivors groups. The disappearance of P3 in most BD diagnosed patients was associated with the compromise of cerebral venous outflow, suggesting the presence of severe disturbance of blood flow in this pathology.…”

Section: Discussionmentioning

confidence: 96%

Qualitative Evaluation of Intracranial Pressure Slopes in Patients Undergoing Brain Death Protocol

Ideta¹,

Oliveira²,

Gonçalves³

et al. 2023

Preprint

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Background: Due to the importance of brain death (BD) diagnostic do not mistake, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system. Methods: A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative data from the ICP waveforms were extracted and analyzed comparing BD patients and health subjects. Results: Fifteen patients were included. ICP waveforms presented substantial differences amidst BD patients when compared to the control group. Moreover, pulse amplitude and time to peak variables values in the case group were also statistically significant. Conclusions: In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.

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“…Interestingly, the ICPW obtained from invasive ICP analysis has been already described in BD. Domínguez et al [ 27 ] identified a P2-predominant pattern, although not specific to BD, once observed in both BD and survivors groups. The disappearance of P3 in most BD diagnosed patients was associated with the compromise of cerebral venous outflow, suggesting the presence of severe disturbance of blood flow in this pathology.…”

Section: Discussionmentioning

confidence: 99%

Qualitative Evaluation of Intracranial Pressure Slopes in Patients Undergoing Brain Death Protocol

et al. 2023

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Background: Due to the importance of not mistaking when determining the brain death (BD) diagnostic, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system. Methods: A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative parameters from the ICP waveforms, such as the P2/P1 ratio, time-to-peak (TTP) and pulse amplitude (AMP) were extracted and analyzed comparing BD patients and health subjects. Results: Fifteen patients were included, and 6172 waveforms were analyzed. ICP waveforms presented substantial differences amidst BD patients when compared to the control group, especially AMP, which had lower values in patients diagnosed with BD (p < 0.0001) and the TTP median (p < 0.00001), but no significance was found for the P2/P1 ratio (p = 0.8). The area under curve for combination of parameters on the BD prediction was 0.77. Conclusions: In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.

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Changes in the intracranial pulse pressure waveform associated with brain death

Cited by 8 publications

References 4 publications

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Qualitative Evaluation of Intracranial Pressure Slopes in Patients Undergoing Brain Death Protocol

Qualitative Evaluation of Intracranial Pressure Slopes in Patients Undergoing Brain Death Protocol

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