Cardiogenic Oscillation and Ventilator Autotriggering in Brain-Dead Patients: A Case Series

2009 ◽  
Vol 18 (5) ◽  
pp. 496-488 ◽  
Author(s):  
Richard Arbour
Keyword(s):  
Brain Death ◽  
Clinical Evaluation ◽  
Case Series ◽  
Clinical State ◽  
Loss Of Consciousness ◽  
Respiratory Drive ◽  
Brain Dead Patient ◽  
Brainstem Function ◽  
Brain Dead ◽  
Cardiogenic Oscillation

Brain death is manifested by a flaccid, areflexic patient on assessment of brain function with fixed and dilated pupils at midpoint, loss of consciousness, no response to stimulation, loss of brainstem reflexes, and apnea. A lesion or clinical state responsible for the loss of consciousness must be found. An integral part of clinical evaluation of brain death is apnea testing, which indicates complete loss of brainstem function and respiratory drive. Ventilator triggering or overbreathing the ventilator’s set rate may be considered consistent with intrinsic respiratory drive consequent to residual brainstem function. Ventilator autotriggering, however, may potentially occur in a brain-dead patient as a result of interaction between the hyperdynamic cardiovascular system and compliant lung tissue altering airway pressure and flow patterns. Also, chest wall and pre-cordial movements may mimic intrinsic respiratory drive. Ventilator autotriggering may delay determination of brain death, prolong the intensive care unit experience for patients and their families, increase costs, risk loss of donor organs, and confuse staff and family members. A detailed literature review and 3 cases of cardiogenic ventilator autotriggering are presented as examples of this phenomenon and highlight the value of close multidisciplinary clinical evaluation and examination of ventilator pressure and flow waveforms.

Brain death and the vegetative state

2010 ◽  
pp. 4847-4850
Author(s):  
P.J. Hutchinson ◽  
J.D. Pickard
Keyword(s):  
Brain Death ◽  
Brain Stem ◽  
Vegetative State ◽  
Clinical State ◽  
Irreversible Loss ◽  
Brain Stem Death ◽  
Brainstem Function ◽  
Irreversible Cessation

Death can be defined as the irreversible loss of the capacity for consciousness and brain stem function, combined with irreversible loss of the capacity to breathe. The irreversible cessation of brainstem function, whether caused by a primary intracranial catastrophe (e.g. trauma, haemorrhage) or the result of extracranial cranial events (e.g hypoxia), will result in the same clinical state, hence brain stem death is the same as death of the patient....

scholarly journals Brain Death and the Dutch Organ Donation Law

2020 ◽  
Vol 87 (2) ◽  
pp. 161-170
Author(s):  
Douwe J. Steensma
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Organ Transplantation ◽  
Scientific Data ◽  
Reliable Information ◽  
Legal Systems ◽  
Biological Perspective ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
The Right

According to many legal systems that regulate organ donation, such as Dutch law, a brain-dead patient is regarded as a mortal remains. In general, these systems do not take into account the fact that this definition is being heavily criticized and the far-reaching consequences thereof. In the case of organ transplantation, vital organs are procured from persons who, from a biological perspective, may not yet be dead. A government that values scientific data and wants to provide honest and reliable information to its citizens has to account for this critique of its policy as citizens have the right to be well-informed. Whoever makes the decision to donate organs performs a special act of human solidarity, but the readiness to donate organs in the case of brain death is not inherent to the demand to love one’s neighbor as one loves oneself. Summary: According to legislation on organ donation in many countries, a brain-dead patient is regarded as a mortal remains. The law disregards the fact, however, that this definition is being heavily criticized and that it has far-reaching consequences. In the case of organ transplantation, vital organs are procured from persons who, from a biological perspective, may not yet been dead. A government that values scientific data and wants to provide honest and reliable information to its citizens has to account for this critique in its policy. Citizens have the right to be well-informed.

scholarly journals Cardiogenic oscillation induced ventilator autotriggering

2015 ◽  
Vol 02 (02) ◽  
pp. 134-135 ◽  
Author(s):  
Narender Kaloria ◽  
Akhilesh Gupta ◽  
Ajay Goila ◽  
Rajesh Sood
Keyword(s):  
Brain Death ◽  
Emergency Laparotomy ◽  
Respiratory Drive ◽  
Mechanically Ventilated ◽  
False Sense ◽  
Gun Shot ◽  
Brain Death Determination ◽  
Cardiogenic Oscillation ◽  
Gcs Score ◽  
Death Determination

