Organ donationClinical Variables and Neuromonitoring Information (Intracranial Pressure and Brain Tissue Oxygenation) as Predictors of Brain-Death Development After Severe Traumatic Brain Injury
Section snippets
Patients and Methods
This prospective observational study involved severe TBI patients who were defined as Glasgow Coma Scale score (GCS) ≤ 8 and admitted to our intensive care unit between October 2009 and May 2011. Our protocol was approved by the Institutional Review Board. Written consent was obtained from relatives for clinical data collection. We excluded patients with an injury severity score (ISS) of 75. The following variables were recorded: gender, age, reference GCS after resuscitation, papillary
Results
Among 61 severe TBI patients who met the inclusion criteria, the average age was 37.69 ± 16.44 years and 53 were males (62.20%). Traffic accidents were the main cause of TBI (62.3%). Prehospital hypotension and desaturation were detected in 18 patients (29.5%). Nine patients (14.8%) progressed to BD. All patients showed pathological computed tomography (CT) findings (none within TCDB category I); 43 showed a diffuse lesion (TCDB II–IV) and 18, a mass lesion (TCDB V–VI) on CT scan.
Clinical
Dicussion
Clinical variables suggest that TBI patients are at risk of deterioration to BD. Data from neuromonitoring techniques, such as brain tissue oxygenation, may lead to a positive selection of patients who are truly at risk. A recent study has proposed Pti02 as ancillary information to diagnose BD in children.8 To our knowledge, no study has been performed in adults using Pti02 as a predictor of BD.
Physicians and coordination teams could use clinical variables and neuromonitoring information to
References (7)
- et al.
Cerebral microdialysis in the current clinical setting
Med Intensiva
(2012) The global observatory on donation and transplantation
- et al.
Cerebral perfusion pressure and risk of brain hypoxia in severe head injury: a prospective observational study
Crit Care
(2005)
Cited by (21)
Donor referral from outside the intensive care unit: A multidisciplinary cooperation model using communication apps and redefining refereal criteria
2020, Medicina IntensivaCitation Excerpt :The implementation of a DCD program in 2015 allowed the wish to donate of those who did not progress to BD to be fulfilled. Criteria used to refer possible donors to DC should be regularly reviewed according to the clinical31 and neuromonitoring32,33 evidence available in order to fine tune their predictive power. The probability of not progressing to BD in possible donor candidates is a risk that should be taken into account and must be clearly transmitted to the patients’ relatives before ICU admission to facilitate donation.
Is brain computed tomography combined with somatosensory evoked potentials useful in the prediction of brain death after cardiac arrest?
2017, Neurophysiologie CliniqueCitation Excerpt :Nevertheless, identifying patients with severe ABIs deteriorating toward BD is particularly difficult in the early acute phase because, to date, no accurate criteria for predicting evolution toward BD in comatose patients have been reported. A few prior studies have evaluated predictors of BD in patients with intracerebral hemorrhage (ICH), traumatic brain injury (TBI), and brain infarction [6,9,16,27]. Severe hypoxic ischemic encephalopathy (HIE) less frequently evolves toward BD compared to acute brain damage of different vascular and traumatic aetiologies [1,5,26,27].
Predictive patterns of sensory evoked potentials in comatose brain injured patients evolving to brain death
2017, Neurophysiologie CliniqueCitation Excerpt :Fifth, we are aware that evolution towards BD is a multifactorial process and that patients’ comorbidities could affect this, but since we did not have complete medical histories we could analyse only age and sex. Sixth, even though we did not carry out a prognostic comparison of neuroradiological data, clinical signs (brainstem reflexes), ICP and brain tissue oxygenation, which have been previously evaluated in other studies [10,15,23], our main aim was to verify whether SEPs were a reliable prognostic indicator to include in future multivariate models. Last but not least, it was true that “self-fulfilling prophecies” might have affected the outcomes of patients with ABI [22]; however, do-not-resuscitate orders or decisions to withdraw life support are not included in our institutional standards of care.
Usefulness of biomarkers in the prognosis of severe head injuries
2016, Medicina Intensiva