Persistence of Cerebral Blood Flow After Brain Death

Flowers, W.M.; Patel, Bharti

doi:10.1097/00007611-200093040-00003

Cited by 53 publications

(10 citation statements)

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“…For example, electroencephalographic (EEG) activity has been documented in more than 20% of brain death patients [19], cerebral blow has been recorded in more than 5% of brain death patients [20], and it has been stated that CDI does not occur in more than half of brain death patients [6]. The most straightforward explanation for the observation of normouria in patients with BD is that the hypothalamic osmoregulation system continues to function, in at least some patients.…”

Section: Discussionmentioning

confidence: 99%

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

Yener

Paksu

Köksoy

2018

The Journal of Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

Yener

Paksu

Köksoy

2018

The Journal of Critical Care Medicine

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“…Numerous articles have stressed the potential pitfalls associated with their use (11-13). Thus, for example, in the presence of skull defects, such as occur following traumatic skull fractures, ventricular drainage or decompressive craniotomy, the increase in intracranial pressure following severe brain injury may be compensated for (14,15). In this instance, clinical findings may be compatible with brain death while angiographic studies or TCD may reveal persistence of some cerebral blood flow, giving a false negative result.…”

Section: Discussionmentioning

confidence: 99%

Brain Death Determination in Israel: The First Two Years Experience Following Changes to the Brain Death Law—Opportunities and Challenges

Cohen

Ashkenazi²,

Katvan

et al. 2012

American Journal of Transplantation

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To increase support for the concept of brain death, changes accommodating requirements of the religious authorities were made to the Brain Death Act in Israel. These included (1) considering patient wishes regarding brain death determination (BDD); (2) mandatory performance of apnea and ancillary testing; (3) establishment of an accreditation committee and (4) requirement for physician training courses. We describe the first 2 years experience following implementation (2010-2011). During 2010, the number of BDD decreased from 21.9/million population (during the years 2007-2009) to 16.0 (p < 0.001). Reasons included family resistance to brain death testing (27 cases), inability to perform apnea testing (7) and logistic problems related to ancillary testing (26 cases). The number of physicians available to declare brain death also decreased (210 vs. 102). During 2011, BDDs increased to 20.5/million following the introduction of radionuclide angiography as an ancillary test; other reasons for nondetermination persisted (family resistance 26 cases, inability to perform apnea testing 10 cases). Instead of increasing opportunities, many obstacles were encountered following the changes to the Brain Death Act. Although some of these challenges have been met, longer term follow-up is required to assess their complete impact.

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“…If apnea testing is not tolerated by the patient, the results are inconclusive, or shorter intervals are required between initiation and completion of a brain death protocol, ancillary neurodiagnostic testing [26][27][28]36,38,[43][44][45][46][47][48][49][50][51][52][53][54][55][56] (Table 5) may be appropriate. Early use of adjunctive testing may decrease intervals between terminal brain stem herniation, declaration of brain death, and organ recovery for transplant, facilitating earlier hormonal resuscitation protocols and earlier organ recovery.…”

Section: Adjunctive Neurodiagnostic Testingmentioning

confidence: 99%

“…Brain death (a clinical diagnosis) can occur with preservation of cerebral blood flow if ICP is insufficient to eliminate all cerebral blood flow. 47 If the results of adjunctive testing are inconclusive, options may include repeating the examination later or waiting for drug clearance (central nervous system depressants), thereby enabling optimal clinical neurological assessment. 47 …”

Section: Adjunctive Neurodiagnostic Testingmentioning

confidence: 99%

Brain Death: Assessment, Controversy, and Confounding Factors

Arbour

2013

Critical Care Nurse

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When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.

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Persistence of Cerebral Blood Flow After Brain Death

Cited by 53 publications

References 0 publications

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

Brain Death Determination in Israel: The First Two Years Experience Following Changes to the Brain Death Law—Opportunities and Challenges

Brain Death: Assessment, Controversy, and Confounding Factors

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