AbstractCardiogenic oscillation during mechanical ventilation can auto-trigger the ventilator resembling patient initiated breadth. This gives a false sense of intact respiratory drive and determination brain death, even if other tests are positive, is not appropriate in such a situation. It will prolong the ICU stay and confound the brain-death determination. In this case report, we describe a 35 year old man who was brought to the hospital after many hours of critical delay following multiple gun shot injuries. The patient suffered a cardiac arrest while on the way from another hospital. After an emergency laparotomy, patient was shifted to Intensive Care Unit (ICU) with Glasgow Coma Scale (GCS) score of E1VTM1 and was mechanically ventilated. Despite absence of brainstem reflexes, the ventilator continued to be triggered on continuous positive airway pressure (CPAP) mode and the patient maintained normal oxygen saturation and acceptable levels of carbon dioxide. An apnoea test confirmed absent respiratory drive. Ventilatory waveform graph analysis, revealed cardiogenic oscillation as the cause for autotrigerring.

scholarly journals Guidelines for supporting a pregnant patient with brain death: A case discussion and literature review

2017 ◽  
Vol 7 (8) ◽  
pp. 86 ◽  
Author(s):  
Lisa Rose Erlinger
Keyword(s):  
Brain Death ◽  
Healthcare Professionals ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Pregnant Patient ◽  
Unborn Child ◽  
Case Discussion ◽  
Brainstem Function ◽  
Brain Dead ◽  
Guidelines And Recommendations

Brain death implies irreversible cessation of the brainstem function. While it is generally considered unethical and futile to continue to support vital organs once a diagnosis of brain death has been made, patients who are both pregnant and brain dead complicate this issue because the appropriateness of continuing maternal somatic support to prolong gestation to delivery is still debated. This article will review the literature, and open up dialogue, about the need for guidelines and recommendations in anesthesia care, including the ethics, legality, and cost of supporting the mother’s life to save an unborn child, when somatically supporting pregnant patients who are brain dead, are in a persistent vegetative state (PVS), or are in a coma due to irreversible brain injury. Making a case for or against supporting such patients is outside the scope of this paper. This review finds that the need for guidelines to assist healthcare professionals in providing care to somatically supported mother is necessary.

Scotist Hylomorphism in Support of Total Brain Death

2019 ◽  
Vol 19 (4) ◽  
pp. 559-565
Author(s):  
Tyler Wittenmyer ◽  
Keyword(s):  
Brain Death ◽  
Empirical Evidence ◽  
The Body ◽  
John Duns Scotus ◽  
Substantial Form ◽  
Total Brain ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
Causal Chains ◽  
Alternative Set

Empirical evidence has led some philosophers to question total brain death (TBD), because a brain-dead patient’s body remains integrated; it can still grow and age. Catholic philosophers have based arguments for and against TBD on Thomist principles of hylomorphism. Given such principles, the arguments against TBD appear stronger. Blessed John Duns Scotus provides an alternative set of principles. Specifically, Scotus is a pluralist regarding substantial form. However, his pluralism is distinct in that he denies a substantial form to the body as a whole and instead speaks of part-substances that are integrated with each other by efficient and final causal chains. Scotus’s hylomorphism, unlike St. Thomas Aquinas’s, can both defend TBD and adequately describe the physical characteristics of the totally brain-dead patient.

Brain Death

2019 ◽  
pp. 437-448
Author(s):  
Jerome B. Posner ◽  
Clifford B. Saper ◽  
Nicholas D. Schiff ◽  
Jan Claassen
Keyword(s):  
Brain Death ◽  
Laboratory Tests ◽  
Clinical Signs ◽  
Clinical History ◽  
Confounding Variables ◽  
Vegetative Survival ◽  
Brain Dead Patient ◽  
Brain Dead ◽  
The Brain ◽  
Prolonged Coma

This chapter considers the issue of brain death. The cornerstone of the diagnosis of brain death is a careful and sure clinical neurologic examination. In addition, a thorough evaluation of clinical history, neuroradiologic studies, and laboratory tests needs to be carried out to rule out potential confounding variables. The diagnosis of brain death rests on two major and indispensable tenets. The first is that the cause of brain nonfunction must be inherently irreversible. The second is that the vital structures of the brain necessary to maintain consciousness and independent vegetative survival are damaged beyond all possible recovery. It looks at how to determine that brain death has occurred. It goes on to outline the clinical signs for brain death. The chapter also looks at the differences between brain death and prolonged coma. Finally, it explains the management of the brain dead patient.

ANENCEPHALIC ORGAN DONORS

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. A42-A42
Author(s):  
Student
Keyword(s):  
Brain Death ◽  
Low Dose ◽  
Organ Donors ◽  
Policy Choices ◽  
Minute Period ◽  
Definite Time ◽  
Periodic Testing ◽  
Basic Protocol ◽  
Brain Dead ◽  
Canadian Group

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.

Brain Death and Organ Donation

2018 ◽  
Author(s):  
Thomas I. Cochrane
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Cardiac Death ◽  
Donation After Cardiac Death ◽  
Donation After Brain Death ◽  
Brain Death Determination ◽  
Brain Dead ◽  
American Academy Of Neurology ◽  
Death Determination

Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.

Apnea Documentation for Determination of Brain Death in Children

PEDIATRICS ◽  
1984 ◽  
Vol 74 (4) ◽  
pp. 505-508
Author(s):  
Thomas W. Rowland ◽  
Joseph H. Donnelly ◽  
Anthony H. Jackson
Keyword(s):  
Brain Death ◽  
Ventilatory Support ◽  
Respiratory Drive ◽  
Test Protocol ◽  
Apnea Test ◽  
Wide Variability ◽  
Adequate Oxygenation

Discontinuing ventilatory support for determination of respiratory drive is a recognized means of assessing clinical brain death. Methodology must include a means for assuring adequate oxygenation during the test as well as providing sufficient duration for appropriate hypercarbia. Nine patients with other findings of clinical brain death were prospectively assessed with a standardized apnea test protocol. None demonstrated spontaneous respirations. Whereas adequate oxygenation was maintained in each case, wide variability was evident in degree of hypercarbia and acidosis.

scholarly journals Brain Death-Induced Inflammatory Activity is Similar to Sepsis-Induced Cytokine Release

2018 ◽  
Vol 27 (10) ◽  
pp. 1417-1424 ◽  
Author(s):  
Patrícia Schwarz ◽  
Geisiane Custódio ◽  
Jakeline Rheinheimer ◽  
Daisy Crispim ◽  
Cristiane B. Leitão ◽  
...  
Keyword(s):  
Brain Death ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Release Kinetics ◽  
Magnetic Bead ◽  
Control Group ◽  
Cytokine Release ◽  
Plasma Cytokine ◽  
Ifn Γ ◽  
Brain Dead

Brain death (BD) is associated with a systemic inflammation leading to worse graft outcomes. This study aimed to compare plasma cytokine values between brain-dead and critically ill patients, including septic and non-septic controls, and evaluate cytokine release kinetics in BD. Sixteen brain-dead and 32 control patients (16 with and 16 without sepsis) were included. Plasma cytokines were measured by magnetic bead assay after the first clinical exam consistent with BD and every 6 hours thereafter, and at the time of study entry in the control group. The values for IL-8 and IFN-γ were higher in brain-dead and septic patients than in non-septic patients [IL-8: 80.3 (18.7–169.6) vs. 68.2 (22.4–359.4) vs. 16.4 (9.2–42.7) pg/mL; P = 0.006; IFN-γ: 2.8 (1.6-6.1) vs. 3.4 (1.2–9.0) vs. 0.5 (0.5–1.8) pg/mL; P = 0.012]. TNF showed a clear tendency to increase in brain-dead patients [2.7 (1.0–4.8) vs. 1.0 (1.0–5.6) vs. 1.0 (1.0–1.0) pg/mL; P = 0.051], and IL-6 values were higher in brain-dead patients than in non-septic controls [174.5 (104.9–692.5) vs. 13.2 (7.3–38.6) pg/mL; P = 0.002]. These differences remained even after excluding brain-dead patients who also had sepsis ( n = 3). IL-1β and IL-10 values increased from baseline to time point 2 (∼6 hours later) [IL-1β: 5.39 (1.93–16.89) vs. 7.11 (1.93–29.13) pg/mL; P = 0.012; IL-10: 8.78 (3.62–16.49) vs. 15.73 (5.49–23.98) pg/mL; P = 0.009]. BD-induced and sepsis-induced plasma cytokine values were similarly high, and both were higher than the observed in non-septic critically ill patients.

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